Jenkins J T, Modak P, Galloway D J
Department of Surgical Gastroenterology, Gartnaval General Hospital, Glasgow, Scotland.
Scott Med J. 2006 Mar;51(1):37-41. doi: 10.1258/RSMSMJ.51.1.37.
Obesity is an increasing problem in Scotland and Laparoscopic Adjustable Gastric Bands (LAGB) are an effective method of weight reduction. Most outcome data are reported from high volume units with extensive experience or dedicated bariatric practice. We aimed to assess an experienced laparoscopic surgeon's outcome working outwith a dedicated bariatric practice in the west of Scotland.
All LAGB procedures performed by a single surgeon were prospectively assessed from 1997 to 2004. LAGB were inserted using pars flaccida approach. Patient selection was based on BMI >35 or significant obesity related co-morbidities. Outcomes included percentage excess weight loss (%EWL) and excess BMI loss (EBL). We assessed total operating time to assess the learning curve for LAGB placement.
125 patients were assessed (107 F:18 M). 123 patients were in regular follow-up (98%). Median age was 44 years (range 25-63). Mean follow-up was 34 months (range 11-91). Median initial BMI was 49 (range 37-73). 31% were BMI 35-45, 36% were BMI 45-50 and 33% were BMI>50. %EWL at 1,3 and 5 years was 45, 58 and 74, respectively. EBL at 1, 3 and 5 years was 11.7, 16.1, and 21.7, respectively. Complications included 4 converted procedures, 1 failed band insertion after conversion and re-operation for removal in five. Eight patients had tubing access port problems requiring intervention. The median overall total operation time was 80 minutes (range 50 - 160).
In this cohort LAGB insertion by an experienced laparoscopic surgeon is safe with few re-operations. Satisfactory weight loss is obtained and patient compliance with follow-up is high.
肥胖在苏格兰是一个日益严重的问题，腹腔镜可调节胃束带（LAGB）是一种有效的减肥方法。大多数结果数据来自经验丰富的高容量单位或专门的减肥手术实践。我们旨在评估一位经验丰富的腹腔镜外科医生在苏格兰西部非专门减肥手术环境下的手术结果。
对1997年至2004年由一位外科医生进行的所有LAGB手术进行前瞻性评估。采用松弛部入路插入LAGB。患者选择基于BMI>35或存在与肥胖相关的严重合并症。结果包括超重减轻百分比（%EWL）和超重BMI降低（EBL）。我们评估了总手术时间以评估LAGB放置的学习曲线。
评估了125例患者（107例女性：18例男性）。123例患者接受定期随访（98%）。中位年龄为44岁（范围25 - 63岁）。平均随访时间为34个月（范围11 - 91个月）。初始BMI中位数为49（范围37 - 73）。31%的患者BMI为35 - 45，36%的患者BMI为45 - 50，33%的患者BMI>50。1年、3年和5年时的%EWL分别为45、58和74。1年、3年和5年时的EBL分别为11.7、16.1和21.7。并发症包括4例中转手术，1例中转后束带插入失败以及5例因取出而再次手术。8例患者出现管道接入端口问题需要干预。总体总手术时间中位数为80分钟（范围50 - 160分钟）。
在该队列中，经验丰富的腹腔镜外科医生进行LAGB插入手术是安全的，再次手术较少。可获得满意的体重减轻效果，患者对随访的依从性较高。
