Lazzati Andrea, De Antonio Marie, Paolino Luca, Martini Francesco, Azoulay Daniel, Iannelli Antonio, Katsahian Sandrine
*Department of General Surgery, Center Hospitalier Intercommunal de Créteil, Paris, France †INSERM, UMR_S 1138, Université Paris Descartes, Center de Recherche des Cordeliers, Paris, France ‡Pole de Coeliochirurgie, Hôpital Joseph Ducuing, Toulouse, France §Department of Digestive, Hepatopancreatobiliary, and Liver Transplantation Surgery, Hôpital Henri Mondor, Paris, France ¶Digestive Unit, Archet 2 Hospital, University Hospital of Nice, Nice, France ||INSERM, U1065, Hepatic Complications of Obesity, University of Nice Sophia-Antipolis, Nice, France **Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Unité d'Épidémiologie et de Recherche Clinique, Paris, France ††INSERM, Center d'Investigation Clinique 1418, module Épidémiologie Clinique, Paris, France.
Ann Surg. 2017 Mar;265(3):439-445. doi: 10.1097/SLA.0000000000001879.
The aim of this study was to analyze the adjustable gastric banding (AGB) natural history on a national basis.
Adjustable gastric banding represented the most common bariatric procedure in France until 2010. Since then, the number of AGBs has decreased and the rate of band removal and revisional surgeries has progressively increased.
For analysis, we included all adult patients operated on with AGB in France between 2007 and 2013. Data were extracted from a national administrative database ("Programme De Médicalisation des Systèmes d'Information," PMSI), which is an exhaustive source of all surgical procedures performed in France. The Cox proportional hazard model was used to test univariate and multivariate associations with band survival and revisional rate. To control for center-specific effects, we performed a frailty analysis, in which each center was assumed to have a random effect indicating the possibility of different baseline risks for patients at different centers.
During the study period, 52,868 patients underwent AGB, and 10,815 bands were removed. The removal rate at 5, 6, and 7 years was 28%, 34%, and 40%, respectively. Female sex, body mass index >50 kg/m, type 2 diabetes, hypertension, dyslipidemia, and sleep apnea were found to be significantly associated with band removal by multivariate analysis. A significant center effect was also found, but this did not change the impact of the highly significant factors already identified. After band removal, the median time to revisional surgery was 1 year (95% confidence interval 1.0-1.1) and the conversion rate at 7 years was 71%.
With a removal rate of about 6% annually and the need for revisional surgery for more than two-thirds of patients after removal, AGB does not appear to provide a long-term solution for obesity.
本研究旨在在全国范围内分析可调节胃束带术（AGB）的自然病史。
直到2010年，可调节胃束带术一直是法国最常见的减肥手术。从那时起，AGB手术数量减少，束带移除和翻修手术的比例逐渐增加。
为进行分析，我们纳入了2007年至2013年间在法国接受AGB手术的所有成年患者。数据从国家行政数据库（“医疗信息系统规划”，PMSI）中提取，该数据库是法国所有外科手术的详尽来源。采用Cox比例风险模型来检验与束带留存率和翻修率的单变量及多变量关联。为控制特定中心效应，我们进行了脆弱性分析，其中假设每个中心具有随机效应，表明不同中心患者存在不同基线风险的可能性。
在研究期间，52,868例患者接受了AGB手术，10,815根束带被移除。5年、6年和7年的移除率分别为28%、34%和40%。多变量分析发现，女性、体重指数>50kg/m²、2型糖尿病、高血压、血脂异常和睡眠呼吸暂停与束带移除显著相关。还发现了显著的中心效应，但这并未改变已确定的高度显著因素的影响。束带移除后，翻修手术的中位时间为1年（95%置信区间1.0 - 1.1），7年时的转化率为71%。
AGB每年的移除率约为6%，且超过三分之二的患者在束带移除后需要翻修手术，因此AGB似乎并不能为肥胖提供长期解决方案。
