Department of Digestive Surgery, Amiens University Hospital-Jules Verne University of Picardie, Place Victor Pauchet, 80054, Amiens Cedex 01, France.
Obes Surg. 2012 Sep;22(9):1420-6. doi: 10.1007/s11695-012-0689-x.
The placement of a gastric band (GB) prior to a sleeve gastrectomy (LSG) would increase postoperative complications, whether it is withdrawn or not at the time of the LSG. The purpose of this retrospective study was to evaluate and compare postoperative morbidity and outcome weight for simultaneous GB removal (RGB) and LSG (the RGB + LSG group) and front-line LSG only (the LSG group) after unsuccessful GB. From May 2005 to May 2009, 305 patients underwent first- or second-line LSG at Amiens University Hospital. The primary endpoint was the postoperative complication rate (according to the Clavien classification) in the RGB + LSG and LSG groups. The secondary endpoints were intra-operative data, postoperative data, and weight loss over a period of 2 years (body mass index, percentage of excess weight loss, and percentage of excess body mass index (BMI) loss). Univariate and multivariate propensity score analyses were used to search for independent risk factors for postoperative complications. The RGB + LSG group (n = 46) had a mean age of 42 and a mean BMI of 44 kg/m(2). The indication for surgery was renewed weight gain or insufficient weight loss in 68 % of these cases. The LSG group (n = 259) had a mean age of 41 and a mean BMI of 49.2 kg/m(2). All procedures were performed laparoscopically. The complication rate was 8.6 % in the RGB + LSG group and 8 % in the SG group (p = 0.42). The fistula rates in the two groups were 4.3 and 3.4 %, respectively (p = 0.56), and the mean BMI at 2 years was 33.4 kg/m(2) (RGB + LSG group) and 34.4 kg/m(2), respectively (p = 0.83). The operating time for LSG (after subtracting the time associated with RGB for a combined procedure) averaged 107 min, whereas the operating time for front-line LSG was 89 min (p = 0.011). The propensity score analysis failed to find independent risk factors for postoperative complications. The performance of RGB + LSG is feasible and does not increase the postoperative morbidity rate. Weight loss after RGB + LSG validates the concept of "restrictive surgery after restrictive surgery". We did not find any independent risk factors that would have justified the avoidance of RGB + SG.
胃束带（GB）的放置会增加袖状胃切除术（LSG）的术后并发症，无论在 LSG 时是否取出。这项回顾性研究的目的是评估和比较同时行胃束带去除术（RGB）和 LSG（RGB+LSG 组）与一线 LSG 仅行（LSG 组）治疗胃束带失败后的术后发病率和体重结局。从 2005 年 5 月至 2009 年 5 月，在亚眠大学医院有 305 例患者行一线或二线 LSG。主要终点是 RGB+LSG 和 LSG 组的术后并发症发生率（根据 Clavien 分类）。次要终点是术中数据、术后数据和 2 年内的体重减轻（体重指数、多余体重减轻百分比和多余体重指数（BMI）减轻百分比）。采用单变量和多变量倾向评分分析寻找术后并发症的独立危险因素。RGB+LSG 组（n=46）的平均年龄为 42 岁，平均 BMI 为 44kg/m2。这些病例中 68%的手术指征为体重再次增加或减重不足。LSG 组（n=259）的平均年龄为 41 岁，平均 BMI 为 49.2kg/m2。所有手术均为腹腔镜下完成。RGB+LSG 组的并发症发生率为 8.6%，LSG 组为 8%（p=0.42）。两组的瘘管发生率分别为 4.3%和 3.4%（p=0.56），两组 2 年时的平均 BMI 分别为 33.4kg/m2（RGB+LSG 组）和 34.4kg/m2（LSG 组）（p=0.83）。LSG 的手术时间（减去联合手术的 RGB 相关时间）平均为 107 分钟，而一线 LSG 的手术时间为 89 分钟（p=0.011）。倾向评分分析未发现术后并发症的独立危险因素。RGB+LSG 的实施是可行的，不会增加术后发病率。RGB+LSG 后的减重证实了“限制手术后再限制手术”的概念。我们没有发现任何独立的危险因素可以证明避免 RGB+SG 的合理性。
