As Gastric Banding Increases, So May Complications

Puzzling respiratory symptoms require investigation, researchers say

THURSDAY, Dec. 22, 2011 (HealthDay News) -- Use of gastric bands as a weight-loss aid is increasing, and doctors need to be alert for potential complications years later, say the authors of a new case report.

The report details problems that developed two years after a 49-year-old British woman underwent the weight-loss procedure. She sought treatment at a hospital after having night sweats and a persistent cough that produced green and yellow sputum for four months. Her medical history showed that she had asthma that had not responded to treatment and that she had been fitted with a laparoscopic adjustable gastric band in September 2008.

Gastric band surgery involves placement of a band around the top portion of the stomach. This creates a small pouch to receive food, which then slowly empties into the larger, lower stomach. Because of the band, people feel full after eating small amounts of food.

Since receiving the gastric band, the woman's body mass index (BMI) had decreased from 45 to 33, according to the report published in the Dec. 22 online edition of The Lancet. A BMI of 30 or more is considered obese.

A chest X-ray revealed that the woman had a cavity within the left upper zone. After ruling out tuberculosis, the doctors suspected the woman's problems were caused by the gastric band.

The specific issues appeared to be repeated aspiration of ingested food (causing reflux down her windpipe and subsequent lung damage) and cavitation (holes formed in the lung, often due to infection) caused by the gastric band fitting, according to a journal news release.

After antibiotics provided only limited relief, doctors emptied the fluid from the gastric band. The woman's symptoms quickly vanished. At her last follow-up visit, after her gastric band was cautiously refilled, her BMI was 35 and she was still symptom-free, the investigators reported.

The report authors noted that band slippage and erosion are the most common complications in patients with gastric bands, while lung-related problems are rare.

But delayed lung complications "can present with asthma-like symptoms and can be misdiagnosed if not properly investigated," concluded Dr. Adam Czapran, of the department of respiratory medicine and coronary care at Russells Hall Hospital in Dudley, West Midlands, U.K., and colleagues.

"Patients who have undergone laparoscopic adjustable gastric banding should have chest radiography or thoracic CT scan, or both, if they present with respiratory symptoms," Czapran's team wrote in the journal news release. "Withdrawal of the fluid from the band should be done as soon as possible to relieve the obstruction. Given the increasing frequency of people undergoing interventional procedures to aid weight loss, recognition of the short-term and long-term complications is paramount."

More information

The U.S. National Library of Medicine has more about laparoscopic gastric banding.

SOURCE: The Lancet, news release, Dec. 21, 2011
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