Horgan Santiago, Holterman Mark J, Jacobsen Garth R, Browne Allen F, Berger Robert A, Moser Federico, Holterman Ai-Xuan L
Division of General Surgery and Minimally Invasive Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA.
J Pediatr Surg. 2005 Jan;40(1):86-90; discussion 90-1. doi: 10.1016/j.jpedsurg.2004.09.034.
Morbid obesity (MO) has reached epidemic proportions and is a major health problem in developed nations. In the adolescent with MO, early intervention can minimize obesity-related comorbidities, avoid premature mortality, improve quality of life, and prevent obesity-related diseases as these patients mature into adulthood. The primary surgical treatment of adolescent patients meeting National Institutes of Health criteria for bariatric surgery has been the gastric bypass (GB). Although GB has led to weight loss and improvement of comorbid conditions, concerns remain over the high incidence of postoperative complications and life-style-altering long-term sequelae of gastrointestinal tract reconstruction. Based on the excellent results from international adult series as well as the authors' own experience of more than 300 adult patients, laparoscopic adjustable gastric banding (LAGB) as an alternative to GB to eligible adolescents was offered.
After medical, psychologic, and nutritional screening, 4 patients (ages 17-19 years) with a body mass index of 40 or more (range, 40-61) who failed medical attempts at weight loss were selected for LAGB.
The operative time was 40 to 90 minutes. All patients were discharged on the day of surgery. There were no early complications. One patient had cholecystitis 6 months after surgery requiring laparoscopic cholecystectomy. For the 4 patients, the amount of excess weight loss was 57% at 30 months, 34% at 12 months, 87% at 7 months, and 15% at 4 months, respectively.
In this preliminary series of the US experience in the use of LAGB for the management of adolescents with MO, the lack of operative morbidity, short operative time/hospital stay, and encouraging initial weight loss mirror the adult experience and illustrate that the LAGB is a safe and effective alternative to GB. These encouraging results support further evaluation of LAGB as a surgical option in a comprehensive adolescent weight loss program.
病态肥胖（MO）已达到流行程度，是发达国家的一个主要健康问题。对于患有MO的青少年，早期干预可将肥胖相关合并症降至最低，避免过早死亡，改善生活质量，并在这些患者成年后预防肥胖相关疾病。符合美国国立卫生研究院减肥手术标准的青少年患者的主要手术治疗方法一直是胃旁路术（GB）。尽管GB已导致体重减轻和合并症改善，但术后并发症的高发生率以及胃肠道重建改变生活方式的长期后遗症仍令人担忧。基于国际成人系列研究的出色结果以及作者自身对300多名成年患者的经验，为符合条件的青少年提供了腹腔镜可调节胃束带术（LAGB）作为GB的替代方法。
经过医学、心理和营养筛查，选择了4名体重指数为40或更高（范围为40 - 61）且减肥药物治疗失败的患者（年龄17 - 19岁）进行LAGB。
手术时间为40至90分钟。所有患者均在手术当天出院。无早期并发症。1例患者在术后6个月发生胆囊炎，需要进行腹腔镜胆囊切除术。对于这4例患者，超重减轻量在30个月时为57%，12个月时为34%，7个月时为87%，4个月时为15%。
在美国使用LAGB治疗青少年MO的这一初步系列研究中，无手术发病率、手术时间/住院时间短以及令人鼓舞的初始体重减轻情况与成人经验相似，表明LAGB是GB的一种安全有效的替代方法。这些令人鼓舞的结果支持在全面的青少年减肥计划中进一步评估LAGB作为一种手术选择。
