Kindel Tammy, Martin Emily, Hungness Eric, Nagle Alex
University of Nebraska Medical Center, Division of General Surgery, Omaha, Nebraska.
Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Department of Surgery, Chicago, Illinois.
Surg Obes Relat Dis. 2014 Nov-Dec;10(6):1070-5. doi: 10.1016/j.soard.2013.11.014. Epub 2013 Dec 6.
Determinants of success of a bariatric procedure are many but paramount is the ability to durably produce significant and reliable weight loss. We sought to determine the primary success of the laparoscopic adjustable gastric band (LAGB) by defining failure as clinical weight loss failure with an intact band (excess weight loss [EWL]<20%) or band removal (terminal removal or conversion to a secondary bariatric procedure).
A retrospective chart review was performed on patients who underwent an LAGB as a primary bariatric procedure between January 2003 and December 2007. Data collected included body mass index (BMI), weight, postoperative follow-up length, EWL, and adjustment number, as well as complications of the LAGB.
Sixteen of 120 patients had the band removed. Nine were terminally removed for unmanageable symptoms, and 7 were converted to an alternative bariatric procedure. The average follow-up for the 104 patients with an intact band was 4.8 years. The average EWL for successful intact bands was 44.9±19.4%; however, an additional 35.6% of patients had an EWL<20%. Patients with an EWL<20% had a significantly higher preoperative BMI and fewer band adjustments. In total, 44% of patients had band failure because of clinical weight loss failure (31%) or eventual band removal (13%).
This study finds that the LAGB failed as a primary bariatric procedure for 44% of patients because of either inadequate weight loss or adequate weight loss with unmanageable symptoms. This suggests that the LAGB should be abandoned as a primary bariatric procedure for the majority of morbidly obese patients because of its high failure rate.
减肥手术成功的决定因素众多，但至关重要的是能够持久地实现显著且可靠的体重减轻。我们试图通过将失败定义为束带完整情况下的临床体重减轻失败（超重减轻[EWL]<20%）或束带移除（最终移除或转换为二次减肥手术）来确定腹腔镜可调节胃束带术（LAGB）的主要成功率。
对2003年1月至2007年12月期间接受LAGB作为初次减肥手术的患者进行回顾性病历审查。收集的数据包括体重指数（BMI）、体重、术后随访时长、EWL、调整次数以及LAGB的并发症。
120例患者中有16例移除了束带。9例因症状难以控制而最终移除，7例转换为另一种减肥手术。104例束带完整患者的平均随访时间为4.8年。成功保留束带患者的平均EWL为44.9±19.4%；然而，另有35.6%的患者EWL<20%。EWL<20%的患者术前BMI显著更高，束带调整次数更少。总体而言，44%的患者因临床体重减轻失败（31%）或最终束带移除（13%）而出现束带失败。
本研究发现，由于体重减轻不足或体重减轻但症状难以控制，44%的患者接受LAGB作为初次减肥手术失败。这表明，由于其高失败率，对于大多数病态肥胖患者而言，LAGB应不再作为初次减肥手术。
