Botched Bariatric Surgery Causes Permanent Inability to Swallow

Emergency Medicine Expert WitnessThis case involves a man in his 40’s who underwent lap band surgery. Immediately after surgery was concluded, the patient realized that he could not swallow. Despite a revision surgery, the patient was still unable to swallow and has not been able to take any solid food by mouth. After further testing and examination by physicians, the patient was told he has a severe esophageal stricture and would require a feeding tube for the foreseeable future.

Question(s) For Expert Witness

  • 1. What is your experience performing lap band surgery?
  • 2. Have you ever heard of this complication?
  • 3. What, if anything, can be done to prevent or mediate against this complication from occurring?

Expert Witness Response E-045014

I’m a board certified general surgeon and a bariatric surgeon certified in the lap band and active in the American Society of Metabolic and Bariatric Surgery. I’ve done many lap bands, and taken out just as many. It’s hard to know what exactly this complication is – if he had too much fluid in the band, if it was slipped, or if it was simply too tight. Generally, removing the fluid is done, followed by an Upper GI swallow study or an EGD. If the patient can’t swallow well, the band would need to be removed.

Expert Witness Response E-008637

I am a minimally invasive and bariatric surgeon. I practice in a bariatric center of excellence, where we perform approximately 400 bariatric cases per year. I take care of many patients who underwent LapBand implantations in the past, and although I do not perform this procedure anymore, I treat complications from it. I have performed many LapBand implantations, but stopped doing them around 2012, due to the high risks and long-term complications associated with them. Since then, I have removed many bands, and converted some of those patients to laparoscopic sleeve gastrectomy or gastric bypass. dysphagia after LapBand surgery is not uncommon and is usually a result of misplaced or slipped gastric band. First, an upper GI study is necessary to determine the exact cause of the complication. The band should be completely emptied prior to the study. Based on the results of the study, a reoperation with repositioning or complete removal of the band may be necessary. My initial thoughts about the case: From the information available, it seems to be the patient started to experience symptoms immediately after the operation, which makes me think the band was malpositioned at the time of the operation. I would have obtained an upper GI and likely an early reoperation depending on what the images showed.


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