Gagner Michel, Steffen Rudolf, Biertho Laurent, Horber Fritz
Mount Sinai School of Medicine, Department of Surgery, Division of Laparoscopic Surgery, New York, NY 10029, USA.
Obes Surg. 2003 Jun;13(3):444-9. doi: 10.1381/096089203765887813.
The procedure of choice for morbid obesity remains controversial. One of the most effective treatments is the biliopancreatic diversion with duodenal switch (BPD/DS), which is, however, associated with a significant morbidity rate. Adjustable gastric banding (AGB) by the laparoscopic approach is an easier procedure with the intent to reduce complication rates. It replaced the sleeve gastrectomy in this study. The objective was to assess the feasibility and safety of this new laparoscopic treatment.
AGB with duodenal switch (DS) was performed laparoscopically with 7 trocars. A gastric band was appropriately placed below the gastroesophageal junction, followed by BPD/DS with a 250-cm alimentary channel and a 100-cm common channel.
All 5 patients were women, with mean preoperative BMI 52.2 kg/m(2) (40.6 to 64.4). The operations were performed via laparoscopy in a mean of 206 +/- 35 minutes. There was no postoperative complication, infection or conversion. Mean hospital stay was 8.8 days (8-11). At 12 months, mean BMI is 35.8 kg/m(2) (26.1-46.0), with continuing weight loss and no hypoalbuminemia.
These data suggest that laparoscopic AGB/DS is feasible, with a low morbidity rate. This technique could combine the long-term weight loss of malabsorptive procedures, with a low-morbidity, adjustable, restrictive procedure. This technique could be used in selected patients, but requires a larger study with longer follow-up.
病态肥胖的首选治疗方法仍存在争议。最有效的治疗方法之一是胆胰转流并十二指肠转位术（BPD/DS），然而，该手术的发病率较高。腹腔镜下可调节胃束带术（AGB）是一种更为简便的手术，旨在降低并发症发生率。在本研究中，它取代了袖状胃切除术。目的是评估这种新型腹腔镜治疗方法的可行性和安全性。
采用7个套管针进行腹腔镜下AGB联合十二指肠转位术（DS）。将胃束带妥善放置在胃食管交界处下方，随后进行BPD/DS，构建一个250厘米的 alimentary通道和一个100厘米的共同通道。
所有5例患者均为女性，术前平均体重指数（BMI）为52.2kg/m²（40.6至64.4）。手术通过腹腔镜平均在206±35分钟内完成。术后无并发症、感染或中转开腹情况。平均住院时间为8.8天（8 - 11天）。在12个月时，平均BMI为35.8kg/m²（26.1 - 46.0），体重持续减轻且无低蛋白血症。
这些数据表明，腹腔镜AGB/DS是可行的，发病率较低。该技术可将吸收不良手术的长期减重效果与低发病率、可调节、限制性手术相结合。这种技术可用于特定患者，但需要进行更大规模、更长随访时间的研究。
