Gastroesophageal Reflux Disease (GERD)
Laparoscopic adjustable gastric banding (lap band) improves chronic vomiting and reflux symptoms associated with gastroesophageal reflux disease (GERD) in the majority of patients with morbid obesity. 1
Evidence for GERD Improvement
The most compelling data comes from a prospective study of 48 patients with significant GERD requiring regular therapy before lap band placement 1:
- 76% achieved complete resolution of all reflux symptoms and discontinued anti-reflux medications 1
- 14% experienced improvement in symptoms 1
- Only 6% had no change and 4% had worsening symptoms 1
- Improvement occurred rapidly after surgery, not just with weight loss 1
The mechanism appears to be direct reduction of reflux by the band placement itself, independent of weight loss effects 1.
Important Caveats About Lap Band and Vomiting
Lap Band CAUSES Vomiting as a Complication
Vomiting occurs in 30-60% of patients after lap band placement, particularly in the first postoperative months, related to inappropriate eating behaviors 2. This is a complication of the procedure, not a therapeutic effect.
When Vomiting Indicates Serious Problems
Refractory vomiting despite proper eating technique may indicate 2:
- Band slippage (12.5% of patients require reoperation) 3
- Esophageal stricture 2
- Bowel obstruction 2
- Band erosion into the stomach (2.8% of patients) 3
Band opening or deflation may be necessary when vomiting persists 2.
Risk of Wernicke's Encephalopathy
When vomiting persists for >2-3 weeks, thiamin supplementation is mandatory to prevent Wernicke's encephalopathy, which presents with ataxia, ophthalmoplegia, nystagmus, and mental confusion 2. Two documented cases occurred after vertical banded gastroplasty with prolonged vomiting 2.
Contradictory Evidence on GERD Outcomes
While one study showed 76% resolution of GERD 1, a systematic review found mixed results 4:
- Gastric banding improves reflux in many patients 4
- However, de novo reflux symptoms or lesions develop in a considerable proportion of patients 4
- Roux-en-Y gastric bypass is more consistently effective for GERD than lap band 4
Relative contraindications to lap band include established Barrett's esophagus and refractory GERD 2, suggesting the procedure is not universally beneficial for reflux.
Clinical Bottom Line
Lap band improves pre-existing GERD in approximately 75% of morbidly obese patients 1, but paradoxically causes new-onset vomiting as a common complication in 30-60% of patients 2. The chronic vomiting condition most likely to improve is GERD associated with morbid obesity 1, though Roux-en-Y gastric bypass provides more consistent GERD improvement 4.