Suter M, Bettschart V, Giusti V, Heraief E, Jayet A
Department of Surgery, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland.
Surg Endosc. 2000 Jun;14(6):532-6. doi: 10.1007/s004640000114.
The introduction of laparoscopic techniques-especially that of gastric banding-and the fact that conservative management does not provide satisfactory long-term results in patients with morbid obesity has resulted in a marked increase in the demand for bariatric surgery in our department since 1995. In this paper, we present our experience during the first 3 years with this approach.
Data for all patients who had bariatric surgery at our institution were collected prospectively. They were analyzed for the purpose of this study.
A total of 150 patients were operated on between December 1995 and December 1998 (37 months). There were 130 women and 20 men, with a mean age of 37.5 years (range, 19-62). The mean initial excess body weight was 102.9% (range, 58-191%), and the mean initial body mass index (BMI) was 44. 6 kg/m(2) (range, 35.1-64.1). A Lapband was used in 101 cases and a SAGB in 47 cases. In two patients in whom conversion was necessary, we performed a vertical banded gastroplasty. Duration of surgery decreased over time from 210 min (first 20 cases) to 73 min (last 20 cases). Six patients (4%) developed major complications, one of whom died. The median duration of postoperative hospital stay was 3 days. The mean follow-up was 17 months. In all, 24 patients (16%) developed late complications, and 22 (14.6%) required reoperation, mainly for band slippage and/or pouch dilatation (14 cases). An incorrect surgical technique used for the first 30 patients (Lapband within the lesser sac) was responsible for more than half of these complications. The mean excess weight loss was 34% at 6 months, 55% at 1 year, and 56% at 2 years. Compared to vertical banded gastroplasty (197 cases between 1981 and 1995), postoperative morbidity was greatly decreased, late morbidity was similar, and weight loss was equivalent.
Laparoscopic gastric banding is followed by a weight reduction that is similar to that observed after vertical banded gastroplasty, with a much lower postoperative morbidity, a shorter hospital stay, and an earlier resumption of normal activities. If these results can be confirmed by long-term follow-up, laparoscopic gastric banding will be confirmed as the restrictive procedure of choice for morbid obesity.
自1995年以来，腹腔镜技术（尤其是胃束带术）的引入，以及保守治疗在病态肥胖患者中无法提供令人满意的长期效果这一事实，导致我院对减重手术的需求显著增加。在本文中，我们介绍了采用这种方法最初3年的经验。
前瞻性收集我院所有接受减重手术患者的数据，并进行本研究相关分析。
1995年12月至1998年12月（37个月）期间，共有150例患者接受了手术。其中女性130例，男性20例，平均年龄37.5岁（范围19 - 62岁）。初始平均超重百分比为102.9%（范围58 - 191%），初始平均体重指数（BMI）为44.6kg/m²（范围35.1 - 64.1）。101例使用了Lapband，47例使用了SAGB。2例患者需要中转手术，我们对其进行了垂直捆绑胃成形术。手术时间随时间从最初20例的210分钟降至最后20例的73分钟。6例患者（占4%）出现严重并发症，其中1例死亡。术后住院时间中位数为3天。平均随访时间为17个月。共有24例患者（占16%）出现晚期并发症，22例（占14.6%）需要再次手术，主要原因是束带滑脱和/或胃囊扩张（14例）。最初30例患者（将Lapband置于小网膜囊内）采用的错误手术技术导致了一半以上的这些并发症。6个月时平均超重减轻34%，1年时为55%，2年时为56%。与1981年至1995年期间的197例垂直捆绑胃成形术相比，术后发病率大幅降低，晚期发病率相似，减重效果相当。
腹腔镜胃束带术后的减重效果与垂直捆绑胃成形术后相似，术后发病率低得多，住院时间短，能更早恢复正常活动。如果这些结果能通过长期随访得到证实，腹腔镜胃束带术将被确认为病态肥胖的首选限制性手术。
