Altieri Maria S, Yang Jie, Telem Dana A, Meng Ziqi, Frenkel Catherine, Halbert Caitlin, Talamini Mark, Pryor Aurora D
Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 101 Nicholls Road, T18-040, Stony Brook, NY, 11794, USA.
Department of Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA.
Surg Endosc. 2016 May;30(5):1725-32. doi: 10.1007/s00464-015-4402-8. Epub 2015 Jul 23.
We sought to determine the rate of revision and explant of the laparoscopic adjustable gastric banding (LAGB) over a ten-year period in the state of New York.
Following IRB approval, the SPARCS administrative database was used to identify LAGB placement from 2004 to 2010. We tracked patients who underwent band placement with subsequent removal/revision, followed by conversion to either Roux-en-Y gastric bypass (RYBG) or sleeve gastrectomy (SG) between 2004 and 2013. McNemar test and Chi-square test were used to compare complications between primary procedure and subsequent revision and to compare complication rates and mortality rates, respectively. Log-rank test was used to assess patient characteristics and comorbidities. p < 0.05 was considered significant.
During a 7-year period, there were 19,221 records of LAGB placements and 6567 records of revisions or removal. We were able to follow up 3158 (16.43 %) who subsequently underwent a band removal or revision over the course of this period. An additional 3606 patients had no records in the state of New York following the procedure, thus making the rate of revision 20.22 %. Initial revision procedures were coded as band removal in 32.77 % (n = 1035), band revision in 30.53 % (n = 964), band removal and replacement in 19.09 % (n = 603), removal and conversion to SG in 5.64 % (n = 178), or removal and conversion to RYGB in 11.97 % (n = 378). From the 3158 patients, 2515 (79.64 %) required only one revision. Six hundred and forty-three patients underwent two or more revisions. Thirty-one out of 3158 (0.0098 %) patients had complications at their initial operation, but 919 (29.1 %) had complications during revision (p < 0.0001).
Over a 7-year period, at least 20.22 % of LAGB required removal or revision. Based on all case numbers, total revision rate may be as high as 34.2 %. Although the band is believed to be a reversible procedure, revisional procedures are significantly more morbid than the initial procedure.
我们试图确定纽约州十年间腹腔镜可调节胃束带术（LAGB）的翻修率和取出率。
经机构审查委员会（IRB）批准，使用SPARCS行政数据库识别2004年至2010年期间的LAGB植入情况。我们追踪了接受束带植入并随后进行取出/翻修，以及在2004年至2013年期间转为 Roux-en-Y 胃旁路术（RYBG）或袖状胃切除术（SG）的患者。使用McNemar检验和卡方检验分别比较初次手术与后续翻修之间的并发症，以及并发症发生率和死亡率。使用对数秩检验评估患者特征和合并症。p < 0.05被认为具有统计学意义。
在7年期间，有19221条LAGB植入记录和6567条翻修或取出记录。在此期间，我们能够随访到3158名（16.43%）随后进行束带取出或翻修的患者。另有3606名患者术后在纽约州没有记录，因此翻修率为20.22%。初次翻修手术中，32.77%（n = 1035）编码为束带取出，30.53%（n = 964）为束带翻修，19.09%（n = 603）为束带取出并更换，5.64%（n = 178）为取出并转为SG，11.97%（n = 378）为取出并转为RYGB。在3158名患者中，2515名（79.64%）仅需一次翻修。643名患者接受了两次或更多次翻修。3158名患者中有31名（0.0098%）在初次手术时有并发症，但919名（29.1%）在翻修时有并发症（p < 0.0001）。
在7年期间，至少20.22%的LAGB需要取出或翻修。基于所有病例数，总翻修率可能高达34.2%。尽管束带术被认为是一种可逆手术，但翻修手术的病态程度明显高于初次手术。
