Obesity continues to be an ongoing health concern that hinders many aspects of life, such as inability to walk, anxiety during traveling, or uncontrollable eating habits. As a result, many have sought bariatric or weight loss surgery to help control their weight along with behavioral issues that go along with poor dietary and physical habits. Therefore, consulting with a board-certified bariatric surgeon will help determine the most appropriate surgical option to maximize potential weight loss and health benefits.

Adjustable gastric banding (commonly known as LAP-BAND®) used to be  a popular surgery choice due to being the least invasive option for weight loss. However, new bariatric options, such as Vertical Sleeve Gastrectomy, recently emerged and became the most common bariatric operations performed in the world. Still, many patients nowadays choose to have gastric banding, and some specialized bariatric centers offer this option. An inflatable band is placed around the upper portion of the stomach, which creates a small stomach pouch above the band. Meanwhile, a port is a place under the skin on the abdominal wall. Here, sterile saline is injected into the port to inflate or deflate the band. The passage of the food from the small pouch to the rest of the stomach depends on the tightness of the band. Weight loss is expected as the smaller stomach pouch forces only a restricted amount of food consumption. This will promote satiety or the feeling of fullness, assuming the appropriate type of food is consumed.

The clinical benefits include the reduction of hunger, which helps the patients to decrease the number of calories that are consumed. Although many have successfully lost weight with the gastric band, patients need to make dietary and lifestyle changes to maximize potential weight loss. Otherwise, poor eating habits can lead to possible complications. A lot of these side effects can be addressed with behavioral modifications, or the worst-case situation involves the removal of the band.

Complications of Gastric Lap Band: Band Problems that Lead to Lap Band Pain

Band Erosion

When the gastric band grows into the stomach, this is known as band erosion. This complication has shown to occur in 0.3 to 14% of patients. Eventually, the band will no longer function properly and do not affect food restriction. As a result, weight gain is likely to occur due to decreased satiety. Overall, the only way to treat this is by removal of the band.

Band Slippage

Band slippage occurs when the stomach portion below the band prolapses above the band, causing significant lap band pain. Therefore, the opening between both stomach portions lessens or completely blocked. As a result, many symptoms can occur due to this constriction, such as:

• Gastroesophageal reflux disease (GERD)
• Difficulty swallowing (dysphagia)
• Vomiting
• Chest pain or pressure

Depending on the severity of the slippage, the band slip can be repaired by draining all the fluid from the band, surgically repositioning the band to work effectively, or removing the band.  For qualified patients, revisional bariatric surgery may be an alternative option.

Dysphagia

Dysphagia refers to someone with difficulty swallowing. It is often described as the feeling of food or liquid getting stuck in the throat, neck, or chest. At the same time, patients that eat too fast, drink with meals, or chew inadequately can have issues with swallowing. Hence, a better outcome can be expected if these eating habits are addressed. Unfortunately for some, dysphagia can be an ongoing, persistent issue in which band removal is the only solution for treatment.

Esophageal Dysmotility and Dilatation

Esophageal Dysmotility and Dilatation occurs when food cannot travel from the esophagus to the stomach regularly. Some for patients, this complication can lead to dysphagia, chest pain, and heartburn.

Gastroesophageal Reflux Disease (GERD)

GERD is a condition when the stomach acid travels back into the esophagus due to a weaker lower esophageal sphincter.  Hence, ongoing heartburn or acid reflux is the main symptom for GERD.  There are numerous ways to treat GERD, such as dietary modification, medications, and surgery.

Port Site Infection

Port Site Infection can occur at various times post-surgery. For instance, early infection can usually be treated with an antibiotic. However, a new port may be necessary despite medical intervention. Additionally, late port infections may be a manifestation of an infected band erosion, which ultimately may lead to a band removal. Lap band port pain is a typical complication post-surgery.

Pouch Dilation

Pouch Dilation is when the new stomach pouch is enlarged from the surgery. Often, deflating the band will address the problem along with ongoing counseling about healthier lifestyle changes.

Shoulder Pain

Shoulder or upper-arm pain can occur with gastric band patients. This may appear odd, considering the pain is not near the abdominal area. However, this discomfort is caused by pressure placed on a nerve called the phrenic nerve. Gas is pumped into the abdominal region to lift the skin and tissues away from the surgical site. This helps the surgeon have better access to your stomach during the surgery. However, not all of the gas goes away post-surgery and can remain trapped. As a result, the pressure from the trapped gas can disrupt the phrenic nerve, which can cause pain in the shoulder area. Luckily, this pain is temporary and will subside soon after the surgery. There are ways to help alleviate the discomfort at home. For example, daily physical activity, compliance with the post-operative diet, and using a heating pad can expedite relieve the irritation.

What to Do if Complications Persist?

Some of the complications can be addressed by merely modifying the diet and daily lifestyle habits. How, when, and what you eat can make a significant difference in how you feel afterward. The following are some tips to help minimize discomfort:

1. Avoid foods that slow down digestions which can lead to heartburn or acid reflux:

• High fatty foods (i.e., pizza, processed snacks, processed meats, dairy, fried foods)
• Red tomato sauce
• Citrus fruits
• Carbonated beverages
• Alcohol
• Caffeine

2. Eat slower, taking smaller sips, and drink slower; this can help minimize nausea and another gastrointestinal discomfort.

3. Don't drink during and right after meals; this can upset the pouch and cause other reactions such as vomiting and nausea.

Unfortunately, these adjustments are not enough to mitigate specific side effects for some patients.

Therefore, the gastric band needs to be removed. At this point, there are few options to consider. Firstly, if the underlying problem was a technical issue such as a leak, then a band replacement can be sufficient. Secondly, some patients may want to attempt losing weight on their own by utilizing what they learned about making the optimal food choices and implementing a disciplined physical activity plan. Lastly, converting to a different surgery or revisional surgery may be the best option for optimal results.