Centre for Obesity Research and Education, Monash University, Commercial Road, Melbourne, Australia.
Ann Surg. 2013 Jun;257(6):1047-52. doi: 10.1097/SLA.0b013e31826bc21b.
To define the changing prevalence of erosion after Laparoscopic Adjustable Gastric Banding (LAGB), describing the range of clinical presentations, the approaches to treatment and the outcomes from these approaches over a 15-year study period.
A recent systematic review of the literature of erosion after LAGB identified 25 relevant studies and reported a total of 231 erosions in 15,775 patients giving an overall incidence of 1.46%. The review highlighted a broad variation of incidence from 0.2% to 33%. The review was unable to identify either common presentations or an optimal pattern of management.
Patients who underwent a primary LAGB operation between September 1994 and January 2010 by 2 surgeons (P.O.B. and W.B.) were identified in a prospectively maintained database. Those patients who had an erosion of their LAGB were identified. Presentation, operative details, demographics, body mass index, weight history, and perioperative problems were analyzed.
In total, 2986 patients were identified. All bands placed were Lap-Bands (Allergan, CA). Hundred erosions were experienced by 85 patients (2.85%) at a median time of 33 months from initial surgery to the erosion (range: 11-170 months). The rate of erosion was highest when the band was placed by the perigastric approach at 6.77%. Since the adoption of the pars flaccida approach, the rate of erosion has dropped to 1.07%. The majority of patients who had experienced an erosion (71 patients; 83.5%) experienced only 1 erosion, 13 patients (15.3%) had 2 erosions, and 1 patient had 3 erosions. The most common presentation was loss of satiety. The band has been successfully replaced in 56 patients. It has been explanted in 27 patients and 2 patients were converted to other bariatric procedures. The weight loss in patients who had a LAGB reinserted after erosion was not significantly different to the background cohort.
Erosion of LAGB is uncommon and its clinical course is benign. It is best treated with a staged surgical approach; initially, with removal and repair followed later by replacement. With this approach, weight loss is maintained and reerosion is uncommon.
定义腹腔镜可调节胃束带术（LAGB）后蚀变的变化流行率，描述各种临床表现，治疗方法以及在 15 年的研究期间这些方法的结果。
最近对 LAGB 后蚀变的文献进行了系统评价，共确定了 25 项相关研究，并报告了 15775 名患者中的 231 例蚀变，总体发生率为 1.46％。该综述强调了发病率从 0.2％到 33％的广泛差异。该综述未能确定常见表现或最佳管理模式。
通过两位外科医生（P.O.B.和 W.B.）在一个前瞻性维护的数据库中确定了 1994 年 9 月至 2010 年 1 月期间接受初次 LAGB 手术的患者。确定了 LAGB 蚀变的患者。分析了临床表现，手术细节，人口统计学，体重指数，体重史和围手术期问题。
总共确定了 2986 名患者。所有放置的乐队均为 Lap-Bands（Allergan，CA）。中位数为初次手术至蚀变 33 个月（范围：11-170 个月）时，85 名患者中有 100 名蚀变。当胃周途径放置乐队时，蚀变率最高，为 6.77％。自从采用松弛部方法以来，蚀变率已降至 1.07％。大多数经历蚀变的患者（71 例；83.5％）仅经历了 1 次蚀变，13 例（15.3％）有 2 次蚀变，1 例有 3 次蚀变。最常见的表现是饱腹感丧失。56 例患者成功更换了乐队。27 例患者已被取出，2 例患者已转为其他减肥手术。蚀变后重新插入 LAGB 的患者的体重减轻与背景队列没有明显差异。
LAGB 蚀变并不常见，其临床过程是良性的。最好采用分阶段手术方法进行治疗；最初是通过切除和修复，然后再进行更换。通过这种方法，可以维持体重减轻并且蚀变并不常见。
