Boschi Sergio, Fogli Luciano, Berta Rossana Daniela, Patrizi Patrizio, Di Domenico Marco, Vetere Fernando, Capizzi Daniele, Capizzi Francesco Domenico
Chirurgia B, Ospedale Maggiore, Bologna, Italy.
Obes Surg. 2006 Sep;16(9):1166-70. doi: 10.1381/096089206778392329.
Among bariatric operations, laparoscopic adjustable gastric banding (LAGB) has been the preferred one in Europe and Australia, and has become recently popular in the USA. Like every surgical procedure, however, it is not devoid of specific complications, like slippage, band erosion, outlet obstruction and port problems. Assuming that the absence of the pouch may avoid postoperative slippage, we introduced the technique of esophago-gastric placement, instead of the original gastric banding technique. A further technical variant, introduced in June 2002, consists of suturing the gastric fundus to the left hemidiaphragm, using two non-resorbable sutures and pledgets.
Between January 1999 and July 2005, 400 LAGBs have been placed in 90 males and 310 females, with the technical variants above. Mean age was 42 (range 17-69 years), and mean BMI was 44.8 kg/m(2) (range 33-67).
Mean hospital stay was 2.5 days (range 1-17). Mortality has been zero. Major complications included: 16 slippages (after a range of 6-45 months), 5 outlet obstructions (immediately after the operation), and one intragastric migration (after 2 years). Minor complications included 18 port problems. Since the introduction of gastric fundus fixation to the diaphragm in 2002, gastric slippage has decreased from 8% to 0.9%. BMI has decreased from 44.8 to 32 kg/m(2) at 60 months.
The technique herein presented is effective and useful to prevent postoperative gastric slippage. It does not induce pseudo-achalasia, if strictly controlled. In fact, it is avoided by the patient due to the immediate appearance of dysphagia, in the case of wrong food ingestion. Long-term clinico-radiological follow-up confirms that the technique is safe and effective in motivated patients with good compliance and willing to undergo periodic studies.
在减肥手术中，腹腔镜可调节胃束带术（LAGB）在欧洲和澳大利亚一直是首选术式，最近在美国也开始流行。然而，与其他外科手术一样，它也存在一些特定并发症，如移位、束带侵蚀、出口梗阻和端口问题。假设没有胃囊可以避免术后移位，我们引入了食管 - 胃放置技术，取代了原来的胃束带技术。2002年6月引入的另一种技术变体是使用两根不可吸收缝线和棉垫将胃底缝合到左半膈。
1999年1月至2005年7月期间，采用上述技术变体为90名男性和310名女性进行了400例LAGB手术。平均年龄为42岁（范围17 - 69岁），平均体重指数（BMI）为44.8kg/m²（范围33 - 67）。
平均住院时间为2.5天（范围1 - 17天）。死亡率为零。主要并发症包括：16例移位（发生在6 - 45个月后）、5例出口梗阻（术后立即发生）和1例胃内移位（2年后发生）。次要并发症包括18例端口问题。自2002年引入胃底固定到膈肌的技术后，胃移位发生率从8%降至0.9%。60个月时BMI从44.8降至32kg/m²。
本文介绍的技术对于预防术后胃移位是有效且有用的。如果严格控制，它不会诱发假性贲门失弛缓症。事实上，患者在摄入不当食物时会因立即出现吞咽困难而避免这种情况。长期临床放射学随访证实，该技术对于有积极性且依从性好、愿意接受定期检查的患者是安全有效的。
