Ganesh R, Leese T, Rao A D, Baladas H G
Department of General Surgery, Alexandra Hospital, 378 Alexandra Road, Singapore 159964.
Singapore Med J. 2006 Aug;47(8):661-9.
Severe obesity is an increasing problem in Singapore. Laparoscopic adjustable gastric banding (LAGB) was introduced at our hospital in 2001 as part of a comprehensive weight management programme. To assess the effectiveness of this procedure, our results to date have been reviewed.
A prospective database was kept of all patients undergoing LAGB and this was used to retrieve the information.
256 consecutive patients underwent LAGB from January 2001 up to December 2005. There were 163 females and 93 males, with a median age of 36 years (range 18-63 years). Median preoperative weight was 112.7 kg (range 71.5-204 kg) and median body mass index (BMI) was 41.9 (range 32-73). Three patients were converted from laparoscopic to open laparotomy (1.2 percent). 91 percent of patients were discharged home on the first postoperative day. There were seven hospital morbidities (2.7 percent) with one mortality (0.4 percent). During follow-up, 20 patients (7.8 percent) developed late complications requiring revision surgery. Ten were band complications, requiring revision or removal of the band. The other ten were minor access port or tubing complications. Median weight loss at one year was 27.6 kg (range 5.6-71.2 kg) and median excess weight loss, using a BMI of 23 as a baseline, was 51.7 percent (range 9-117.5 percent). Easily measurable comorbidities such as diabetes mellitus and hypertension improved or resolved in 85.4 percent of patients.
There is a clear demand for LAGB in Singapore. This has increased since the BMI thresholds for severe obesity were reduced in Asian patients. The surgery provides effective, lasting weight loss with improvement or resolution of comorbidity for most patients. LAGB has the advantages of allowing controlled weight loss and life-long treatment while being easily reversible. When compared to other bariatric surgical procedures, low hospital morbidity has to be offset against the closer follow-up required and the need for secondary surgical procedures in some patients.
在新加坡，重度肥胖问题日益严重。2001年，我院引入了腹腔镜可调节胃束带术（LAGB），作为综合体重管理计划的一部分。为评估该手术的效果，我们回顾了迄今为止的结果。
对所有接受LAGB的患者建立了前瞻性数据库，并用于检索信息。
2001年1月至2005年12月，连续256例患者接受了LAGB。其中女性163例，男性93例，中位年龄36岁（范围18 - 63岁）。术前中位体重为112.7千克（范围71.5 - 204千克），中位体重指数（BMI）为41.9（范围32 - 73）。3例患者由腹腔镜手术转为开腹手术（1.2%）。91%的患者术后第一天出院。有7例医院内发病（2.7%），1例死亡（0.4%）。在随访期间，20例患者（7.8%）出现晚期并发症，需要进行翻修手术。其中10例为束带并发症，需要对束带进行翻修或移除。另外10例为小的接入端口或管道并发症。一年时的中位体重减轻为27.6千克（范围5.6 - 71.2千克），以BMI 23为基线计算，中位超重减轻为51.7%（范围9 - 117.5%）。诸如糖尿病和高血压等易于测量的合并症在85.4%的患者中得到改善或缓解。
在新加坡，对LAGB有明确需求。自亚洲患者重度肥胖的BMI阈值降低以来，这种需求有所增加。该手术能为大多数患者提供有效、持久的体重减轻，并改善或缓解合并症。LAGB具有允许控制体重减轻和终身治疗且易于逆转的优点。与其他减肥手术相比，低医院发病率必须与所需的更密切随访以及部分患者需要二次手术相权衡。
