Spivak Hadar, Beltran Oscar R, Slavchev Plamen, Wilson Erik B
Department of Surgery, Park-Plaza Hospital, Houston, TX, USA.
Surg Endosc. 2007 Aug;21(8):1388-92. doi: 10.1007/s00464-007-9223-y. Epub 2007 Mar 14.
While the majority of patients achieve good outcomes with the LAP-BAND, there is a subset of patients who experience complications or fail to lose sufficient weight after the banding procedure. This study examines the feasibility and outcome of performing laparoscopic Roux-en-Y gastric bypass (RYGBP) as a single-step revision surgery after a failed LAP-BAND procedure.
In the past five years we have performed more than 1400 LAP-BAND procedures. We laparoscopically converted 33 (30 females) of these patients (mean age = 43.8 years) from LAP-BAND to RYGBP because of inadequate weight loss and/or complications. Key steps in the revision procedures were (1) identification and release of the band capsule; (2) careful dissection of the gastrogastric sutures; (3) creation of a small gastric pouch; and (4) Roux-en-Y anterior colic anterior gastric pouch-jejunum anastomosis. Revisions took place at a mean 28.2 months (range = 11-46; SD = 11.3) after the original gastric banding. Change in body mass index (BMI) between pre- and postrevision was evaluated with paired t tests.
Among the 33 patients who would undergo revision surgery, the mean BMI before the LAP-BAND procedure was 45.7 kg/m2 (range = 39.9-53.0; SD = 3.4) and the mean weight was 126 kg (range = 99-155; SD = 17). The lowest BMI achieved by this group with the LAP-BAND before revision was 39.7 kg/m2 (range = 30-49.2; SD = 4.9); however, the mean BMI at the time of revision was 42.8 kg/m2 (range = 33.1-50; SD = 4.8). The mean revision operative time was 105 min (range = 85-175), and the mean hospital stay was 2.8 days (range = 1-10). Complications included one patient who underwent open reoperation and splenectomy for a bleeding spleen and one patient who required repair of an internal hernia. After conversion to RYGBP, mean BMI decreased to 33.9 kg/m2 at 6 months (p < 0.001) and 30.7 kg/m2 (range = 22-39.6; SD = 5.3) at 12 months or more of followup (average = 15.7 months; p < 0.0001).
Laparoscopic conversion from LAP-BAND to RYGBP is safe and can be an alternative for patients who failed the LAP-BAND procedure. However, revision surgery is technically challenging and should be performed only by surgeons who have completed the learning curve for laparoscopic RYGBP.
虽然大多数患者使用胃束带术（LAP - BAND）能取得良好效果，但仍有一部分患者在束带手术后出现并发症或体重减轻不足。本研究探讨了在LAP - BAND手术失败后，进行腹腔镜Roux - en - Y胃旁路术（RYGBP）作为单步翻修手术的可行性和结果。
在过去五年中，我们进行了1400多例LAP - BAND手术。由于体重减轻不足和/或出现并发症，我们通过腹腔镜将其中33例患者（30名女性）从LAP - BAND转换为RYGBP，平均年龄为43.8岁。翻修手术的关键步骤包括：（1）识别并松解束带囊；（2）仔细分离胃胃缝合线；（3）创建一个小胃囊；（4）Roux - en - Y结肠前胃囊 - 空肠吻合术。翻修手术在原胃束带手术后平均28.2个月（范围 = 11 - 46；标准差 = 11.3）进行。采用配对t检验评估翻修前后体重指数（BMI）的变化。
在这33例接受翻修手术的患者中，LAP - BAND手术前的平均BMI为45.7kg/m²（范围 = 39.9 - 53.0；标准差 = 3.4），平均体重为126kg（范围 = 99 - 155；标准差 = 17）。该组患者在翻修前使用LAP - BAND达到的最低BMI为39.7kg/m²（范围 = 30 - 49.2；标准差 = 4.9）；然而，翻修时的平均BMI为42.8kg/m²（范围 = 33.1 - 50；标准差 = 4.8）。翻修手术的平均操作时间为105分钟（范围 = 85 - 175），平均住院时间为2.8天（范围 = 1 - 10）。并发症包括1例因脾出血接受开腹再次手术和脾切除术的患者，以及1例需要修复内疝的患者。转换为RYGBP后，6个月时平均BMI降至33.9kg/m²（p < 0.001），随访12个月或更长时间（平均 = 15.7个月）时降至30.7kg/m²（范围 = 22 - 39.6；标准差 = 5.3）（p < 0.0001）。
从LAP - BAND腹腔镜转换为RYGBP是安全的，对于LAP - BAND手术失败的患者可以作为一种选择。然而，翻修手术在技术上具有挑战性，应由已完成腹腔镜RYGBP学习曲线的外科医生进行。
