Keidar A, Szold A, Carmon E, Blanc A, Abu-Abeid S
Department of Surgery B, Tel Aviv Sourasky Medical Center and the Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, 64239 Tel Aviv, Israel.
Surg Endosc. 2005 Feb;19(2):262-7. doi: 10.1007/s00464-003-8261-3. Epub 2004 Nov 11.
Laparoscopic adjustable gastric banding is a safe and effective procedure for the management of morbid obesity. However, band slippage is a common complication with variable presentation that can be rectified by a second laparoscopic procedure.
We studied case series of 125 consecutive patients who suffered from band slippage between November 1996 and May 2001 from a group of 1,480 laparoscopic adjustable gastric banding procedures performed during this time. The decision of whether to remove or replace/reposition the band was made prior to the operation, although the specific method used when replacement or repositioning was deemed suitable was determined by the operative findings. A laparoscopic approach was used in all but three patients.
A total of 125 patients (8.4%) suffered band slippage (posterior slippage, 82.4%; anterior slippage, 17.6%). In 70 patients (56%), the band was removed, whereas in 55 patients (44%) it was repositioned or replaced immediately. Of these 55 patients, six underwent later removal, five due to recurrent slippage and one due to erosion. Fourteen patients suffered complications, including gastric perforation (n = 8), intraoperative bleeding (n = 1), postoperative fever (n = 3), aspiration pneumonia (n = 1), upper gastrointestinal bleeding (n = 1), and pulmonary embolism (n = 1).
Band slippage is not a rare complication after laparoscopic adjustable gastric banding. The decision to remove or replace the band or convert to another bariatric procedure should be made preoperatively, taking both patient preference and etiology into consideration. Short-term results indicate that band salvage is successful when the patient population is chosen correctly.
腹腔镜可调节胃束带术是治疗病态肥胖的一种安全有效的手术方法。然而，束带滑脱是一种常见并发症，表现多样，可通过再次腹腔镜手术纠正。
我们研究了1996年11月至2001年5月期间连续125例束带滑脱患者的病例系列，这些患者来自同期进行的1480例腹腔镜可调节胃束带术。手术前决定是否移除或更换/重新定位束带，尽管在认为更换或重新定位合适时使用的具体方法由手术发现决定。除3例患者外，所有患者均采用腹腔镜手术。
共有125例患者（8.4%）发生束带滑脱（后滑脱，82.4%；前滑脱，17.6%）。70例患者（56%）的束带被移除，而55例患者（44%）的束带立即被重新定位或更换。在这55例患者中，6例后来被移除，5例因复发性滑脱，1例因侵蚀。14例患者出现并发症，包括胃穿孔（n = 8）、术中出血（n = 1）、术后发热（n = 3）、吸入性肺炎（n = 1）、上消化道出血（n = 1）和肺栓塞（n = 1）。
腹腔镜可调节胃束带术后束带滑脱并非罕见并发症。术前应综合考虑患者偏好和病因，决定是否移除或更换束带或改行其他减肥手术。短期结果表明，正确选择患者群体时，挽救束带是成功的。
