Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
Surg Obes Relat Dis. 2010 Jul-Aug;6(4):367-71. doi: 10.1016/j.soard.2009.09.021. Epub 2009 Dec 11.
The current National Institutes of Health guidelines have recommended bariatric surgery for patients with a body mass index (BMI) >40 kg/m(2) or BMI >35 kg/m(2) with significant co-morbidities. However, some preliminary studies have shown that patients with a BMI that does not meet these criteria could also experience similar weight loss and the benefits associated with it.
An institutional review board-approved protocol was obtained to study the effectiveness of laparoscopic adjustable gastric banding in patients with a low BMI. A total of 66 patients with a BMI of 30-35 kg/m(2) and co-morbidities (n = 22) or a BMI of 35-40 kg/m(2) without co-morbidities (n = 44) underwent laparoscopic adjustable gastric banding. These patients were compared with 438 standard patients who had undergone laparoscopic adjustable gastric banding who met the National Institutes of Health criteria for bariatric surgery. The excess weight loss at 3, 6, 12, and 18 months and the status of their co-morbidities were compared between the 2 groups.
The average BMI for the study group was 36.1 +/- 2.6 kg/m(2) compared with 46.0 +/- 7.3 kg/m(2) for the control group. Both groups had significant co-morbidities, including hypertension, diabetes, hyperlipidemia, arthritis, gastroesophageal reflux disease, stress incontinence, and obstructive sleep apnea. The mean percentage of excess weight loss was 20.3% +/- 9.0%, 28.5% +/- 14.0%, 44.7% +/- 19.3%, and 42.2% +/- 33.7% at 3, 6, 12, and 18 months, respectively. This was not significantly different from the excess weight loss in the control group, except for at 12 months. Both groups showed similar improvement of most co-morbidities.
Moderately obese patients whose BMI is less than the current guidelines for bariatric surgery will have similar weight loss and associated benefits. Laparoscopic adjustable gastric banding is a safe and effective treatment for patients with a BMI of 30-35 kg/m(2).
目前，美国国立卫生研究院的指南建议对体重指数（BMI）>40kg/m²或 BMI>35kg/m² 且有明显合并症的患者进行减重手术。然而，一些初步研究表明，不符合这些标准的患者也可能经历类似的体重减轻及其相关益处。
获得机构审查委员会批准的方案，以研究腹腔镜可调节胃束带术在 BMI 较低的患者中的有效性。共 66 名 BMI 在 30-35kg/m² 之间且有合并症（n=22）或 BMI 在 35-40kg/m² 之间且无合并症（n=44）的患者接受了腹腔镜可调节胃束带术。将这些患者与符合美国国立卫生研究院减重手术标准的 438 名标准患者进行比较。比较两组患者在 3、6、12 和 18 个月时的超重减轻量以及合并症的状况。
研究组的平均 BMI 为 36.1±2.6kg/m²，而对照组为 46.0±7.3kg/m²。两组患者均有明显的合并症，包括高血压、糖尿病、高脂血症、关节炎、胃食管反流病、压力性尿失禁和阻塞性睡眠呼吸暂停。在 3、6、12 和 18 个月时，超重减轻的平均百分比分别为 20.3%±9.0%、28.5%±14.0%、44.7%±19.3%和 42.2%±33.7%，与对照组相比，这一比例在 12 个月时无显著差异。两组患者的大多数合并症均有类似程度的改善。
BMI 低于当前减重手术指南的中度肥胖患者将获得类似的体重减轻和相关益处。腹腔镜可调节胃束带术是治疗 BMI 在 30-35kg/m² 之间患者的安全有效方法。
