Isolated food intolerance after adjustable gastric banding: A major cause of long-term band removal

Background Erosion, slippage, and esophageal dilatation have been acknowledged as typical long-term issues after lap banding. Yet it seems from our experience that isolated food intolerance has become a leading cause for band removal, although not reported as such in the literature. Methods There were 1,450 patients who have been operated on over 12 years (May 1995-May 2007). Food intolerance occurred in 41 cases (2.9%), representing 1/3 of the causes of band removal. The average time for diagnosis was 58 months (16-110). Seventeen cases occurred before 5 years of follow-up, and 25 after. Results The postoperative course has been uneventful in all cases of simple removal. No patient had re-banding after removal, one had vertical banded gastroplasty in another center, two a gastric bypass, one a BPD, and four had a sleeve gastrectomy at the same operative time as band removal. Food intolerance is rarely reported in the literature, or often attributed to "poor compliance" or "poor results" after lap banding. The background and symptoms of this entity should be separated from other issues, i.e., esophageal dilatation and band slippage. Gastric bypass is a valuable option after band removal, but like others, we prefer sleeve gastrectomy as a second step procedure, given the weight loss that has already been achieved in many cases. Conclusion Food intolerance after lap-banding is likely to represent the most common cause for band removal in the long run, although we do not know its future rate. From the literature and our experience, there is no clear cause to this complication in the majority of the cases; neither the type of band nor the type of procedure are sufficient explanations.