Ulmer Tom Florian, Ambe Peter, Alizai H P, Lambertz A, Rheinwald K, Plamper A, Son M, Tuerler A, Gärtner D, Neumann U
Department of General, Visceral and Transplantation Surgery, University Hospital of the RWTH-Aachen, Pauwelsstr. 30, 52074, Aachen, Germany,
World J Surg. 2015 Aug;39(8):2000-5. doi: 10.1007/s00268-015-3036-2.
Esophageal dilation (ED) has been described as a long-term complication following laparoscopic adjustable gastric banding (LAGB) with an incidence of 0.5-50%. The purpose of this study was to evaluate the effect of major ED on weight loss and find methods to diagnose ED and possible treatment strategies based on a classification.
We performed a retrospective analysis of all patients undergoing LAGB between 2004 and 2008 in three community-based hospitals. ED was classified in four stages of dilation using gastrografin swallow. We report body mass index (BMI), failure rates and reoperations among these patients, with a mean follow-up period of 6.7 years.
Nineteen (18.4%) of 103 patients who underwent LAGB presented with esophageal dilation. Band deflation failed for all nine patients (8.7%) with major ED. The mean BMI at LAGB (BMI 1), revision (BMI 2), and 1 year after conversion (BMI 3) were 45.9±3.2, 42.8±4.9 and 30.3±5.5 kg/m2, respectively. No significant difference was found comparing BMI 1 and BMI 2 (p=0,065, EWL1: 14.2±21.7 kg/m2). In contrast, the weight loss after the revision surgery was significant (p=0.001, EWL2: 67.1±30 kg/m2). No significant difference was found concerning age, gender, ASA, preoperative (LAGB) weight, and mean interval between LAGB and revision comparing patients with major ED (IV) to patients with milder forms (ED I-III).
ED is a serious long-term complication after LAGB and seems to prevent effective weight loss in stage IV. Furthermore, untreated dilation could cause long-term damage to the esophagus. Therefore, we suggest routine radiographic follow-up after LAGB even in asymptomatic patients and a treatment based on a classification with an early surgical revision for major ED.
食管扩张（ED）被认为是腹腔镜可调节胃束带术（LAGB）后的一种长期并发症，发生率为0.5%-50%。本研究的目的是评估重度ED对体重减轻的影响，并基于一种分类方法找到诊断ED的方法和可能的治疗策略。
我们对2004年至2008年期间在三家社区医院接受LAGB的所有患者进行了回顾性分析。使用泛影葡胺吞咽造影将ED分为四个扩张阶段。我们报告了这些患者的体重指数（BMI）、失败率和再次手术情况，平均随访期为6.7年。
103例行LAGB的患者中有19例（18.4%）出现食管扩张。所有9例（8.7%）重度ED患者的束带放气均失败。LAGB时的平均BMI（BMI 1）、翻修时的平均BMI（BMI 2）和转换后1年的平均BMI（BMI 3）分别为45.9±3.2、42.8±4.9和30.3±5.5kg/m²。比较BMI 1和BMI 2时未发现显著差异（p=0.065，EWL1：14.2±21.7kg/m²）。相比之下，翻修手术后体重减轻显著（p=0.001，EWL2：67.1±30kg/m²）。比较重度ED（IV期）患者与较轻形式（ED I-III期）患者，在年龄、性别、美国麻醉医师协会（ASA）分级、术前（LAGB）体重以及LAGB与翻修之间的平均间隔方面未发现显著差异。
ED是LAGB术后一种严重的长期并发症，似乎会阻碍IV期患者有效减重。此外，未经治疗的扩张可能会对食管造成长期损害。因此，我们建议即使在无症状患者中，LAGB术后也应进行常规影像学随访，并基于分类进行治疗，对于重度ED应尽早进行手术翻修。
