Pulmonary Problems May Be Late Complication of Lap Band

Norra MacReady

December 22, 2011

December 22, 2011 — Physicians caring for patients with laparascopic adjustable gastric bands (lap bands) should remain alert for late complications, according to a report published online December 22 in the Lancet.

"Given the increasing frequency of people undergoing interventional procedures to aid weight loss, recognition of the short-term and long-term complications is paramount," the authors warn.

Adam Czapran, MBChB, from the Department of Respiratory Medicine and the Coronary Care Unit at Russells Hall Hospital in Dudley, West Midlands, United Kingdom, and colleagues describe the case of a 49-year-old woman who presented in May 2010 with a 4-month history of night sweats and a persistent productive cough. Her body mass index (BMI) at the time of presentation was 32.6 kg/m2, which was down from 45.4 kg/m2 after undergoing lap band surgery in September 2008.

Despite a history of asthma, the patient had not responded to treatment for asthma exacerbations. Blood tests revealed evidence of inflammation (C-reactive protein 81 mg/L; erythrocyte sedimentation rate 96 mm/hour), and chest X-rays (CXR) showed left upper zone cavitation. Tuberculosis (TB) was suspected, given the night sweats and the CXR appearance. Referral to the TB clinic led to a thoracic computerized tomography (CT) scan, which confirmed a 3.2 × 2.8 cm apical lung lesion with irregular cavitation and showed esophageal dilatation. Tests for tuberculosis (including bronchoscopy and bronchioalveolar lavage) and autoimmune disease were persistently negative, and treatment with metronidazole and doxycycline for 6 weeks provided only modest and temporary relief.

"At this point, the diagnosis of recurrent aspiration and cavitation secondary to a severe restriction from her gastric banding was suspected," the authors write. Her clinical and radiographic symptoms resolved when the gastric band was emptied, confirming the diagnosis. At her last follow-up examination in May 2011, her gastric band had been refilled, her BMI was 34.8 kg/m2, and she had experienced no recurrence of the aspiration.

Lap bands are associated with a high rate of late complications, the authors explain. Pouch expansion, band slippage, and erosion are most common, but in rare patients, aspiration pneumonia may develop "secondary to severe restriction and oesophageal dilatation or reflux." The symptoms may resemble asthma, and chest radiography or thoracic CT scan is recommended for patients with lap bands who present with respiratory symptoms. Emptying the band promptly relieves the obstruction.

The authors have disclosed no relevant financial relationships.

Lancet. Published online December 22, 2011. Extract

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