Utech M, Shaheen H, Halter J, Riege R, Knapp A, Wolf E, Büsing M
Klinik für Allgemein- und Viszeralchirurgie, Klinikum Vest, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Deutschland.
Zentralbl Chir. 2014 Feb;139(1):79-82. doi: 10.1055/s-0032-1328213. Epub 2013 Aug 1.
The number of bariatric surgical procedures is still increasing in Germany and also worldwide. According to the German quality assurance study of surgical treatment of obesity, the laparoscopic adjustable gastric banding (LAGB) was the most common bariatric operation with a total of 678 cases between 2004 and 2006 in Germany. In the meantime a high rate of LAGB treatment failures has been reported, so that a high rate of revisional bariatric operations is required. But still the question is open which bariatric procedure can be recommended. The aim of this study is to report the results and follow-up of conversion of failed LAGB to laparoscopic sleeve gastrectomy (LSG). Between 8/2008 and 4/2012 39 patients (31♀/8♂) with a mean age of 43.7 ± 7.8 (26-61) years and a BMI of 47.1 ± 9.1 (30.4 to 67.4) kg/m² had revisional surgery for converting a failed LAGB to LSG. The indications for conversion were dysphagia (38.5 %), weight regain (33.3 %), band slippage (17.9 %), band erosion (5.1 %), band defect (2.6 %) as well as band sepsis (2.6 %). 19 procedures were performed as a one-stage operation and 20 procedures as a two-stage operation. The average operating time was 129 ± 49 (50-312) min. The complication rate was 7.7 %. There were one proximal leak, one gastric sleeve stenosis and one pronounced wound infection. The percent excess weight loss was 23 %, 39 %, 51 %, 52 %, 60 % and 46 % after 1, 3, 6, 12, 24 and 36 months follow- up, respectively. Converting a failed LAGB into a LSG is a revision procedure with low complication rate and promising results, which can be performed as a two-stage as well as a one-stage procedure.
德国以及全球范围内，减肥手术的数量仍在不断增加。根据德国肥胖症手术治疗质量保证研究，在2004年至2006年间，德国共有678例腹腔镜可调节胃束带术（LAGB），这是最常见的减肥手术。与此同时，已有报道称LAGB治疗失败率很高，因此需要进行大量的减肥修正手术。但哪种减肥手术可被推荐这一问题仍然悬而未决。本研究的目的是报告失败的LAGB转换为腹腔镜袖状胃切除术（LSG）的结果及随访情况。在2008年8月至2012年4月期间，39例患者（31例女性/8例男性）接受了修正手术，将失败的LAGB转换为LSG，平均年龄为43.7±7.8（26 - 61）岁，体重指数（BMI）为47.1±9.1（30.4至67.4）kg/m²。转换的指征包括吞咽困难（38.5%）、体重反弹（33.3%）、束带滑脱（17.9%）、束带侵蚀（5.1%）、束带缺陷（2.6%）以及束带感染（2.6%）。19例手术为一期手术，20例为二期手术。平均手术时间为129±49（50 - 312）分钟。并发症发生率为7.7%。出现了1例近端渗漏、1例胃袖状狭窄和1例严重伤口感染。随访1、3、6、12、24和36个月后，超重体重减轻百分比分别为23%、39%、51%、52%、60%和46%。将失败的LAGB转换为LSG是一种并发症发生率低且效果良好的修正手术，可作为一期手术或二期手术进行。
