Issues with Lapband

Question
Hi Dr. Pilcher,

I have a bit of a lengthy story, so here goes:

I have a 10cm (4cc) lapband that was placed Nov 5, 2008. I had a starting weight of 308lbs, surgical weight of 270lbs and today weigh 172lbs. I have been as low as 160lbs but have been slowly gaining back weight due to constant struggles with solid food. This has been on going since about two months post op. I get severe bouts of nausea and very painful gas episodes. I struggle with constipation and have almost constant pain in my abdomen. I have undergone numerous tests in the last year and a half including an upper GI series, HIDA scan, gastric emptying study and three abdominal ultrasounds. The only thing that has been found was a 2mm gallbladder polyp however my gallbladder function seems to be fine.

I am at my wits end. I end up living on liquids for weeks on end and have a hard time with solid proteins and vegetables. I get very painful attacks that I've been told are more than likely esophageal spasms though this has not been officially diagnosed. I was told I had pancreatitis in July 2009 and have been put on omeprazole for acid reflux (which I had never had an issue with prior to having the lap band installed.) I have also been on domperidone to try and restore motility with limited success as traditional treatment for the constipation did not work so I was given a diagnosis of gastroparesis (which a gastric emptying series subsequently ruled out. I have since stopped taking the domperidone.)

The upper GI series (done in March 2009) had shown that my band had not slipped, my esophagus appeared to be fine and there was no evidence of erosion. I still to this day do not seem to have the traditional symptoms of a slip however the constant nausea, "PB-ing" episodes, pain and constipation are severely affecting my quality of life.

In your experience, could a revision to the sleeve potentially be a curative measure, being that the root cause of the nausea etc. is unknown. Have you come across instances such as my own in your own practice?

I have a history of DVT/PE so the idea of intubation really scares me, which was part of the reason I went with the lapband procedure. Is this a valid concern, above and beyond the normal risk associated with the surgery?

I imagine with the increase of PB-ing, there is a marked increase of risk of the band slipping but is there a potential of erosion of the band as well? I guess what I'm asking is is the stress this is causing me potentially adding stress to my stomach and/or the band, and will that increase the risk of erosion?

I have wondered as well, I seem to be tighter recently and PB-ing more as a result, and noticed that seems to correspond with allergy attacks. Is it possible that mucous or some other factor relating to my allergies could be causing this additional restriction? This has been the worst allergy season I have ever experienced, so this is new territory for me, especially with my band. (For reference, I currently have 2.2cc in my 4cc band.)

I appreciate and thank you in advance for any advice you may be able to offer and apologize for the mini-novel. :)

Thank you Doctor!

Amanda

Answer
Amanda,
I totally get your set of problems.  I have had patients in my practice with similar problems, and I do think I can give you some constructive feedback.

First of all, I think you deserve a lot of respect for all the weight you have lost.  The fact that you lost a substantial amount of weight prior to your surgery, then lost a LOT more with your Band, says a lot for your dedication and your willpower.  Great work.

My understanding of your current problem boils down to this: the Band feels too tight but all the tests are normal.  As surgeons, we are always nervous about recommending additional surgery without objective proof of a problem, but in 3-5 similar cases in my own practice the patient and I have taken the "leap of faith" and revised the Band to a gastric bypass (earlier cases) or to a sleeve (more recent cases).  So far, in every case the symptoms of spasm and swallowing difficulty have completely resolved.

Your history of a DVT/PE is a serious consideration, and honestly it is a risk factor for any surgery you might have.  Only you and your doctors together can decide how much this risk stands in the way of a revision operation, but it sounds like it is going to be pretty hard to continue on your current course.

Best of luck!
Dr JP

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