50/50 chance of esophageal dilation - really upset

[addie1978 5]

I got the band 5 years ago but then was a total failure. I didn't follow the rules very well, I was pregnant, etc. I started again in January. Since January I have lost over 40lbs. My doctor told me (he does all the fills under the flourosope) in Janauary and again a month later that the band was in perfect condition and the perfect location. The problem he had was my stomach spasms continuously so it was really hard to fill it and gauge how well it was filled. I am on some medicine for the stomach spasms but it's not working that well.

I went to get another fill the other day because i see him monthly and he had not filled it since the original fill because I was losing weight. My weightloss has slowed a bit and I did not have as much restriction. He told me the band is now more vertical and I have a 50% chance of esophageal dilation. I don't really understand what that is. I kind of get it but it still doesn't make a lot of sense. I asked him if he could just move the band back but he said that they used to do that but now that doesn't work or isn't that effective. So far it has not dilated - I have restriction. But if I lose restriction I am going to be so upset. I asked him about revision - he is SUPER conservative. Absolutely will not do revisions unless I meet very stringent criteria. I think he is trying to build a record that he has done everything with the band for insurance purposes (i.e. I am going to the dietician a lot). It doesn't help that I am on the low end of the weight spectrum - my BMI is 35 I believe - so aside from PCOS, my other co-morbidity (sleep apnea) has disappeared.

Has this happened to anyone else? what is it exactly? how did your doctor solve it? I was told he would unfill it and I would know if it dilated because I would lose restriction. But what happens then? I just have a non-working band in me the rest of my life? Can't that cause erosion? I am just confused and distressed. I didn't really know what to ask my doctor other than was I in any kind of danger................

[DELETE THIS ACCOUNT! 12,703]

I'm very sorry you're dealing with this.

You need to have your doctor explain two things to you: How can it be fixed and what can you do to help fix it.

I am shocked he didn't completely unfill your band. Right now, you need to be concerned with the esophageal dilation not whether or not you have "restriction". This is especially true because of one of the causes of esophageal dilation is having a band too tight. Another cause is chronic over-eating. Being as you already said you weren't compliant with your band it's really important that you are given clear instructions what to do now and follow them exactly.

Here's portion of an article that covers esophageal dilation:

Esophageal and gastric pouch dilatation have been reported in many series [6,18–23]. The most likely cause of dilatation is over inflation of the LAP-BAND combined with patients who do not comply with instructions regarding oral intake. Inappropriate intake can stretch the gastric pouch; eventually, the pouch, and even the esophagus, may dilate as occurs in other restrictive procedures. Although these changes are usually reversible if the problem is detected sufficiently early, failure to address the issue will result in an atonic pouch and, potentially, a large, atonic esophagus.Gastric pouch dilatation should be viewed as a preprolapse condition that can be alleviated with prompt diagnosis and treatment. Its management typically involves complete deflation of the band and, after 2 to 3 months, slow re-inflation,with the surgeon being careful not to reach the previous point of over inflation.

Get back into your doctor. It's really important you get proactive with this before a fixable problem is left untreated and becomes something that costs you your band.

Best wishes.

[addie1978 5]

thank you for your reply. My doctor didn't seem that concerned and said if it does dialate then he will unfill the band....I do think it is too tight and I will call Monday to get in to have it unfilled somewhat. I am just so frustrated right now.....

[jad0264 5]

Dilation alone isn't the huge concern, well most of the time, but can be sign of ulceration or perforation later on. I had dilation continued to vomit then ended up perforating. I just recommend continuing to update your doctor on symptom as I did not do thirs like I should have done