Introduction Laparoscopic adjustable gastric banding (LAGB) is a common bariatric procedure in the UK due to its relative technical ease and reversibility. The technique has been around since the 1990s and although its immediate complications have been evident and known, the longer term complications are still emerging and not yet completely understood. Oesophageal dysmotility post-LAGB is now increasingly being recognised as a long-term complication associated with LAGB. This paper presents a potentially life-threatening complication associated with oesophageal dysmotility more than a decade after LAGB placement.
Methods A 58yr old lady presented with chronic cough and mediastinal widening on chest X-ray. A computed tomogram (CT) revealed a mega-oesophagus with a collection in the mediastinum in keeping with a contained oesophageal perforation and a LAGB in situ. On further questioning, she mentioned that she had had a LAGB placed 12yrs previously.. She had been experiencing recurrent coughs, chest infections, weight loss and dysphagia for 2 yrs but had not sought medical help.
Results The LAGB was completely emptied (9mls of fluid). She was managed conservatively with nil orally, nasogastric drainage, antibiotics, parenteral nutrition over a period of 4 weeks and serial imaging was performed to monitor progress. She responded well to it, the perforation had completely healed, she resumed oral intake and was discharged.
Conclusion While oesophageal dysmotility is emerging as a long-term complication occurring around 5–7 yrs post-LAGB, its association with oesophageal perforation has not been described in the literature prior to this incident. It is likely that oesophageal dysmotility resulted in mega-oesophagus and the associated reflux caused frequent coughing in our patient. The valsalva manoeuvre during coughing which closes the cricipharyngeus proximally and the presence of LAGB distally may have generated a high pressure zone within the oesophagus leading to perforation. This was a potentially life-threatening complication. This re-inforces the importance of life-long commitment to follow-up in patients who undergo bariatric surgery. We suggest at-risk patients developing mega-oesophagus should be identified and timely band –emptying performed to avoid this serious complication. Further long-term cohort studies need to be performed to determine the exact prevalence of oesophageal dysmotility and such complications.
Disclosure of Interest None Declared.
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