Shropshire Upper GI and Laparoscopic Surgery Unit, Princess Royal Hospital, Telford TF6 1TF, England.
Surg Endosc. 2010 Aug;24(8):2031-8. doi: 10.1007/s00464-010-0899-z. Epub 2010 Feb 23.
Gastric band erosion is a well-reported complication after laparoscopic adjustable gastric banding (LAGB). The published literature is limited and inconclusive with regard to its management. The authors therefore reviewed all band erosions detected during a 5-year period in a high-volume bariatric practice. Because a significant proportion of the band insertions (65%) were undertaken by an operator beyond his learning curve, the authors hoped to gain a mature, comprehensive understanding of this significant complication.
The authors retrospectively reviewed the operative log of the operating theaters in their obesity surgery unit to find all the operations performed on LAGB patients for erosion from January 2003 to December 2007. The clinical notes and electronic records for each patient were reviewed. These data were cross-referenced against the authors' obesity surgery database, and denominator data such as the total number operations performed and demographics were found. Finally, postoperative outcomes were collated from the outpatient follow-up data and telephonic interviews, and the results were analyzed.
From January 2003 to December 2007, a single surgeon performed 865 LAGBs in the authors' unit. The authors identified 18 operations performed for LAGB erosions. The 18 patients (one referred from elsewhere, 14 women) formed the final study cohort (median preoperative body mass index [BMI], 46 kg/m(2)). Of the 17 erosions, 15 occurred relatively early in the series. The patients with the 213 Swedish adjustable gastric bands experienced 12 erosions (incidence, 5.6%) compared with 6 erosions with the 652 LAP-BANDs (incidence, 0.9%). The median time to presentation was 7 months (range, 1-60 months). However, 55% of the erosions (n = 10) occurred within the first year, and only 10% occurred after the second year. The most common presenting symptom was pain followed by weight regain. None of the patients experienced peritonitis. After surgical management of the erosion, three patients had a second LAGB and at this writing are well. Of the remaining patients, 11 are well, but 6 of these patients have returned to their previous weight (4 patients were lost to follow-up evaluation).
The overall incidence of LAGB erosions in our series was 1.96%. This incidence fell with increasing experience to 0.5% after the initial 300 bands were excluded from the analysis (3 band erosions in the last 565 band insertions). However, further increases in incidence are likely with a longer follow-up period. The most common presentation was abdominal pain followed by weight regain and port-site sepsis. In the authors' hands, laparoscopic omental plugging and band removal through a separate anterior gastrotomy appear to be effective methods for dealing with band erosions. Band erosion is a significant source of morbidity, with at least one-third of the erosion patients in our series not achieving their final goal of weight loss despite appropriate treatment. This study highlights the need for a future prospective randomized study to clarify the apparent strong influence of band design and construction on the etiopathogenesis of band erosion.
胃带侵蚀是腹腔镜可调胃带（LAGB）后报道的一种并发症。发表的文献对其管理的结论并不明确。因此，作者回顾了高容量减肥实践中在 5 年内发现的所有带侵蚀。由于 65％的带插入（超过）是由操作人员在学习曲线之外进行的，因此作者希望对这种严重并发症有一个成熟、全面的了解。
作者回顾性地查阅了肥胖手术单位手术室的手术记录，以查找 2003 年 1 月至 2007 年 12 月期间所有因侵蚀而进行 LAGB 手术的患者的手术。回顾了每位患者的临床记录和电子记录。这些数据与作者的肥胖手术数据库交叉引用，并找到了操作总数和人口统计学等分母数据。最后，从门诊随访数据和电话访谈中收集术后结果，并进行分析。
从 2003 年 1 月至 2007 年 12 月，一位外科医生在作者的单位进行了 865 次 LAGB。作者发现了 18 次因 LAGB 侵蚀而进行的手术。这 18 名患者（一名从其他地方转来，14 名女性）组成了最终的研究队列（术前平均体重指数 [BMI]，46kg/m2）。在 17 个侵蚀中，有 15 个发生在系列早期。在 213 个瑞典可调胃带中，有 12 个发生侵蚀（发生率为 5.6％），而在 652 个 LAP-BAND 中，有 6 个发生侵蚀（发生率为 0.9％）。出现症状的中位时间为 7 个月（范围，1-60 个月）。然而，55％（n=10）的侵蚀发生在第一年，只有 10％发生在第二年以后。最常见的症状是疼痛，其次是体重减轻。没有患者发生腹膜炎。在对侵蚀进行手术治疗后，有 3 名患者再次接受 LAGB 治疗，目前情况良好。在其余患者中，11 人情况良好，但其中 6 人恢复到了以前的体重（4 人失去了随访评估）。
在我们的研究中，LAGB 侵蚀的总发生率为 1.96％。随着经验的增加，这个发生率下降到 300 个带被排除在分析之外后为 0.5％（在最后 565 个带插入中发生了 3 个带侵蚀）。然而，随着随访时间的延长，发病率可能会进一步增加。最常见的表现是腹痛，其次是体重减轻和端口部位感染。在作者的手中，腹腔镜网膜填塞和通过单独的前胃切开术去除带似乎是处理带侵蚀的有效方法。带侵蚀是一种严重的发病率源，在我们的研究中，至少有三分之一的侵蚀患者尽管经过适当治疗，但仍未达到减肥的最终目标。这项研究强调需要进行未来的前瞻性随机研究，以明确带设计和结构对带侵蚀病因学的明显强烈影响。
