A sharp rise in obesity has increased the use of gastric banding procedures for weight management. Gastric banding, particularly the lap-band system, restricts the size of the stomach using a silicone ring that contains a balloon inflated with saline. The degree of band tension is adjusted throughout the duration of weight loss. While this surgery is considered low-risk and moderately successful for many people, serious complications may occur.
Band Erosion
Band erosion describes the absorption of the band partially or completely from the outer stomach wall into the food compartment of the stomach. While this is thought to result from band over-inflation, an article entitled "Intra-Gastric Band Erosion from an Uninflated Lap-Band" in the July 2008 issue of "Obesity Surgery" reports a case of band erosion in the absence of band inflation. Suspected explanations for this include infection of the stomach wall or organ injury sustained during band insertion. Additionally, the lack of the development of a fibrous scar on the stomach wall seen in patients without complications may contribute to the organ's perforation when compressed by the band.
Band Slippage
As weight loss occurs, the band must be adjusted due to stomach shrinkage. In some cases, the original pouch, created near the top edge of the stomach, becomes enlarged, pulling the lower stomach through the band and causing strangulation. Over-consumption of food is associated with this condition, which is correctable by surgical repositioning of the device.
Port Blockages
The quantity of saline moved into and out of the band controls the stomach volume. Fluid is delivered to the device through a single tube and port. Leakage of the tubing or obstruction of the port opening through which saline is exchanged will diminish band control. Such a blockage was reported in the article "Thrombosis of the Lap Band System" in the February 2008 issue of the journal "Surgery Endoscopy" on a patient whose band was found to contain a blood clot. Other complications involve disconnection or displacement of the port, which require surgical management.
Gastric Cancer
Although rare, cases of gastric and esophageal cancer have been reported after gastric banding. This may be caused by chronic exposure of the inner stomach lining to cancer-causing substances in foods or irritation of stomach walls due to chronic compression of the band. An inflammatory effect or infection caused by these conditions may cause cancer-cell production or may reduce the strength of cancer-fighting antioxidants.
Failure to Lose Weight
Failure of gastric banding surgery is defined by the authors of "A 10-Year Experience with Laparoscopic Gastric Banding for Morbid Obesity" as losing less than 25 percent of excess weight or needing a major re-operation. In their July 2006 article published in "Obesity Surgery," they suggest, "Only about 60 percent of the patients without major complication maintain an acceptable excess weight loss in the long term." Peak weight loss occurs within two years after surgery. Over time, however, poor eating habits creep in, stretching the stomach pouch to allow for greater energy intake. Additional failure occurs when patients need band deflation or removal because of unmanageable esophageal reflux issues.
References
- Obesity Surgery; Intra-Gastric Band Erosion from an Uninflated Lap-Band: A Case Report; George L.D. Angus, Kaleem Rizvon, Dahua Zhou, Eric Seitelman, Supriya Cardoza; July 2008
- Surgery Endoscopy; Thrombosis of the Lap Band System; Danny A. Sherwinter, Colin J. Powers, Alan C. Geiss, Melanie Howard, June Warman; Feb. 2008
- Obesity Surgery; A 10-Year Experience with Laparoscopic Gastric Banding for Morbid Obesity: High Long-Term Complication and Failure Rates; M. Suter, J.M. Calmes, A. Paroz, V. Giusti; July 2006
Member Comments