腹腔镜可调节胃束带术：如何降低早期发病率。

Laparoscopic adjustable gastric band: how to reduce the early morbidity.

作者信息

Hussain Abdulzahra A, Nicholls Jacqueline, El-Hasani Shamsi S

机构信息

Bariatric Unit, General Surgery Department, Princess Royal University Hospital, Orpington, Greater London, United Kingdom.

Bariatric Unit, University College London Hospitals, Greater London, United Kingdom.

出版信息

JSLS. 2014 Jul-Sep;18(3). doi: 10.4293/JSLS.2014.00241.

DOI:10.4293/JSLS.2014.00241

PMID:25392623

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4154413/

Abstract

BACKGROUND

Laparoscopic adjustable gastric band insertion is a safe weight reduction procedure, but serious complications can develop. The aim of this study was to evaluate our technique in preventing early band complications.

METHODS

Patients were given the choice of procedure according to body mass index, the presence of diabetes, and preference. Weight loss data were not considered, as our aim was to evaluate the morbidity of band surgery using a specific technique. A pars flaccida approach and plication technique were used for all patients. Postoperative follow-up was provided at 1 month, 2 months, and every 3 months for the first year and then yearly for a further 2 years. Thereafter, general practitioners referred patients if late complications arose.

RESULTS

From January 2007 to August 2011, 1149 patients (245 men [21.32%], 904 women [78.67%]) underwent laparoscopic adjustable gastric band insertion under the care of a single bariatric surgeon. Patients were hospitalized for 1 night only unless they developed early complications. The primary and secondary outcomes were major and minor band complications, respectively. Patients' age range was 18 to 64 years (mean, 44 years). Body mass index ranged from 33 to 62 kg/m2 (mean, 42 kg/m2). There were 2 band erosions (0.17%), 6 cases of band prolapse (0.52%), 4 port problems (0.34%), 1 band leak (0.08%), 3 tight bands (0.26%), 2 port infections (0.17%), and no deaths. Five procedures (0.43%) were abandoned and excluded from this study, and 1 (0.17%) was converted to minilaparotomy to control abdominal wall bleeding. The duration of follow-up ranged from 16 to 60 months.

CONCLUSIONS

A combined pars flaccida and plication technique is associated with a low early complication rate.

摘要

背景

腹腔镜可调节胃束带置入术是一种安全的减重手术，但可能会出现严重并发症。本研究的目的是评估我们预防早期束带并发症的技术。

方法

根据体重指数、糖尿病情况和患者偏好，为患者提供手术选择。由于我们的目的是评估使用特定技术的束带手术的发病率，因此未考虑体重减轻数据。所有患者均采用松弛部入路和折叠技术。术后1个月、2个月进行随访，第一年每3个月随访一次，此后2年每年随访一次。此后，如果出现晚期并发症，由全科医生转诊患者。

结果

2007年1月至2011年8月，1149例患者（245例男性[21.32%]，904例女性[78.67%]）在一名减重外科医生的照料下接受了腹腔镜可调节胃束带置入术。除非出现早期并发症，患者仅住院1晚。主要和次要结局分别为主要和次要束带并发症。患者年龄范围为18至64岁（平均44岁）。体重指数范围为33至62 kg/m²（平均42 kg/m²）。有2例束带侵蚀（0.17%）、6例束带脱垂（0.52%）、4例端口问题（0.34%）、1例束带渗漏（0.08%）、3例束带过紧（0.26%）、2例端口感染（0.17%），无死亡病例。5例手术（0.43%）被放弃并排除在本研究之外，1例（0.17%）转为迷你剖腹术以控制腹壁出血。随访时间为16至60个月。