Long-term failures of lap-banding

[The causes of long-term failures of lapbanding]

THE CAUSES OF LONG TERM FAILURE OF A LAPAROSCOPIC ADJUSTABLE BAND
In 2008, the laparoscopic placement of an adjustable band for morbid obesity is a very popular operation worldwide. This is due to its simplicity and its reproducibility, and to reliable long-term results regarding weight-loss. Yet this operation faces also criticism because complications occur in the long run:
- Band slippage and/or "pouch dilatation" (above the band). This complication used to be quite common in the early times of the procedure (up to 20%), but new bands and changes in the procedure have made it rarer, although not  exceptional (around 3-4%). In most cases, surgery is mandatory, and can be urgent; band deflation is a priority once the diagnosis has been established: important vomiting, abdominal pain, specific radiological signs.
- Erosion through the gastric lumen (also called gastric migration of the band) : it affects 1 to 3% of the patients, and requests band removal owing to the risk of bleeding or abscess. Yet this surgery is not usually to be carried out in emergency.
- Oesophageal dilatation is quite an issue in the long run, for instance if the band has stayed over-inflated too long. Weight-loss is often disappointing in these cases because the enlargement of the oesophagus makes it possible to stockpile food. In the majority of cases, band ajustments have to be handled carefully (step by step) then, but reoperation is not mandatory.
- Isolated food intolerance can be observed after many years without any complication. Eventually, it turns out the band has to be taken out and sometimes another surgery is performed.
- Problems related to the catheter or the access-port . They are less common at the moment thanks to improvements in the design of the devices.

Do not forget that in many cases insufficient weight-loss is not related to a complication, but to poor food control. Once again, this emphasizes the necessity of a strict diet follow-up!