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World Journal of Surgery
Published in: World Journal of Surgery 8/2015

01-08-2015 | Original Scientific Report

Major Esophageal Dilation After Laparoscopic Adjustable Gastric Banding in Symptomatic Patients: Does It Prevent Effective Weight Loss and How Should It be Treated?

Authors: Tom Florian Ulmer, Peter Ambe, H. P. Alizai, A. Lambertz, K. Rheinwald, A. Plamper, M. Son, A. Tuerler, D. Gärtner, U. Neumann

Published in: World Journal of Surgery | Issue 8/2015

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Abstract

Introduction

Esophageal dilation (ED) has been described as a long-term complication following laparoscopic adjustable gastric banding (LAGB) with an incidence of 0.5–50 %. The purpose of this study was to evaluate the effect of major ED on weight loss and find methods to diagnose ED and possible treatment strategies based on a classification.

Materials and methods

We performed a retrospective analysis of all patients undergoing LAGB between 2004 and 2008 in three community-based hospitals. ED was classified in four stages of dilation using gastrografin swallow. We report body mass index (BMI), failure rates and reoperations among these patients, with a mean follow-up period of 6.7 years.

Results

Nineteen (18.4 %) of 103 patients who underwent LAGB presented with esophageal dilation. Band deflation failed for all nine patients (8.7 %) with major ED. The mean BMI at LAGB (BMI 1), revision (BMI 2), and 1 year after conversion (BMI 3) were 45.9 ± 3.2, 42.8 ± 4.9 and 30.3 ± 5.5 kg/m2, respectively. No significant difference was found comparing BMI 1 and BMI 2 (p = 0,065, EWL1: 14.2 ± 21.7 kg/m2). In contrast, the weight loss after the revision surgery was significant (p = 0.001, EWL2: 67.1 ± 30 kg/m2). No significant difference was found concerning age, gender, ASA, preoperative (LAGB) weight, and mean interval between LAGB and revision comparing patients with major ED (IV) to patients with milder forms (ED I-III).

Conclusion

ED is a serious long-term complication after LAGB and seems to prevent effective weight loss in stage IV. Furthermore, untreated dilation could cause long-term damage to the esophagus. Therefore, we suggest routine radiographic follow-up after LAGB even in asymptomatic patients and a treatment based on a classification with an early surgical revision for major ED.
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Metadata
Title
Major Esophageal Dilation After Laparoscopic Adjustable Gastric Banding in Symptomatic Patients: Does It Prevent Effective Weight Loss and How Should It be Treated?
Authors
Tom Florian Ulmer
Peter Ambe
H. P. Alizai
A. Lambertz
K. Rheinwald
A. Plamper
M. Son
A. Tuerler
D. Gärtner
U. Neumann
Publication date
01-08-2015
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 8/2015
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-015-3036-2

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