Pulmonary Problems May Be Late Complication of Lap

[So Blessed]

www.medscape.com/viewarticle/755965

From Medscape Medical News
Pulmonary Problems May Be Late Complication of Lap Band
Norra MacReady

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.



www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2961517-1/fulltext

The Lancet, Early Online Publication, 22 December 2011
doi:10.1016/S0140-6736(11)61517-1Cite or Link Using DOI
Recurrent aspiration and upper lobe cavitation
Original Text Dr Adam Czapran MBChB a b , Martin Doherty FRCP a, Angela Haddon MBBS c, Mourad Labib FRCPath c

In May, 2010, a 49-year-old woman presented to the outpatient clinic with a 4-month history of feeling generally unwell with night sweats and a persistent productive cough of green and yellow sputum. She described coughing when lying flat, particularly in the early morning hours. Medical history included laparoscopic adjustable gastric banding fitted in September, 2008, for class III obesity, when her body-mass index (BMI) was 45·4 kg/m 2 . She had been referred to a weight management clinic in Ju ...

[hislady]

Thanks for the info! I have COPD so this is very interesting for me. I hate my band and this just gives me one more reason! I had mine emptied to try to stop any further damage from it but have no insurance for a revision so am relying on luck and a prayer!

[Michelle J]

Well hell. One more thing to look out for.

Thanks for posting this.

[kmg9122]

Ditto for me, Michelle. I was thinking the same thing.

[msbatt]

Did you post this OvertHere? You should.

[So Blessed]

Dec 31, 2011 0:09:26 GMT -5 msbatt said:

Did you post this OvertHere? You should.

No, I didn't.

Am I being petty?

[chicarita]

Lovely. One more nasty I need to watch out for!

I don't think you're petty at all! But I think they need to hear it for sure.

[pumpkin]

Dec 28, 2011 8:26:56 GMT -5 So Blessed said:

www.medscape.com/viewarticle/755965

From Medscape Medical News
Pulmonary Problems May Be Late Complication of Lap Band
Norra MacReady

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.



www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2961517-1/fulltext

The Lancet, Early Online Publication, 22 December 2011
doi:10.1016/S0140-6736(11)61517-1Cite or Link Using DOI
Recurrent aspiration and upper lobe cavitation
Original Text Dr Adam Czapran MBChB a b , Martin Doherty FRCP a, Angela Haddon MBBS c, Mourad Labib FRCPath c

In May, 2010, a 49-year-old woman presented to the outpatient clinic with a 4-month history of feeling generally unwell with night sweats and a persistent productive cough of green and yellow sputum. She described coughing when lying flat, particularly in the early morning hours. Medical history included laparoscopic adjustable gastric banding fitted in September, 2008, for class III obesity, when her body-mass index (BMI) was 45·4 kg/m 2 . She had been referred to a weight management clinic in Ju ...

I hope you don't mind, but I am going to ask Kelly to move this over to the Failed Bands Forum and sticky it. Thank you for bringing this to our attention.

Lisa

[jenniferinwv]

This is my very first post here!

I have been coughing for MONTHS! All the time. My dr thought it was reflux so emptied half out of my band...I still cough. I've been on two back-to-back doses of steroids (gained 30 pounds) and 3 types of antibiotics. I've started the process to get a revision. I hope that stops my cough. It's horrible

[So Blessed]

Feb 13, 2012 10:19:52 GMT -5 jenniferinwv said:

This is my very first post here!

I have been coughing for MONTHS! All the time. My dr thought it was reflux so emptied half out of my band...I still cough. I've been on two back-to-back doses of steroids (gained 30 pounds) and 3 types of antibiotics. I've started the process to get a revision. I hope that stops my cough. It's horrible

I hope you get some relief. (((((HUGS)))))

[redbabe08]

Feb 13, 2012 10:19:52 GMT -5 jenniferinwv said:

This is my very first post here!

I have been coughing for MONTHS! All the time. My dr thought it was reflux so emptied half out of my band...I still cough. I've been on two back-to-back doses of steroids (gained 30 pounds) and 3 types of antibiotics. I've started the process to get a revision. I hope that stops my cough. It's horrible

probably your band has slipped & you need all of your band emptied.
have you had any tests done - upper GI, sonogram, ? is your band dr prescribing the steroids or your PCP?

sorry for the questions & what your going thru - been there.

[jenniferinwv]

I'm pretty sure my band has never been in the right place. I had 11.5 cc's in my 14 cc band and I still didn't have restriction. I had an upper-GI done, and it showed esophogeal dilation. Right now I think I have maybe 3 or 4 cc's in my band. My pcp has given me the steroids and all other medicines.

[formerlyfluffy]

Feb 13, 2012 15:08:20 GMT -5 jenniferinwv said:

I'm pretty sure my band has never been in the right place. I had 11.5 cc's in my 14 cc band and I still didn't have restriction. I had an upper-GI done, and it showed esophogeal dilation. Right now I think I have maybe 3 or 4 cc's in my band. My pcp has given me the steroids and all other medicines.

Make sure you update us and let us know what the Dr. says about the cough.

Good luck!

[redbabe08]

Feb 13, 2012 15:08:20 GMT -5 jenniferinwv said:

I'm pretty sure my band has never been in the right place. I had 11.5 cc's in my 14 cc band and I still didn't have restriction. I had an upper-GI done, and it showed esophogeal dilation. Right now I think I have maybe 3 or 4 cc's in my band. My pcp has given me the steroids and all other medicines.

sorry for what your dealing with - it's probably best to be completely emptied. at least my experience after slip #1 - i could barely have any kind of fill & slipped afterwards with i think around 2cc's. spent 18 months unfilled thinking i could manage on my own - but more problems crept up.

what revision are you considering?
will you be using the same dr - given that you think that the band might not have been installed properly?

stick around !!

[jenniferinwv]

I saw a hemotologist yesterday. After he looked at all my test results, he saw that my upper-gi reported that I have reflux. I have no type of heartburn or anything else like that, just this damn cough!

I am NOT using the same surgeon for my revision. The one who did my lap band also did my ex-husbands (husband at the time) surgery and he had MAJOR complications, and we almost lost him more than once. I'll be seeing Dr. Brethauer at the Cleveland Clinic. I have an appointment there for 02-29-12. I may see if he'll do a quick unfill of my band.

OH! The hemotologist gave me a B12 shot...LOVE HIM! I actually have a little bit of energy again!

[larra]

Jennifer, coughing can definitely be caused by reflux. I have a good friend, someone who has never been MO and never had any kind of wls, who had a persistent cough. Her pcp tried all sorts of meds for asthma and other resp problems, even steriods, to no avail. Then she read a book about reflux and changed her diet to eliminate foods that are known to cause reflux, and she's much, much better.
It's entirely possible that you are experiencing reflux with "only" a cough as a symptom, and I hope that removing your band and revision will help you.

Larra