New York University School of Medicine, New York, New York 10021, USA.
Surg Obes Relat Dis. 2010 Jul-Aug;6(4):386-9. doi: 10.1016/j.soard.2009.11.020. Epub 2009 Dec 22.
Laparoscopic gastric banding has several known complications, including gastric erosion. No clear factors have been determined for the development of band erosion, but technical factors such as covering the buckle of the band have been implicated. The objective of the present study was to determine whether band management after surgery, band size, or filling beyond the manufacturer-determined maximal volume has an effect on the incidence of erosion at a university hospital in the United States.
We performed a retrospective review of a prospective institutional review board-approved database. All patients who had been followed from 2002 to 2008 were identified. The maximal band volume was 4 cm(3) for the 9.75-cm/10-cm band and 10 cm(3) for the Vanguard band. The bands were considered overfilled if they had been filled to greater than the maximal volume for >/=3 months.
A total of 2437 patients had undergone Lap-Band surgery. Of these 2437 patients, 14 developed erosion (.57%). The primary erosion rate was .39% (9 of 2359). These patients were divided into 3 groups according to the type of band placed: group 1, Vanguard (n = 735); group 2, 9.75-cm/10-cm band (n = 1624); and group 3, revisions to Vanguard, including a band placed around a bypass (n = 78). The incidence of gastric erosion by group was .95% (7 of 735) in group 1, .12% (2 of 1624) in group 2, and 6.41% (5 of 78) in group 3. The difference in the erosion rate among the groups was significant (group 1 versus 2, P = .005; group 3 versus 1, P = .003; and group 3 versus 2, P = .001). Erosions developed in each group without overfilling. Also, comparing the erosion rate in the overfilled versus underfilled bands, statistical significance was found only for group 1 at 3.18% versus .35% (P = .006). The erosion rate in the overfilled versus underfilled was 1.01% versus .07% in group 2 and 11.11% versus 3.92% in group 3.
A band that needs to be overfilled might be a sign of erosion, and patients should undergo endoscopy. Band revision has a greater rate of erosion than primary banding. The Vanguard band has a greater risk of erosion than the 4-cm(3) bands.
腹腔镜胃束带术有多种已知的并发症，包括胃侵蚀。虽然已经确定了一些技术因素，如覆盖束带的扣，但尚未明确带侵蚀的发展的明确因素。本研究的目的是在美国的一家大学医院确定术后束带管理、束带大小或超过制造商确定的最大容量的填充是否会影响侵蚀的发生率。
我们对一个经过机构审查委员会批准的前瞻性数据库进行了回顾性分析。确定了从 2002 年到 2008 年期间随访的所有患者。对于 9.75 厘米/10 厘米的束带和 Vanguard 束带，最大束带容量为 4 立方厘米（3 立方厘米）和 10 立方厘米。如果填充超过最大容量超过 3 个月，则认为束带被过度填充。
共有 2437 名患者接受了 Lap-Band 手术。在这 2437 名患者中，有 14 名发生了侵蚀（0.57%）。原发性侵蚀率为 0.39%（9 例/2359 例）。这些患者根据放置的束带类型分为 3 组：第 1 组，Vanguard（n=735）；第 2 组，9.75 厘米/10 厘米束带（n=1624）；第 3 组，Vanguard 修订版，包括环绕旁路放置的束带（n=78）。各组的胃侵蚀发生率为第 1 组为 0.95%（7/735），第 2 组为 0.12%（2/1624），第 3 组为 6.41%（5/78）。各组之间的侵蚀率差异有统计学意义（第 1 组与第 2 组，P=0.005；第 3 组与第 1 组，P=0.003；第 3 组与第 2 组，P=0.001）。在每组中，侵蚀都没有发生在过度填充的情况下。此外，在比较过度填充与未过度填充的带的侵蚀率时，仅第 1 组发现统计学意义，分别为 3.18%与 0.35%（P=0.006）。过度填充与未过度填充的带的侵蚀率分别为第 2 组的 1.01%与 0.07%和第 3 组的 11.11%与 3.92%。
需要过度填充的束带可能是侵蚀的迹象，患者应接受内镜检查。束带修正比初次束带术有更高的侵蚀率。Vanguard 束带比 4 立方厘米（3 立方厘米）的束带的侵蚀风险更高。
