O'Brien Paul E, Dixon John B, Laurie Cheryl, Anderson Margaret
The Australian Centre for Obesity Research and Education, Monash University and The Avenue Hospital, Melbourne, Victoria 3004, Australia.
Obes Surg. 2005 Jun-Jul;15(6):820-6. doi: 10.1381/0960892054222858.
Laparoscopic adjustable gastric banding (LAGB) is a safe and effective method for the treatment of obesity. The most common problem after LAGB has been the occurrence of prolapse (slippage) of the stomach through the band. It has been proposed that the pars flaccida (PF) pathway (dissection from the base of the right crus, along the left crus to the angle of His) is less likely to be associated with prolapse than the traditional perigastric (PG) pathway (dissection between the lesser curvature of stomach and lesser omentum, across the apex of the lesser sac, to the angle of His). We have tested this hypothesis using a randomized controlled trial format.
We have performed a randomized controlled trial to compare the outcomes after LAGB using PF and PG pathways. 202 patients (mean age 40 years, mean weight 123 kg, mean BMI 45) were randomly allocated to the PF or PG pathway and followed for 2 years.
At 24 months, there have been 16 revisional procedures for prolapse, 4 in the PF group (all anterior prolapse) and 15 in the PG group (12 posterior and 3 anterior). This difference is significant (P<0.001). The mean % excess weight lost was 53% for the PF group and 46% for the PG group. There was equally significant improvements in the metabolic syndrome in both groups (59% preoperatively and 19% at 2 years). All 8 paired domain scores of the SF-36 measures of quality of life were improved significantly in both group (P<0.001).
The PF pathway is as effective as the PG pathway in generating substantial weight loss, improved health and improved quality of life and is significantly less likely to be associated with prolapse (slippage). It is recommended as the primary dissection pathway.
腹腔镜可调节胃束带术（LAGB）是治疗肥胖症的一种安全有效的方法。LAGB术后最常见的问题是胃通过束带发生脱垂（滑脱）。有人提出，与传统的胃周（PG）路径（在胃小弯和小网膜之间进行解剖，穿过小网膜囊顶部，到达His角）相比，松弛部（PF）路径（从右膈脚基部开始解剖，沿左膈脚至His角）与脱垂的相关性较小。我们采用随机对照试验的形式对这一假设进行了验证。
我们进行了一项随机对照试验，比较采用PF路径和PG路径进行LAGB术后的结果。202例患者（平均年龄40岁，平均体重123kg，平均BMI为45）被随机分配至PF组或PG组，并随访2年。
在24个月时，共有16例因脱垂进行了修复手术，PF组4例（均为前部脱垂），PG组15例（12例后部脱垂和3例前部脱垂）。这一差异具有统计学意义（P<0.001）。PF组平均超重减轻百分比为53%，PG组为46%。两组的代谢综合征均有同样显著的改善（术前为59%，2年后为19%）。两组SF-36生活质量测量的所有8个配对领域得分均有显著改善（P<0.001）。
PF路径在实现显著体重减轻、改善健康状况和提高生活质量方面与PG路径同样有效，且与脱垂（滑脱）的相关性显著较低。建议将其作为主要的解剖路径。
