Gastric Stenosis Due to Fibrous Capsule Post Gastric Band Removal: Review of Literature and Case Report

Laparoscopic adjustable gastric banding (LAGB) was widely used as a minimally invasive and reversible bariatric procedure; however, mid- and long-term follow-up has revealed a significant incidence of late complications and suboptimal results. Although band removal is generally considered curative, persistent or delayed gastric obstruction due to a retained fibrous capsule is increasingly recognized and remains underreported in the literature. We report the case of a 54-year-old woman with a history of LAGB placement from 2009 to 2020 who presented with progressive vomiting and intolerance to both liquids and solids. Computed tomography demonstrated esophageal dilatation with stasis and a restrictive calcified structure encircling the gastric cardia. Upper gastrointestinal endoscopy revealed severe narrowing of the cardia with normal mucosa, and endoscopic balloon dilation was unsuccessful. Surgical exploration identified a rigid, circumferential calcified perigastric ring at the site of the previous band, consistent with a persistent fibrous capsule causing luminal stenosis. Complete excision of this structure was performed, and intraoperative endoscopy confirmed immediate restoration of gastric patency without residual stenosis. This case together with a review of the available literature, highlights a rare but clinically significant complication of LAGB removal that requires revisional surgery and excision of the fibrous capsule to achieve durable symptom resolution. Therefore, meticulous dissection of the capsule during the removal procedure may be necessary to prevent gastric stenosis, but further studies are needed to reach a definitive conclusion and recommendation.