Department of Surgery, Medical University of Vienna, Vienna General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Surg Endosc. 2011 Sep;25(9):2993-9. doi: 10.1007/s00464-011-1658-5. Epub 2011 May 14.
During the last 30 years a threefold increase in the number of overweight children has been reported in Western countries. More than 15% of adolescents have a body mass index (BMI) higher than the 95th percentile. The use of surgical strategies in adolescent patients is still controversial due to the impact on the continuing maturing process. Laparoscopic adjustable gastric banding (LAGB) is considered a minimal invasive procedure that does not alter the physiological behavior of the bowel and has already shown promising results in short-term studies.
Between 1998 and 2004, 50 adolescent patients above the 99.5th age- and gender-adjusted growing percentile were treated with LAGB. The surgical procedure was performed at three highly experienced centers for bariatric surgery. Mean age was 17.1 ± 2.2 years (range = 9-19 years) at the time of surgery. Follow-up investigations were performed in the outpatient clinic of the treating hospitals. Psychological changes were analyzed using the BAROS questionnaire.
The mean BMI decreased from 45.2 ± 7.6 kg/m(2) at the time of surgery to 38.3 ± 6.2 kg/m(2) 1 year after surgery, 31.5 ± 6.6 kg/m(2) after 3 years, and 27.3 ± 5.3 kg/m(2) after 5 years. Mean excessive weight loss was 49.7 ± 29.2, 76.8 ± 27.5, and 92.6 ± 24.5% at 1, 3, and 5 years after surgery. Quality of life showed a further significant improvement between 3 and 5 years after surgery (BAROS: 5.5 ± 1.9 increased to 6.3 ± 2.2, p = 0.01). All preoperative comorbidities resolved in patients with a functional band after 5 years of follow-up.
LAGB shows promising results in the long-term follow-up with continuous weight loss in patients with a functional band. Nevertheless, most of the weight loss is within the first 3 years after surgery. Thereafter, further weight reduction is about 10% over the following 2 years. Perioperative comorbidities resolve within the first 5 years after treatment.
在过去的 30 年中，报告称西方国家超重儿童的数量增加了两倍。超过 15%的青少年的体重指数（BMI）高于第 95 百分位数。由于手术对持续成熟过程的影响，在青少年患者中使用手术策略仍存在争议。腹腔镜可调节胃束带术（LAGB）被认为是一种微创程序，不会改变肠道的生理行为，并且在短期研究中已经显示出有希望的结果。
1998 年至 2004 年间，对 50 名超过 99.5 年龄和性别调整生长百分位的青少年患者进行了 LAGB 治疗。手术在三个具有丰富减重手术经验的中心进行。手术时的平均年龄为 17.1 ± 2.2 岁（范围为 9-19 岁）。在治疗医院的门诊进行了随访调查。使用 BAROS 问卷分析心理变化。
BMI 平均值从手术时的 45.2 ± 7.6 kg/m2 下降到手术后 1 年的 38.3 ± 6.2 kg/m2，3 年后的 31.5 ± 6.6 kg/m2，以及 5 年后的 27.3 ± 5.3 kg/m2。手术后 1、3 和 5 年时，平均过度减重分别为 49.7 ± 29.2%、76.8 ± 27.5%和 92.6 ± 24.5%。手术后 3 至 5 年时，生活质量进一步显著改善（BAROS：5.5 ± 1.9 增加至 6.3 ± 2.2，p = 0.01）。所有术前合并症在具有功能性束带的患者中在 5 年随访后均得到解决。
LAGB 在具有功能性束带的患者中具有长期随访的前景，持续减轻体重。然而，大多数体重减轻发生在手术后的前 3 年。此后，接下来的 2 年体重将进一步减轻约 10%。围手术期合并症在治疗后 5 年内得到解决。
