Silecchia G, Restuccia A, Elmore U, Polito D, Perrotta N, Genco A, Bacci V, Basso N
Dipartimento di Chirurgia Paride Stefanini, Universita La Sapienza Rome, Italy.
Surg Laparosc Endosc Percutan Tech. 2001 Aug;11(4):229-34. doi: 10.1097/00129689-200108000-00001.
Intragastric prosthesis (Lap-Band, BioEnterics Co., Carpinteria, CA, U.S.A.) migration is one of the major long-term complications of laparoscopic adjustable silicone gastric banding. The causes, clinical signs, timing, and overall incidence of band entrapment have not been prospectively investigated in a large series. The purpose of this study was to assess prospectively the incidence of Lap-Band intragastric migration and to establish the safety and effectiveness of minimally invasive band removal. Between January 1996 and June 2000, 148 consecutive patients enrolled in a multidisciplinary bariatric program underwent laparoscopic adjustable silicone gastric banding. In the follow-up treatment, gastrointestinal endoscopy was performed routinely. One hundred twenty-three patients with a minimum follow-up period of 12 months were entered into the study group. Eleven (9.2%) patients had long-term major complications. Intragastric band migration was observed in nine (7.5%) patients. The diagnosis was established by routine endoscopy between 10 and 41 months after surgery. Five erosions occurred in the first 30 cases (learning curve period). In six patients, the band was removed by an intragastric endoscopic-assisted approach avoiding laparotomy. The remaining three patients are under endoscopic surveillance. The results of this study show that routine upper gastrointestinal endoscopy can discover asymptomatic band migrations early. Band erosion did not require emergency treatment and can be removed safely by a minimally invasive approach.
胃内假体（美国加利福尼亚州卡平特里亚市BioEnterics公司生产的Lap-Band）移位是腹腔镜可调节硅胶胃束带术的主要长期并发症之一。束带卡压的原因、临床体征、发生时间以及总体发生率尚未在大量病例中进行前瞻性研究。本研究的目的是前瞻性评估Lap-Band胃内移位的发生率，并确定微创取出束带的安全性和有效性。1996年1月至2000年6月，148例连续纳入多学科肥胖症治疗项目的患者接受了腹腔镜可调节硅胶胃束带术。在后续治疗中，常规进行胃肠内镜检查。123例随访期至少12个月的患者进入研究组。11例（9.2%）患者出现长期严重并发症。9例（7.5%）患者观察到胃内束带移位。诊断通过术后10至41个月的常规内镜检查确定。在前30例（学习曲线期）中有5例发生糜烂。6例患者通过胃内内镜辅助方法避免开腹取出束带。其余3例患者接受内镜监测。本研究结果表明，常规上消化道内镜检查可早期发现无症状的束带移位。束带糜烂无需紧急处理，可通过微创方法安全取出。
