Szewczyk Tomasz, Janczak Przemyslaw, Jezierska Natalia, Jurałowicz Piotr
Department of Gastroenterology, Oncology and General Surgery, Medical University, Kopcinskiego 22, 90-153, Lodz, Poland.
Department of Emergency and Disaster Medicine, USK, Lodz, Poland.
Obes Surg. 2017 Oct;27(10):2637-2642. doi: 10.1007/s11695-017-2683-9.
Laparoscopic adjustable gastric banding is a well-established method of morbid obesity treatment. One of the complications is slippage.
The aim of the study was to assess the prevalence, causes, and handling of slippage after LAGB in own material.
There were 740 procedures performed by one surgical team. The patients were selected according to the IFSO principles. The pars flaccida technique was applied and the position of the band was controlled. There was neither plication nor the bands were sutured to the stomach wall. Slippage was recognized during X-ray examination. With these patients, the band was emptied of liquid, gastric endoscopy was performed routinely, and patients were qualified for surgery.
The patient group consisted of 500 women and 240 men. The average body weight was 128 kg and BMI 44.60 kg/m. The slippage was observed in 8.1% cases in 7.03% patients. In 1.08%, slippage occurred twice. The main problems reported by patients were pain, a significant increase of disposable food intake, vomiting, and weight gain. In a small group of patients, these complications were detected incidentally. All patients were treated surgically. In 38.33%, the band repositioning was performed. In 33.33%, a different surgical approach was performed. In the group of reoperated patients, there were no fatal cases or any severe complications.
In conclusion, we believe that slippage is and will continue to be a significant problem in patients with gastric banding. Patient education focused on dietary errors may reduce the incidence of this complication. The grace period between the primary surgery and the redo operation should be applied regarding reoperation.
腹腔镜可调节胃束带术是一种成熟的病态肥胖治疗方法。其中一个并发症是胃束带滑脱。
本研究的目的是评估自体材料中腹腔镜可调节胃束带术（LAGB）后胃束带滑脱的发生率、原因及处理方法。
由一个手术团队实施了740例手术。患者根据国际肥胖与代谢病外科学会（IFSO）原则进行选择。采用松弛部技术并控制束带位置。既不进行胃壁折叠也不将束带缝合至胃壁。通过X线检查识别胃束带滑脱。对于这些患者，将束带内液体排空，常规进行胃镜检查，并使患者符合手术条件。
患者组包括500名女性和240名男性。平均体重为128千克，体重指数（BMI）为44.60千克/平方米。在7.03%的患者中，8.1%的病例观察到胃束带滑脱。1.08%的患者发生了两次胃束带滑脱。患者报告的主要问题是疼痛、一次性食物摄入量显著增加、呕吐和体重增加。一小部分患者的这些并发症是偶然发现的。所有患者均接受手术治疗。38.33%的患者进行了束带重新定位。33.33%的患者采用了不同的手术方法。再次手术的患者组中，无死亡病例或任何严重并发症。
总之，我们认为胃束带滑脱过去是、将来也仍将是接受胃束带术患者的一个重要问题。针对饮食错误的患者教育可能会降低这种并发症的发生率。再次手术应考虑初次手术与再次手术之间的间隔期。
