Esophageal Dysmotility Disorders After Laparoscopic Gastric Banding-An Underestimated Complication

Objective: To evaluate the effects of laparoscopic adjustable gastric banding (LAGB) on esophageal dysfunction over the long term in a prospective study, based on a 12-year experience. Background: Esophageal motility disorders and dilatation after LAGB have been reported. However, only a few studies present long-term follow-up data. Methods: Between June 1998 and June 2009, all patients with implantation of a LAGB were enrolled in a prospective clinical trial including a yearly barium swallow. Esophageal motility disorders were recorded and classified over the period. An esophageal diameter of 35 mm or greater was considered dilated. Results: Laparoscopic adjustable gastric banding was performed in 167 patients (120 females and 47 males) with a mean age of 40.1 +/- 5.2 years. Overall patient follow-up was 94%. Esophageal dysmotility disorders were found in 108 patients (68.8% of patients followed). Esophageal dilatation occurred in 40 patients (25.5%) with a mean esophageal diameter of 47.3 +/- 6.9 mm(35.0-94.6) after a follow-up of 73.8 +/- 6.8 months (36-120) compared with 26.2 +/- 2.8 mm (18.3-34.2) in patients without dilatation (diameter of < 35mm) (P < 0.01). Thirty-four patients suffered from stage III dilatation (band deflation necessary) and 6 from stage IV (major achalasia-like dilatation, band removal mandatory). In 29 patients, upper endoscopy was carried out because of heartburn/dysphagia. In 18 patients, the endoscopy was normal; 9 patients suffered from gastroesophageal reflux disease, 1 from a stenosis, and 1 from a hiatus hernia. Conclusions: This study demonstrates that esophageal motility disorders after LAGB are frequent, poorly appreciated complications. Despite adequate excess weight loss, LAGB should probably not be considered the procedure of first choice and should be performed only in selected cases until reliable criteria for patients with a low risk for the procedures long-term-complications are developed.