Trouble eating after repair of LapBand slippage

By Dr. Rachael Keilin August 4, 2011
lapband questions Question: I had lap band surgery in Feb 2010. During recovery, I found out I had a large hiatal hernia they also repaired during that surgery. I followed instructions, and lost almost 80 pounds. (The first 50 I lost with no restriction–just followed the eating plan.) In October of 2010, I suddenly couldn’t eat and drinking anything become tough. I gurgled all the time and had a lot of pain. I found out my hernia was back and it pulled my stomach up, which in turn made my lap band slip–I ended up with a prolapse. I had the repair surgery in Oct 2010. I never had another restriction; no saline at all since the second surgery. After this surgery, I never was able to vomit. The PA told me it was due to the type of repair they did to the hernia during the second surgery. (I cannot remember what she told me it was, but I do know that it was not a fundoplication. (sp) ) I was fine until this past April. I started having the same symptoms, but the fluoroscope showed everything being normal. Everything started getting worse and my surgeon ordered several tests: endoscopy, ph test, motility test, and finally an upper GI. All came back normal. Since those tests, I’ve developed acid reflux at night. I still have a hard time eating, and drinking can be hard too. I physically cannot vomit at all. If I try to eat “too much,” I’m in so much pain for hours. My friend told me she’s heard about something called “mucus syndrome” and actually knows someone diagnosed with this. I cannot find this on any sites and the only talk I ever hear about mucus being a problem is when someone’s band it too tight. Considering I have no fluid in my band, what do you think is my issue? My doctor told me he had never heard of anything like this before. Initially, the PA said she thought I should have the band removed. She cannot order this, however. Am I rejecting the band? What can I do to fix the situation? I am miserable. Help.

Lawton, OK

Answer: Dr. Rachael Keilin, weight loss surgeon in TexasDr Rachael Keilin Answer:

First let me say that I’m sorry you’ve had such a difficult time in the last year. I know it can be very frustrating when everything was going well and then to suddenly have problems that are difficult to treat.

I have not heard of “mucus syndrome” either and cannot find any reference to it, so I’m not quite sure to what your friend was referring. However, an inability to vomit after repair of a hiatal hernia is very common and is actually a good sign that the repair is still intact and keeping the stomach within the abdomen and out of the chest. This is true whether the repair involves a fundoplication (where the stomach is wrapped around the top of the stomach to form a sphincter, kind of like the cuff at the end of a sleeve is wrapped around the sleeve itself) or placement of a Lap Band where the fundoplication would otherwise be.

What is not normal is the difficulty that you’re having eating or drinking even with the band completely empty. I have seen and heard about a few patients with similar problems and I believe this is what happens: When the stomach prolapses through the band (what is commonly known as a slip), it is usually from chronic over-distention of the pouch and esophagus above the band which can be from either over-eating or an excessively small band. The part that had been over-stretched for so long has a hard time squeezing and pushing food forward as well as it would normally and any barrier to the flow of food forward then causes the food to back up distending the pouch and esophagus and causing pain. Since you lost 50 lbs without a fill, I wonder if your band was not very tight to begin with (even empty) and after replacement still offers just enough resistance to the already weakened stomach muscle that food is getting hung-up. I have seen something like this in one patient who, like you, had normal appearing tests but after we removed the band altogether (and the underlying scar tissue which can sometimes constrict the stomach even after the band is removed) she returned to normal eating and drinking without difficulty.

Another possible solution would be to replace the band you currently have with a larger size (either an APL if you have an APS, or an APS if you currently have one of the older style bands of sizes 9.75, 10 or VG). This would allow for passage of food with less resistance and may solve the problem. There is actually no such thing as “rejecting the band”, only complications from either the band, scar tissue formed from the prior operations or decreased motility (“squeeze”) of the stomach and esophagus, so I would not worry about replacing the band for another band. I hope this helps and wish you the very best luck in finding a solution!

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Dr. Rachael Keilin Dr. Rachael Keilin

Dr. Rachael Keilin

2717 Summerhill Road, Texarkana, TX, 75503