可调节胃束带滑脱的处理

Management of slipped adjustable gastric bands.

作者信息

Manganiello Marc, Sarker Sharfi, Tempel Michael, Shayani Vafa

机构信息

Department of Surgery, Loyola University Stritch School of Medicine, Chicago, Illinois, USA.

出版信息

Surg Obes Relat Dis. 2008 Jul-Aug;4(4):534-8; discussion 538. doi: 10.1016/j.soard.2007.11.003. Epub 2008 Jan 28.

DOI:10.1016/j.soard.2007.11.003

PMID:18226972

Abstract

BACKGROUND

A small percentage of patients undergoing laparoscopic adjustable gastric banding (LAGB) experience band slippage that might require subsequent surgical intervention. We present our experience with band slippage in 660 consecutive LAGBs performed since November 2001 in order to determine the optimal management for slipped gastric bands.

METHODS

The treatment options for patients with slipped bands include band removal, gastric reduction and reapplication of the original band, and band replacement. Data from electronic medical records, as well as telephone interviews, were collected and tabulated. The original weight and body mass index, weight and body mass index before the revisional procedure, and the most recent weight, body mass index, and percentage of excess weight loss are presented.

RESULTS

Of the 660 LAGB patients, 34 (5%) experienced band slippage and required 40 subsequent operative procedures. Of the 34 patients, 6 underwent multiple procedures for their slipped band. Overall, 10 removals, 13 gastric reductions, and 17 replacements were performed (40 total procedures). Of the 34 patients, 28 (82%) were available for follow-up. This group of 28 patients underwent 34 operative procedures (7 removals, 11 gastric reductions, and 16 replacements). No complications were associated with these 34 operations. Of the 11 patients with gastric reduction, 6 (55%) had subsequent recurrence of band slippage, resulting in 6 additional operations (5 replacements and 1 removal).

CONCLUSION

After band slippage, all 3 management options result in maintenance of most of the lost weight. However, because a large number of patients who undergo gastric reduction experience repeated slippage and require additional surgical intervention, gastric reduction should not be routinely performed in this population. Given the overall experience with revisional surgery after band slippage, additional investigation of the etiology of band slippage and its prevention is warranted.

摘要

背景

一小部分接受腹腔镜可调节胃束带术（LAGB）的患者会出现出现胃胃束带滑脱，这可能需要后续手术干预。我们介绍自2001年11月以来连续进行的660例LAGB手术中胃束带滑脱的经验，以确定胃束带滑脱的最佳处理方法。

方法

胃束带滑脱患者的治疗选择包括移除束带、胃缩窄并重新应用原束带以及更换束带。收集电子病历数据以及电话访谈数据并制成表格。列出初始体重和体重指数、翻修手术前的体重和体重指数，以及最近的体重、体重指数和超重减轻百分比。

结果

在660例LAGB患者中，34例（5%）发生胃束带滑脱，需要进行40次后续手术。在这34例患者中，6例因胃束带滑脱接受了多次手术。总体而言，进行了10次移除、13次胃缩窄和17次更换（共40次手术）。34例患者中，28例（82%）可进行随访。这组28例患者接受了34次手术（7次移除、11次胃缩窄和16次更换）。这34次手术均无并发症。在11例接受胃缩窄的患者中，6例（55%）随后出现胃束带滑脱复发，导致另外6次手术（5次更换和1次移除）。