Service de chirurgie digestive, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
J Visc Surg. 2011 Jun;148(3):e205-9. doi: 10.1016/j.jviscsurg.2011.05.004. Epub 2011 Jun 22.
Laparoscopic sleeve gastrectomy (LSG) is performed in certain circumstances after failure of gastric banding. The goal of this study was to evaluate the impact of first-line gastric banding on the morbidity associated with secondary LSG for obesity.
The case records of 102 consecutive patients undergoing LSG were studied retrospectively. The technique of LSG was standardized. Two groups were compared: one with patients having undergone LSG after first-line gastric banding (n = 31) and the second, with patients having undergone first-line LSG (n = 71). Endpoints were overall morbidity and intra/postoperative complications including gastric leaks consecutive to staple line disruption as well as other septic or hemorrhagic complications. Multivariable analysis was performed to detect independent risk factors for morbidity.
Overall morbidity was significantly higher in patients having undergone LSG after first-line gastric banding compared with those undergoing first-line LSG (32.2% vs. 7%, P = 0.002). Gastric leaks secondary to staple line disruption also occurred statistically significantly more often in patients with first-line gastric banding (16.1% vs. 2.8%, P = 0.043). Waiting 6 months between gastric band removal and performing LSG did not prevent the increased morbidity compared with first-line LSG. Multivariable analysis revealed that among the factors analyzed (age, gender, comorbidity, body mass index, surgeon, first-line gastric banding), the only independent risk factor for staple line disruption was first-line gastric banding with an odds ratio = 6.6 (95% confidence interval = [1.2-36.3]).
Undergoing first-line gastric banding increases the risk of complications after secondary LSG. We recommend that patients who undergo LSG after a first-line gastric banding should be warned of the increased risks of morbidity or, alternatively, that LSG be performed preferentially as the initial procedure.
腹腔镜袖状胃切除术（LSG）在胃带治疗失败的某些情况下进行。本研究的目的是评估一线胃带治疗对肥胖相关继发性 LSG 相关发病率的影响。
回顾性研究了 102 例连续接受 LSG 的患者的病历。LSG 技术标准化。比较两组：一组为一线胃带后行 LSG 的患者（n=31），另一组为一线行 LSG 的患者（n=71）。终点为总发病率和围手术期并发症，包括因吻合线破裂导致的胃漏以及其他感染性或出血性并发症。进行多变量分析以确定发病率的独立危险因素。
与一线行 LSG 的患者相比，一线胃带后行 LSG 的患者总发病率显著更高（32.2%比 7%，P=0.002）。因吻合线破裂导致的胃漏也更常发生在一线胃带的患者中（16.1%比 2.8%，P=0.043）。与一线行 LSG 相比，在胃带去除和行 LSG 之间等待 6 个月并不能预防发病率的增加。多变量分析显示，在所分析的因素中（年龄、性别、合并症、体重指数、外科医生、一线胃带），吻合线破裂的唯一独立危险因素是一线胃带，比值比=6.6（95%置信区间为[1.2-36.3]）。
一线胃带会增加继发性 LSG 后并发症的风险。我们建议，对一线胃带后行 LSG 的患者应告知发病率增加的风险，或者应优先选择 LSG 作为初始手术。
