Basa Nicole R, Dutson Erik, Lewis Catherine, Derezin Marvin, Han Soohwa, Mehran Amir
Section of Minimally Invasive and Bariatric Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA.
Surg Obes Relat Dis. 2008 Mar-Apr;4(2):194-7. doi: 10.1016/j.soard.2007.12.012.
Gastric erosion is a well-known complication of laparoscopic adjustable gastric band (LAGB) placement for morbid obesity. We describe a novel approach for the removal of an eroded band through a laparoscopic gastrotomy with subsequent intraluminal division and removal of the band. A 67-year-old woman with a body mass index of 35.5 kg/m2 was seen 1 year after LAGB placement performed outside the United States. She had developed dysphagia and regurgitation of undigested food a few months after the procedure. The LAGB had been adjusted twice by her primary surgeons and was completely deflated once her symptoms began. The patient failed to improve and was subsequently referred to our institution where an upper endoscopy revealed intragastric band erosion. The patient was taken to the operating room for LAGB removal; however, standard laparoscopic and endoscopic attempts at band retrieval were unsuccessful. We then attempted a novel laparoscopic technique. An anterior gastrotomy was created, distal to the area of erosion, to facilitate easy intraluminal band division and removal. The gastrotomy was repaired, and a leak test was performed. A postoperative Gastrografin upper gastrointestinal series showed no extravasation. The patient began a diet, was discharged, and was seen in follow-up with complete resolution of her symptoms. The results of this case have shown that laparoscopic transgastric removal of an eroded gastric band is safe and feasible when standard endoscopic and laparoscopic techniques fail.
胃糜烂是腹腔镜可调节胃束带（LAGB）治疗病态肥胖症时一种众所周知的并发症。我们描述了一种通过腹腔镜胃切开术切除侵蚀性胃束带的新方法，随后在腔内分割并移除胃束带。一名67岁女性，体重指数为35.5kg/m²，在美国境外接受LAGB植入术后1年前来就诊。术后几个月，她出现了吞咽困难和未消化食物反流的症状。她的主刀医生对LAGB进行了两次调整，症状出现后胃束带完全放气。患者病情未见改善，随后转诊至我院，上消化道内镜检查显示胃内束带侵蚀。患者被送往手术室进行LAGB移除；然而，标准的腹腔镜和内镜下取出束带的尝试均未成功。然后我们尝试了一种新的腹腔镜技术。在侵蚀区域远端做一个前壁胃切开术，以便于在腔内轻松分割和移除束带。胃切开术进行了修补，并进行了渗漏试验。术后泛影葡胺上消化道造影显示无造影剂外渗。患者开始进食，出院，随访时症状完全缓解。该病例结果表明，当标准的内镜和腹腔镜技术失败时，腹腔镜经胃切除侵蚀性胃束带是安全可行的。
