Esophageal adjustable dilatation after laparoscopic gastric banding: Definition and strategy

Background: Laparoscopic adjustable gastric banding (LAGB) has become a method of choice worldwide to treat morbid obesity. Long-term complications such as esophageal dilatation require that a relevant strategy for treatment be defined. Esophageal dysmotility is commonly described in morbidly obese patients. Methods: 1,232 patients have undergone LAGB over 9 years (1995-2004), and 162 (13.1%) have had a reoperation for complications (excluding access-port problems): slippage (109), erosion (28), intolerance (25). 80 patients (6.4%) had their band removed, and 10 had a switch to another procedure. Esophageal dilatation has been an isolated cause for removal in 2 patients and an associated cause in 6 patients. Results:There was no significant correlation between esophageal dilatation and insufficient excess weight loss (< 25%) after 5 years (37/257:14.3%). 4 stages of dilatation were identified, with the relevant treatment for each, the ultimate alternative being conversion to a laparoscopic gastric bypass. We suggest that esophageal dilatation be a separate issue from pouch dilatation and gastric erosion, and that it be classified as a complication only in severe cases requiring band removal. Most cases can be handled through deflation of the band under radiological control. Conclusion: LAGB can lead to significant esophageal troubles which must remain under scrutiny but generally respond to "radiological management", which also makes LAGB more demanding than other operations in terms of follow-up.