Foletto Mirto, De Marchi Francesco, Bernante Paolo, Busetto Luca, Pomerri Fabio
Clinica Chirurgica II, University of Padua, Padua, Italy.
Obes Surg. 2005 Nov-Dec;15(10):1487-90. doi: 10.1381/096089205774859272.
Late band slippage has occurred in nearly 3-10% of patients after laparoscopic adjustable gastric banding (LAGB) with an average delay of 13 months. Band slippage can rarely lead to necrosis of the enlarged pouch, a potentially life-threatening condition. We report a female (BMI 39.92 with co-morbidities) who developed acute outlet obstruction 2 years after LAGB placement. After prompt band deflation, an urgent Gastrografin swallow showed stomach slippage without emptying. At re-operation pouch strangulation was discovered. The pouch appeared to be ill-fated, but as no tear was evident on intra-operative assessment, we decided to simply remove the band and drain. The patient was successfully discharged after 8 days, and the last upper endoscopy showed only a large ulcer in the fundus that was healing. Proper and prompt management of symptomatic patients with stomach slippage, with early operation when acute obstruction is evident, can enable a successful stomach-sparing approach.
在接受腹腔镜可调节胃束带术（LAGB）的患者中，近3% - 10%会出现晚期束带滑脱，平均延迟时间为13个月。束带滑脱很少会导致扩张胃囊坏死，这是一种潜在的危及生命的情况。我们报告一例女性患者（BMI为39.92，伴有多种合并症），在放置LAGB两年后出现急性出口梗阻。在迅速放气束带后，紧急服用泛影葡胺显示胃滑脱且未排空。再次手术时发现胃囊绞窄。胃囊似乎预后不佳，但术中评估未发现明显撕裂，因此我们决定仅移除束带并引流。患者在8天后成功出院，最后一次上消化道内镜检查仅显示胃底有一个正在愈合的大溃疡。对于有症状的胃滑脱患者，进行恰当且及时的处理，在明显出现急性梗阻时尽早手术，能够成功实施保留胃的治疗方法。
