Nadler Evan P, Youn Heekoung A, Ginsburg Howard B, Ren Christine J, Fielding George A
Division of Pediatric Surgery, New York University School of Medicine, New York, NY 10016, USA.
J Pediatr Surg. 2007 Jan;42(1):137-41; discussion 141-2. doi: 10.1016/j.jpedsurg.2006.09.014.
Obesity in the adolescent population has reached epidemic proportions. Although diet and behavior modification can help a minority of teenagers, most of these patients go on to become obese adults. Recently, surgical intervention for morbid obesity has gained increasing support. To date, this has only included gastric bypass procedures. However, this procedure carries at least a 1% mortality rate even in the hands of the most experienced surgeons. Therefore, our center has been using laparoscopic adjustable gastric banding (LAGB) to treat adolescents with morbid obesity. This analysis is a report of our short-term results in our first 53 patients.
All adolescents aged 13 to 17 years who had undergone LAGB at our institution and had been entered into our prospectively collected database since 2001 were reviewed. Data collected preoperatively included age, sex, race, and body mass index (BMI). Postoperatively recorded data included length of stay, operative morbidity, need for reoperation, as well as percentage of excess weight loss (%EWL) and BMI at 3-month intervals.
Fifty-three teenagers aged 13 to 17 years (mean, 15.9 years) underwent LAGB at our institution since September 2001. Of these, 41 were female and 12 were male. The mean preoperative weight was 297 +/- 53 lb and the mean initial BMI was 47.6 +/- 6.7 kg/m2. The %EWL was 37.5 +/- 17.0 at 6 months, 62.7 +/- 27.6 at 1 year, and 48.5 +/- 15.6 at 18 months of follow-up. There were no intraoperative complications. Two patients had band slips that required laparoscopic repositioning, and 2 patients developed a symptomatic hiatal hernia that required laparoscopic repair. All of these procedures were performed as outpatient procedures. A fifth patient developed a wound infection requiring incision and drainage. Other complications included mild hair loss in 5 patients, iron deficiency in 4 patients, nephrolithiasis and cholelithiasis in 1 patient, and gastroesophageal reflux in 1 patient.
Laparoscopic adjustable gastric banding is not only a safe operation for morbidly obese pediatric patients, but also represents an effective treatment strategy with a %EWL of approximately 50% at both 1 year and 18 months of follow-up. Because of the minimal morbidity and complete absence of mortality of the LAGB, it is the optimal surgical option for pediatric patients with morbid obesity.
青少年肥胖问题已呈流行态势。尽管饮食和行为调整能帮助少数青少年，但这些患者中的大多数最终会成为肥胖成年人。近来，针对病态肥胖的手术干预获得了越来越多的支持。迄今为止，这仅包括胃旁路手术。然而，即便由最有经验的外科医生操作，该手术的死亡率至少为1%。因此，我们中心一直在使用腹腔镜可调节胃束带术（LAGB）治疗青少年病态肥胖。本分析报告了我们首批53例患者的短期结果。
对2001年以来在我院接受LAGB手术并录入前瞻性收集数据库的所有13至17岁青少年进行回顾。术前收集的数据包括年龄、性别、种族和体重指数（BMI）。术后记录的数据包括住院时间、手术并发症、再次手术需求，以及每隔3个月的超重减轻百分比（%EWL）和BMI。
自2001年9月以来，我院有53名13至17岁青少年（平均15.9岁）接受了LAGB手术。其中，41名女性，12名男性。术前平均体重为297±53磅，初始平均BMI为47.6±6.7kg/m²。随访6个月时%EWL为37.5±17.0，1年时为62.7±27.6，18个月时为48.5±15.6。术中无并发症。2例患者出现束带滑脱，需行腹腔镜重新定位；2例患者出现有症状的食管裂孔疝，需行腹腔镜修补。所有这些手术均作为门诊手术进行。第5例患者发生伤口感染，需要切开引流。其他并发症包括5例患者轻度脱发，4例患者缺铁，1例患者肾结石和胆结石，1例患者胃食管反流。
腹腔镜可调节胃束带术不仅对病态肥胖儿童患者是一种安全的手术，而且是一种有效的治疗策略，在随访1年和18个月时%EWL约为50%。由于LAGB的发病率极低且完全没有死亡率，它是青少年病态肥胖患者的最佳手术选择。
