Torchia Fiore, Mancuso Vincenza, Civitelli Simona, Di Maro Antonio, Cariello Pasquale, Rosano Pasquale Tricarico, Sionne Giuseppe Ciriaco, Lorenzo Michele, Cascardo Antonio J
Ninetta Rosano Institute, Casa di Cura Tricarico, Via Capo Tirone n.12.20, 87021 Belvedere Marittimo (CS), Italy.
Obes Surg. 2009 Sep;19(9):1211-5. doi: 10.1007/s11695-008-9760-z. Epub 2008 Nov 20.
Bariatric surgery in superobese (BMI > 50 kg/m(2)) and super-superobese (BMI > 60 kg/m(2)) patients can be a formidable technical and therapeutic challenge because these patients often present multiple medical, surgical, and anesthetic risks. Only a few dedicated reports on different surgical options in this kind of patient population are available. The aim of this study is the evaluation of laparoscopic adjustable gastric banding (LAGB) results in an unselected populations of super-superobese patients operated during the last 4 years.
Super-superobese (BMI > 60 kg/m(2)) patients who underwent LAGB were recruited from the prospective database of our institution. LapBand System (Allergan, Irvine, CA, USA) was positioned in all cases via pars flaccida, 1-2 cm below the gastroesophageal junction and fixed anteriorly with three non-absorbable stitches. The band was not filled at the time of surgery. Operative time, co-morbidities, laparotomic conversion, intra- and postoperative complications, mortality, and weight-loss-related parameters were considered. Data were expressed as mean +/- standard deviation, except as otherwise indicated.
From January 2003 to December 2006, 823 patients underwent a bariatric surgical procedure, 95 of whom (11.5%) were BMI > 60 kg/m(2) (59 F/ 36 M; mean BMI, 62.5 +/- 4.2; range, 60.1-77 kg/m(2); mean age 38.5 +/- 13.5, range 18-61 years old). Mortality, intraoperative, and 30-day major complications were absent. One or more preoperative co-morbidities were diagnosed in 90 of 95 (94.7%) patients. After 1 year, co-morbidity-free patients increased from five of 95 (5.3%) to 27 of 95 (28%; p < 0.001). Patients with three or more co-morbidities decreased from 62 of 95 (65.3%) to 0 (p < 0.001). Mean BMI was 43.6 in 95 of 95, 37.9 in 55 of 55, 29.1 in 11 of 11, and 28.9 in five of five patients at 12, 24, 36, and 48 months, respectively. At the same time, %EWL was 53.6, 69.7, 81.3, and 82.1 and %EBL was 50, 66, 90, and 91.
LAGB can be considered an appropriate bariatric surgical option in super-superobese patients both for low morbidity rate and weight loss. The end-point of BMI < 30 can be achieved with a multidisciplinary follow-up. Additional studies with more patients and longer follow-up are needed to confirm these observations.
对超级肥胖（体重指数[BMI]＞50kg/m²）和极度肥胖（BMI＞60kg/m²）患者实施减肥手术可能是一项艰巨的技术和治疗挑战，因为这些患者通常存在多种医疗、手术及麻醉风险。关于这类患者群体不同手术方式的专门报道仅有少数。本研究旨在评估过去4年中对未经挑选的极度肥胖患者实施腹腔镜可调节胃束带术（LAGB）的效果。
从我们机构的前瞻性数据库中招募接受LAGB的极度肥胖（BMI＞60kg/m²）患者。所有病例均经胃食管交界下方1 - 2cm的松弛部置入LapBand系统（美国加利福尼亚州欧文市的艾尔建公司生产），并在前方用3针不可吸收缝线固定。手术时束带不充盈。记录手术时间、合并症、开腹转换情况、术中和术后并发症、死亡率以及与体重减轻相关的参数。数据以均数±标准差表示，另有说明的除外。
2003年1月至2006年12月，823例患者接受了减肥手术，其中95例（11.5%）BMI＞60kg/m²（59例女性/36例男性；平均BMI为62.5±4.2；范围为60.1 - 77kg/m²；平均年龄38.5±13.5岁，范围为18 - 61岁）。无死亡、术中及30天内的严重并发症。95例患者中有90例（94.7%）诊断出一种或多种术前合并症。1年后，无合并症患者从95例中的5例（5.3%）增至95例中的27例（28%；p＜0.001）。有三种或更多合并症的患者从95例中的62例（65.3%）降至0例（p＜0.001）。95例患者在12、24、36和48个月时的平均BMI分别为43.6、37.9、29.1和28.9，对应的体重减轻百分比（%EWL）分别为53.6、69.7、81.3和82.1，多余体脂减少百分比（%EBL）分别为50、66、90和91。
鉴于低发病率和体重减轻情况，LAGB可被视为极度肥胖患者合适的减肥手术方式。通过多学科随访可实现BMI＜30的终点目标。需要更多患者和更长随访时间的进一步研究来证实这些观察结果。
