Emily from Pasadena sent us this question: “Had lap band removed in Nov 2019. Having esophagus trouble.  Food and drink sticking.  Food still there in the morning, wheezing and coughing at night. Constant heartburn etc…”

Dear Emily,

Lap band for weight loss causes significant damage to esophagus especially when over-restricted. Many bariatric surgeons fell in the trap of over-restriction in hopeless attempts at promoting weight loss. The end result of lap band over-restriction was damage to esophagus, and dissatisfied bariatric patients. Lap band damages esophageal motility resulting in a condition called pseudo-achalasia. Pseudo-achalasia patients have a dilated esophagus secondary to chronic partial obstruction created by lap band. Heartburn, difficulty swallowing, food regurgitation, cough and wheezing (especially at night) are some of the symptoms associated with band over-restriction and pseudo-achalasia. Aspiration pneumonia is a serious side effect of lap band over-restriction.

The first step in lap band over-restriction management is fluid removal. The earlier fluid is removed the less is esophageal damage. Patients who present after years of over-restriction require lap band removal. Most patients will slowly improve, and acid reflux symptoms resolve. Some may develop irreversible esophageal function loss resulting in persistent symptoms of acid and food regurgitation. In this case, first line of treatment consists of diverting gastric content from esophagus by performing a Roux-en-Y gastric bypass. Gastric bypass is quite an effective solution for acid reflux. Dysphagia, however, may not resolve. In these rare cases and especially in the setting of recurrent aspiration episodes esophageal resection is necessary. Fortunately, Lap Band is rarely performed these days in Houston. Our understanding of weight loss surgery mechanism of action has greatly evolved. We no longer think that mechanical restriction leads to weight loss. Rather, we know that bariatric surgery modifies a number of neuro-hormonal signals that alter satiety and metabolism leading to long-term weight loss.