Steffen R, Horber F, Hauri P
Obes Surg. 1999 Apr;9(2):171-6. doi: 10.1381/096089299765553430.
Dissatisfied with vertical banded gastroplasty in superobese patients, the authors adopted Salmon's gastroplasty/distal gastric bypass (DGBP) in 1995. When the Swedish adjustable gastric band (SAGB) became available in Switzerland, the authors started using that device instead of the gastroplasty because implanting a SAGB is much easier and gastric restriction with a SAGB is adjustable to the patients' individual demands.
The authors evaluated 40 consecutive patients with SAGB-DGBP (27 primary and 13 secondary operations) for weight loss and complications, and compared weight loss with that obtained by SAGB alone. The mean initial body weight was 156.6 kg in women and 188.1 kg in men for primary and 108.2 kg/147.0 kg for secondary indications, respectively. The band was placed in a high position without tunneling sutures, and DGBP was done with a 50- to 60-cm common channel and a 60- to 80-cm biliopancreatic limb.
Weight loss at 1 year was 33.3% of initial body weight for primary operations. Weight loss was significantly more than with SAGB-alone cases. Complications were as follows: no death, no slipping or pouch dilatation; one marginal ulcer, one splenectomy, four cholecystectomies, one Roux-en-O reconstruction, two band leaks, eight port-related reoperations. Iron or vitamin deficiencies occurred in 75% of patients, with one case of transient protein malnutrition and one of intermittent diarrhea.
The SAGB as gastric restriction in combination with DGBP can be implanted easily. The new-generation SAGB is safe, but longer follow-up is necessary. SAGB-DGBP is more efficient than SAGB alone for weight reduction. It is too early to recommend banded DGBP as a primary procedure. However, in cases of insufficient weight loss after placement of an adjustable band, adding a DGBP without removing the band is an option. Follow-up by a specialized team is mandatory.
由于对超级肥胖患者实施垂直束带胃成形术不满意，作者于1995年采用了萨尔蒙胃成形术/远端胃旁路术（DGBP）。当瑞典可调节胃束带（SAGB）在瑞士可用时，作者开始使用该装置而非胃成形术，因为植入SAGB要容易得多，且SAGB造成的胃限制可根据患者的个体需求进行调整。
作者评估了40例连续接受SAGB-DGBP手术的患者（27例初次手术和13例二次手术）的体重减轻情况及并发症，并将体重减轻情况与单纯接受SAGB手术的患者进行比较。初次手术患者中，女性的平均初始体重为156.6千克，男性为188.1千克；二次手术患者的平均初始体重分别为108.2千克/147.0千克。束带置于高位，不使用隧道缝合，DGBP采用50至60厘米的共同通道和60至80厘米的胆胰支。
初次手术患者1年后体重减轻了初始体重的33.3%。体重减轻明显多于单纯接受SAGB手术的患者。并发症如下：无死亡，无束带滑脱或胃囊扩张；1例边缘溃疡，1例脾切除术，4例胆囊切除术，1例Roux-en-Y重建术，2例束带渗漏，8例与端口相关的再次手术。75%的患者出现铁或维生素缺乏，1例短暂性蛋白质营养不良，1例间歇性腹泻。
SAGB作为胃限制与DGBP联合使用时易于植入。新一代SAGB是安全的，但需要更长时间的随访。SAGB-DGBP在减轻体重方面比单纯SAGB更有效。将带束DGBP推荐为主要手术方式还为时过早。然而，在可调节束带置入后体重减轻不足的情况下，在不移除束带的情况下加做DGBP是一种选择。必须由专业团队进行随访。
