Balogh Julius, Vizhul Andrey, Dunkin Brian J, Tariq Nabil, Sherman Vadim
Houston Methodist Hospital, Houston, Texas.
University of Alberta, Edmonton, Alberta.
Yale J Biol Med. 2014 Jun 6;87(2):159-66. eCollection 2014 Jun.
A number of bariatric surgical procedures have been developed to manage morbid obesity and related co-morbidities. The non-adjustable gastric band (NAGB) was one such procedure that created restriction to food intake by gastric segmentation. Benefits of the procedure included a low risk of perioperative complications and substantial early weight loss. Unfortunately, the long term results of NAGB include a high incidence of complications and failure to maintain weight loss. The purpose of this study was to examine the presentation, workup, and treatment of patients presenting with complications following NAGB placement.
A retrospective review of the diagnosis and management of 11 patients who presented with complications related to NAGB placement.
All patients presented with some degree of proximal gastric outlet obstruction. The majority of patients (8/11) presented with vomiting as the main complaint. Other complaints included intolerance to solids, liquids, and reflux. Only 2/11 patients presented with weight loss since undergoing NAGB placement, while the remainder had weight regain to their pre-NAGB level and above. Depending on clinical presentation, desire for additional weight loss and co-morbid conditions, patients underwent a variety of treatments. This included NAGB removal (endoscopic, laparo-endoscopic, and laparoscopic) as well as conversion to another bariatric procedure (sleeve gastrectomy, Roux-en-Y gastric bypass).
Patients with NAGB complications present with symptoms related to a proximal gastric outlet obstruction, related to constriction imposed by the band. This may result in severe food and liquid intolerance and subsequent weight loss, but more likely results in maladaptive eating and subsequent weight gain. Optimal therapy involves removal of the NAGB. Laparoscopic conversion to another bariatric procedure, optimally a Roux-en-Y gastric bypass, is warranted to treat morbid obesity and associated co-morbidities.
为治疗病态肥胖症及相关合并症，已研发出多种减肥手术方法。不可调节胃束带术（NAGB）就是其中一种，通过胃分隔来限制食物摄入。该手术的优点包括围手术期并发症风险低以及早期体重显著减轻。遗憾的是，NAGB的长期效果包括并发症发生率高以及无法维持体重减轻。本研究的目的是检查接受NAGB植入术后出现并发症的患者的临床表现、检查及治疗情况。
对11例出现与NAGB植入相关并发症的患者的诊断和治疗进行回顾性研究。
所有患者均出现一定程度的近端胃出口梗阻。大多数患者（8/11）以呕吐为主要症状。其他症状包括对固体食物、液体食物不耐受以及反流。自接受NAGB植入术后，只有2/11的患者出现体重减轻，其余患者体重恢复至术前水平及以上。根据临床表现、进一步减重的意愿及合并症情况，患者接受了多种治疗。这包括取出NAGB（内镜下、腹腔镜辅助内镜下及腹腔镜下）以及转换为另一种减肥手术（袖状胃切除术、Roux-en-Y胃旁路术）。
NAGB并发症患者出现与近端胃出口梗阻相关的症状，这与束带造成的狭窄有关。这可能导致严重的食物和液体不耐受以及随后的体重减轻，但更可能导致适应不良的饮食及随后的体重增加。最佳治疗方法是取出NAGB。对于病态肥胖症及相关合并症，有必要通过腹腔镜转换为另一种减肥手术，最佳选择是Roux-en-Y胃旁路术。
