Delayed Mid-to-Distal Esophageal Perforation as a Rare Long-Term Complication of Laparoscopic Adjustable Gastric Banding: A Case Report

Background: Laparoscopic adjustable gastric banding (LAGB) has been widely used for the treatment of morbid obesity. Despite early success, long-term complications have become increasingly recognized. Among these, esophageal perforation is exceptionally rare. Case Presentation: We report the case of a 60-year-old male with LAGB placement ten years prior, who presented with acute respiratory distress, sepsis, and chest pain after vomiting. Imaging revealed a mid-to-distal esophageal perforation with an esophago-pulmonary fistula and right lower lobe abscess. Management and Outcome: The patient underwent direct full-thickness esophageal repair with an intercostal muscle flap. The gastric band was intentionally preserved due to the absence of stenosis or mucosal damage. Postoperative recovery was uneventful, and follow-up was favorable. Conclusion: To our knowledge, this is the first reported case of delayed esophageal perforation years after LAGB. It highlights the importance of long-term follow-up in bariatric patients and awareness of rare but serious complications. Multidisciplinary management is essential for optimal outcomes.