Shen Xiaojun, Zhang Xin, Bi Jianwei, Yin Kai
Department of General Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Department of General Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Surg Obes Relat Dis. 2015 Jul-Aug;11(4):956-64. doi: 10.1016/j.soard.2014.11.011. Epub 2014 Nov 21.
At present, bariatric surgery is the most effective option for morbidly obese patients. Among all of the surgical procedures, laparoscopic adjustable gastric banding (LAGB) is characterized by superior safety, a stable weight loss effect, and unique reversibility. However, the worldwide popularity of LAGB is challenged and overshadowed by a number of adverse events. This systematic review examined the incidence and outcomes of the long-term complications that require reoperations after LAGB. A PubMed search was conducted through October 31, 2014, for relevant studies that included minimal 10-year follow-up data for LAGB patients. The defined outcomes of interest were weight loss outcomes, long-term complications, and reoperations. Seventeen studies, including 2 randomized controlled trials and 15 observational studies, were identified involving a total of 9706 LAGB patients, of which 8215 patients (84.6%) were followed up and 1974 patients (20.3%) were available 10 years after LAGB. The follow-up data indicated that the mean percentage of excess weight loss at 10 years after LAGB was 49.1% ± 13.1% and the median long-term complication rate and reoperation rate for the LAGB patients were 42.7% (5.9%-52.9%) and 36.5% (7.2%-66.1%), respectively. At the end of long-term follow-up, approximately 22.9% (5.4%-54.0%) of the LAGB patients had their bands removed and the commonest reason was complications. In conclusion, long-term adverse events are important and remarkable for LAGB patients. The role of LAGB in bariatric surgery is worthy of further appraisal, by comparing with other types of bariatric procedures, because of the limited high-quality evidence.
目前，减肥手术是病态肥胖患者最有效的选择。在所有外科手术中，腹腔镜可调节胃束带术（LAGB）具有安全性高、体重减轻效果稳定和独特的可逆性等特点。然而，LAGB在全球的普及受到了一些不良事件的挑战并蒙上阴影。本系统评价研究了LAGB术后需要再次手术的长期并发症的发生率和结局。通过在PubMed上检索截至2014年10月31日的相关研究，纳入了对LAGB患者至少随访10年的数据。感兴趣的既定结局为体重减轻结局、长期并发症和再次手术。共确定了17项研究，包括2项随机对照试验和15项观察性研究，涉及9706例LAGB患者，其中8215例患者（84.6%）得到随访，1974例患者（20.3%）在LAGB术后10年仍有可用数据。随访数据表明，LAGB术后10年多余体重减轻的平均百分比为49.1%±13.1%，LAGB患者的长期并发症发生率和再次手术率中位数分别为42.7%（5.9%-52.9%）和36.5%（7.2%-66.1%）。在长期随访结束时，约22.9%（5.4%-54.0%）的LAGB患者移除了束带，最常见的原因是并发症。总之，长期不良事件对LAGB患者来说很重要且很显著。由于高质量证据有限，通过与其他类型的减肥手术进行比较，LAGB在减肥手术中的作用值得进一步评估。
