Edwards M A, Grinbaum R, Schneider B E, Walsh A, Ellsmere J, Jones D B
Department of Surgery, Medical College of Georgia, 1120 15th Street, BI 4072, Augusta, GA 30912, USA.
Surg Endosc. 2007 Nov;21(11):1950-6. doi: 10.1007/s00464-007-9302-0. Epub 2007 May 5.
Since the Food and Drug Administration (FDA) approval of laparoscopic adjustable gastric bands (LAGB) in June 2001, the number LAGB procedures performed in the United States has increased exponentially. This study aimed to benchmark the authors' initial hospital experience to FDA research trials and evidence-based literature.
Over a 2-year period, 87 consecutive patients with a mean age of 43 years (range, 21-64 years) and a body mass index of 45.6 kg/m2 (range, 35-69 kg/m2) underwent an LAGB procedure at the authors' institution. The authors conducted a retrospective review of the outcomes including conversion, reoperation, mortality, perforation, erosion, prolapse, port dysfunction, excess weight loss, and changes in comorbidities, then compared the data with published benchmarks.
Gender, age, and body mass index were comparable with those of other series. Perioperative adverse events included acute stoma obstruction (n = 1) and respiratory complications (n = 2). Delayed complications included gastric prolapse (n = 4) and port reservoir malposition (n = 4). Five bands were explanted. The mean follow-up period was 14 months (n = 79). The mean percentage of excess weight loss was 30% (range, 4.7-69%) at 6 months, 41% (range, 9.6-82%) at 12 months, and 47% (range, 14-92%) at 24 months. Comorbidities resolved included diabetes (74%), hypertension (57%), gastroesophageal reflux disease (55%) and dyslipidemia (38%).
The short-term outcomes for LAGB were comparable with published benchmarks. With adequate weight loss, most patients achieve significant improvement in obesity-related illnesses. With new bariatric accreditation standards and mandates required for financial reimbursement, hospitals will need to demonstrate that their clinical outcomes are consistent with best practices. The authors' early experience shows that LAGB achieves significant weight loss with low mortality and morbidity rates. Despite a more gradual weight loss, most patients achieve excellent weight loss with corresponding improvement of comorbidities within the first 2 years postoperatively.
自2001年6月美国食品药品监督管理局（FDA）批准腹腔镜可调节胃束带术（LAGB）以来，美国实施的LAGB手术数量呈指数级增长。本研究旨在将作者所在医院的初始经验与FDA研究试验及循证文献进行对比。
在2年期间，作者所在机构对87例连续患者进行了LAGB手术，这些患者的平均年龄为43岁（范围21 - 64岁），体重指数为45.6 kg/m²（范围35 - 69 kg/m²）。作者对包括中转、再次手术、死亡率、穿孔、侵蚀、脱垂、端口功能障碍、超重减轻情况以及合并症变化等结果进行了回顾性分析，然后将数据与已发表的基准进行比较。
性别、年龄和体重指数与其他系列研究相当。围手术期不良事件包括急性吻合口梗阻（1例）和呼吸并发症（2例）。延迟并发症包括胃脱垂（4例）和端口储液器位置异常（4例）。取出了5条束带。平均随访期为14个月（n = 79）。6个月时超重减轻的平均百分比为30%（范围4.7 - 69%），12个月时为41%（范围9.6 - 82%），24个月时为47%（范围14 - 92%）。已缓解的合并症包括糖尿病（74%）、高血压（57%）、胃食管反流病（55%）和血脂异常（38%）。
LAGB的短期结果与已发表的基准相当。随着体重的充分减轻，大多数患者肥胖相关疾病有显著改善。鉴于新的减肥手术认证标准和财务报销要求，医院需要证明其临床结果与最佳实践一致。作者的早期经验表明，LAGB能实现显著的体重减轻，死亡率和发病率较低。尽管体重减轻较为缓慢，但大多数患者在术后头2年内实现了出色的体重减轻，并相应改善了合并症。
