Suter M, Jayet C, Jayet A
Department of Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Obes Surg. 2000 Feb;10(1):41-6; discussion 47. doi: 10.1381/09608920060674094.
Vertical banded gastroplasty (VBG) has been our procedure of choice for the treatment of morbid obesity from 1981-1995, at which time it was replaced by laparoscopic gastric banding. Three different techniques have been used for banding: silastic band, marlex mesh, adjustable sphincter. The purpose of this paper is to present the long-term results.
The charts from all patients operated on during the aforementioned period were reviewed and the data analysed retrospectively.
This series comprises 197 patients, 172 females and 25 males, with a mean initial excess weight of 94.8% (6-300%) and a mean initial Body Mass Index (BMI) of 42.9 kg/m2 (23-88 kg/m2). 73 patients had a silastic band, 40 Marlex mesh, and 84 an adjustable sphincter. Overall excess weight loss was 66% after 12-24 months, and remained between 50 and 60% up to 9 years postoperatively. There was no difference between the 3 groups. 82 patients (41%) developed a total of 117 complications during follow-up. Among them were stenosis 20%, staple-line disruption 11%, incisional hernia 13%, severe esophagitis 7% and band migration 1.5%. Stenosis developed more often with a silastic band or an adjustable sphincter, and severe esophagitis was more prevalent after the adjustable sphincter. 58 patients required one or more procedures for correction, including dilatation in 21, band removal in 17, band replacement in 15, restapling in 19 and incisional hernia repair in 11 patients. Overall, 29.4% of patients had to be reoperated. There were more reoperations in the silastic and adjustable sphincter groups compared with the Marlex mesh group.
VBG is associated with a rapid weight loss that is relatively well-maintained over time, although there is a tendency to slight weight regain after 2 years. The price for these results is high if complications and further necessary procedures are considered, especially after banding with a silastic band or an adjustable sphincter. Marlex mesh represents the banding material of choice if VBG is chosen.
1981年至1995年期间，垂直束带胃成形术（VBG）一直是我们治疗病态肥胖症的首选手术方法，后来被腹腔镜胃束带术所取代。束带术采用了三种不同的技术：硅橡胶带、聚脂纤维网和可调节括约肌。本文旨在介绍其长期疗效。
回顾了上述期间所有接受手术治疗的患者的病历，并对数据进行了回顾性分析。
该系列包括197例患者，其中女性172例，男性25例，初始超重平均为94.8%（6%-300%），初始体重指数（BMI）平均为42.9kg/m²（23-88kg/m²）。73例患者使用硅橡胶带，40例使用聚脂纤维网，84例使用可调节括约肌。术后12至24个月时总体超重减轻了66%，术后9年时仍保持在50%至60%之间。三组之间无差异。82例患者（41%）在随访期间共出现117例并发症。其中狭窄占20%，吻合口破裂占11%，切口疝占13%，严重食管炎占7%，束带移位占1.5%。硅橡胶带或可调节括约肌导致狭窄的发生率更高，可调节括约肌术后严重食管炎更为常见。58例患者需要进行一次或多次矫正手术；其中21例进行扩张，17例取出束带，15例更换束带，19例重新吻合，11例进行切口疝修补。总体而言，29.4%的患者需要再次手术。与聚脂纤维网组相比，硅橡胶带组和可调节括约肌组的再次手术更多。
VBG术后体重迅速减轻，且随着时间推移相对保持良好，尽管术后2年有轻微体重反弹的趋势。如果考虑到并发症和进一步必要的手术，尤其是使用硅橡胶带或可调节括约肌进行束带术后，这些结果的代价是高昂的。如果选择VBG，聚脂纤维网是首选的束带材料。
