Myers Jonathan A, Sarker Sharfi, Shayani Vafa
Department of Surgery, Loyola University Medical Center, Maywood, IL 60513, USA.
Surg Obes Relat Dis. 2006 Jan-Feb;2(1):37-40; discussion 40. doi: 10.1016/j.soard.2005.09.015. Epub 2006 Jan 4.
Controversy exists concerning the optimal treatment of patients with massive super-obesity (body mass index >60 kg/m(2)). The ideal surgical operation must balance optimal weight loss with minimal morbidity and mortality. We report our results for this patient population undergoing laparoscopic adjustable gastric banding (LAGB).
We performed a retrospective review of all consecutive patients undergoing LAGB at our institution. Patients with a preoperative body mass index >60 kg/m(2) were identified and their charts were reviewed. Weight loss data were collected when the patients returned for band adjustments. All band adjustments were patient driven and performed under fluoroscopic guidance.
Between November 2001 and October 2004, 352 patients underwent LAGB. Of these, 53 had a preoperative body mass index >60 kg/m(2) (15%). The mean absolute weight and body mass index was 186.6 kg (range 139.6-250.6) and 66 kg/m(2) (range 60.0-79.8), respectively. The average follow-up was 12.5 months (range 1.3-31). The most prevalent co-morbidities were obstructive sleep apnea (64%), hypertension (42%), and diabetes mellitus (42%). Postoperative complications included one band removal for chronic obstruction, one band revision for slippage, and one nonfatal pulmonary embolism. The mean percentage of excess weight loss was 15% (-1.1 to 27.4) with <6 months of follow-up, 28.1% (range 1.9-44.5) with 6-12 months of follow-up, 35.1% (range 8.8-84.9) with 12-18 months of follow-up, and 42.9% (range 15.7-80.1) with >18 months of follow-up. Compared with our cohort of nonmassive super-obese patients, massive super-obese patients required a longer period of follow-up to accomplish a similar percentage of excess weight loss.
LAGB is an appropriate surgical option for the treatment of massive super-obesity. The procedure can be performed with minimal morbidity and mortality and leads to promising medium-term weight loss. Longer term follow-up of massive super-obese patients is necessary and may demonstrate even more successful results.
对于极度肥胖（体重指数>60kg/m²）患者的最佳治疗方法存在争议。理想的手术必须在实现最佳体重减轻的同时，将发病率和死亡率降至最低。我们报告了接受腹腔镜可调节胃束带术（LAGB）的这类患者的治疗结果。
我们对在本机构接受LAGB的所有连续患者进行了回顾性研究。确定术前体重指数>60kg/m²的患者，并查阅其病历。当患者回来进行束带调整时收集体重减轻数据。所有束带调整均由患者驱动，并在荧光透视引导下进行。
在2001年11月至2004年10月期间，352例患者接受了LAGB。其中，53例术前体重指数>60kg/m²（15%）。平均绝对体重和体重指数分别为186.6kg（范围139.6 - 250.6）和66kg/m²（范围60.0 - 79.8）。平均随访时间为12.5个月（范围1.3 - 31）。最常见的合并症为阻塞性睡眠呼吸暂停（64%）、高血压（42%）和糖尿病（42%）。术后并发症包括1例因慢性梗阻取出束带、1例因束带滑脱进行修复以及1例非致命性肺栓塞。随访时间<6个月时，超重减轻的平均百分比为15%（-1.1至27.4）；6 - 12个月时为28.1%（范围1.9 - 44.5）；12 - 18个月时为35.1%（范围8.8 - 84.9）；>18个月时为42.9%（范围15.7 - 80.1）。与我们的非极度肥胖患者队列相比，极度肥胖患者需要更长的随访时间才能实现相似的超重减轻百分比。
LAGB是治疗极度肥胖的一种合适的手术选择。该手术可在发病率和死亡率最低的情况下进行，并能带来有前景的中期体重减轻效果。对极度肥胖患者进行长期随访是必要的，可能会显示出更成功的结果。
