Czeiger David, Abu-Swis Shadi, Shaked Gad, Ovnat Amnon, Sebbag Gilbert
Department of General Surgery, Soroka University Medical Center and Ben Gurion University, Beer Sheva, 84101, Israel.
Department of General Surgery, Soroka University Medical Center, Beer Sheva, 84101, Israel.
Obes Surg. 2016 Dec;26(12):2931-2935. doi: 10.1007/s11695-016-2210-4.
Optimal adjustment of the filling volume of laparoscopic adjustable gastric banding is challenging and commonly performed empirically. Patients with band over-inflation and gastric obstruction arrive at the emergency department complaining of recurrent vomiting. In cases of gastric obstruction, intra-band pressure measurement may assist in determining the amount of fluid that should be removed from the band; however, our investigations have determined that intra-band pressure assessment need not play a role in the treatment of gastric band obstruction.
In patients coming to the emergency department with gastric band obstruction, we measured intra-band pressure at arrival and following stepped removal of fluid, comparing the initial pressure with post-deflation pressure and measuring the volume of fluid removed.
Forty-eight patients participated in the study. Forty-five patients had a low-pressure/high-volume band. Their mean baseline pressure was 54.6 ± 22.3 mmHg. The mean volume of fluid removed from the band was 1.3 ± 0.8 ml. The mean post-deflation pressure was 22.5 ± 16.3 mmHg. Nearly 30 % of patients required as little as 0.5 ml of fluid removal, and 60 % of them were free of symptoms with removal of 1 ml.
Our results indicate that intra-band pressure measurement is of little value for determining the amount of fluid that should be removed for treatment of band obstruction. We suggest the removal of fluid in volumes of 0.5 ml until symptoms are relieved. Only in complicated cases, such as in patients having recurrent obstructions, should additional modalities be employed for further management guidance.
腹腔镜可调节胃束带术填充量的最佳调整具有挑战性，通常凭经验进行。胃束带过度充气和胃梗阻的患者会因反复呕吐而前往急诊科就诊。在胃梗阻的情况下，带内压力测量可能有助于确定应从束带中抽出的液体量；然而，我们的研究已确定带内压力评估在胃束带梗阻的治疗中无需发挥作用。
对于因胃束带梗阻前来急诊科就诊的患者，我们在其就诊时及逐步抽出液体后测量带内压力，将初始压力与放气后的压力进行比较，并测量抽出的液体量。
48例患者参与了该研究。45例患者使用的是低压/大容量束带。他们的平均基线压力为54.6±22.3 mmHg。从束带中抽出的液体平均量为1.3±0.8 ml。放气后的平均压力为22.5±16.3 mmHg。近30%的患者只需抽出0.5 ml液体，60%的患者在抽出1 ml液体后症状消失。
我们的结果表明，带内压力测量对于确定治疗束带梗阻应抽出的液体量价值不大。我们建议每次抽出0.5 ml液体，直至症状缓解。仅在复杂病例中，如反复梗阻的患者，才应采用其他方法以获得进一步的管理指导。
