Gastric Sleeve Center, Jackson South Community Hospital, Miami, FL 33176, USA.
Obes Surg. 2011 Feb;21(2):157-60. doi: 10.1007/s11695-010-0315-8.
The aim of this study is to evaluate the safety and efficacy of converting failed restrictive procedures such as laparoscopic adjustable gastric banding (LAGB), non-adjustable gastric banding (NAGB), and vertical banded gastroplasty (VBG) to laparoscopic sleeve gastrectomy (LSG). A prospective database was maintained of 32 patients who failed restrictive procedures. Twenty-six patients failed LAGB, three patients failed NAGB, one of which was performed open, and three patients failed VBG. These patients were converted to LSG between January 2006 and May 2010. Post-conversion outcomes, BMI, and excess weight loss (EWL) were recorded. Four patients were excluded from the weight loss statistical data secondary to short follow-up (less than 6 months since conversion); however, these patients were included in the overall number of cases and in the discussion of complications. Causes of failed restrictive procedures in our series include inadequate weight loss, 15 (47%); weight gain, six (19%); slippage, five (16%); esophageal dilatation, one (3%); unhappy with device, one (3%); tear of silastic ring, one (3%); infection, one (3%), gastrogastric fistula with VBG and weight gain, one (3%); and intractable nausea and vomiting, one (3%). The average hospital stay was 1.5 days (range, 1-3). The average length of follow-up was 26 months. The mean pre-conversion BMI was 42.69, post-conversion to SG mean BMI was 33.3, mean EWL pre-conversion was 10%, and post-conversion mean EWL was 60%. There was no mortality, no conversion to open, and there was one complication, a contained leak resolved by antibiotic treatment. Conversion to LSG from a prior restrictive procedure may be a feasible and acceptable alternative for patients. Average EWL was 60% at an average of 26 months.
本研究旨在评估将失败的限制手术（如腹腔镜可调节胃束带术（LAGB）、不可调节胃束带术（NAGB）和垂直束带胃成形术（VBG））转换为腹腔镜袖状胃切除术（LSG）的安全性和有效性。我们对 32 例限制手术失败的患者进行了前瞻性数据库维护。26 例 LAGB 手术失败，3 例 NAGB 手术失败，其中 1 例为开放性手术，3 例 VBG 手术失败。这些患者于 2006 年 1 月至 2010 年 5 月期间接受了 LSG 转换。记录了转换后的结果、BMI 和多余体重减轻（EWL）。由于随访时间短（转换后少于 6 个月），4 例患者被排除在体重减轻统计数据之外，但这些患者被纳入了总病例数和并发症讨论中。我们的系列中限制手术失败的原因包括：减肥不足 15 例（47%）；体重增加 6 例（19%）；胃束带滑脱 5 例（16%）；食管扩张 1 例（3%）；对装置不满意 1 例（3%）；硅橡胶环撕裂 1 例（3%）；感染 1 例（3%），胃-胃瘘合并 VBG 和体重增加 1 例（3%）；和难治性恶心和呕吐 1 例（3%）。平均住院时间为 1.5 天（1-3 天）。平均随访时间为 26 个月。术前平均 BMI 为 42.69，SG 术后平均 BMI 为 33.3，术前平均 EWL 为 10%，术后平均 EWL 为 60%。无死亡，无转为开放性手术，仅有 1 例并发症，经抗生素治疗后得到控制的漏诊。从先前的限制手术转换为 LSG 可能是一种可行和可接受的选择。平均 EWL 为 60%，平均随访时间为 26 个月。
