Biertho Laurent, Steffen Rudolf, Ricklin Thomas, Horber Fritz F, Pomp Alfons, Inabnet William B, Herron Daniel, Gagner Michel
The Mount Sinai School of Medicine, Department of Surgery, Division of Minimally Invasive Surgery, New York, NY, USA.
J Am Coll Surg. 2003 Oct;197(4):536-44; discussion 544-5. doi: 10.1016/S1072-7515(03)00730-0.
Indications for and results of laparoscopic adjustable gastric banding (LAGB) and laparoscopic gastric bypass (LGB) are still controversial, especially between Europe and the United States. The recent availability of gastric bandings in the United States made it necessary to compare the two techniques.
We compared a series of 456 LGB to a series of 805 LAGB performed in two different institutions. Body mass index (BMI), complication rate, mortality, and excess weight loss (EWL) after 3, 6, 12, and 18 months were obtained. A Fischer's exact test and a Student t test with covariance analysis were used for statistical analysis.
Results are expressed as a mean +/- standard deviation, comparing LGB with LAGB. Preoperative BMI was 49.4 +/- 8.3 kg/m(2) versus 42.2 +/- 4.9 kg/m(2) (p = 0.0001), respectively. Perioperative major complication rates were 2.0% versus 1.3% (NS), and the early postoperative major complication rates were 4.2% versus 1.7% (p = 0.02), respectively. Mortality rate was 0.4% versus 0% (NS), respectively. The global EWL was 36.3% for LGB versus 14.7% for LAGB at 3 months (p < 0.0001), 51.6% versus 21.9% at 6 months (p < 0.0001), 67.0% versus 33.3% at 12 months (p < 0.0001), and 74.6% versus 40.4% at 18 months (p < 0.0001), respectively. Longterm followup for the LAGB group showed an EWL of 47% at 2 years, 56% at 3 years, and 58% at 4 years. Patients were sorted after their preoperative BMI (30 to 40, 40 to 50, and 50 to 60 kg/m(2)). The EWL at 3, 6, 12, and 18 months was statistically superior in the LGB group, for any BMI ranges.
These data suggest that LGB provides a higher EWL at 18 months, compared with LAGB, and this was true for any preoperative BMI range. It is associated with a higher early postoperative complication rate.
腹腔镜可调节胃束带术（LAGB）和腹腔镜胃旁路术（LGB）的适应证及效果仍存在争议，尤其是在欧洲和美国之间。胃束带术近期在美国得以应用，因此有必要对这两种技术进行比较。
我们将在两个不同机构实施的456例LGB系列手术与805例LAGB系列手术进行了比较。获取了患者的体重指数（BMI）、并发症发生率、死亡率以及术后3、6、12和18个月的超重减轻（EWL）情况。采用费舍尔精确检验和带协方差分析的学生t检验进行统计分析。
结果以均值±标准差表示，比较LGB与LAGB。术前BMI分别为49.4±8.3kg/m²和42.2±4.9kg/m²（p = 0.0001）。围手术期主要并发症发生率分别为2.0%和1.3%（无统计学差异），术后早期主要并发症发生率分别为4.2%和1.7%（p = 0.02）。死亡率分别为0.4%和0%（无统计学差异）。LGB组3个月时的总体EWL为36.3%，LAGB组为14.7%（p < 0.0001）；6个月时分别为51.6%和21.9%（p < 0.0001）；12个月时分别为67.0%和33.3%（p < 0.0001）；18个月时分别为74.6%和40.4%（p < 0.0001）。LAGB组的长期随访显示，2年时EWL为47%，3年时为56%，4年时为58%。根据术前BMI（30至40、40至50和50至60kg/m²）对患者进行分类。在任何BMI范围内，LGB组在3、6、12和18个月时的EWL在统计学上均更优。
这些数据表明，与LAGB相比，LGB在18个月时的EWL更高，且在任何术前BMI范围内均如此。它与术后早期较高的并发症发生率相关。
