Kowalewski Piotr K, Olszewski Robert, Kwiatkowski Andrzej P, Paśnik Krzysztof
Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland.
Department of Cardiology, Military Institute of Medicine, Warsaw, Poland.
Wideochir Inne Tech Maloinwazyjne. 2017;12(1):32-36. doi: 10.5114/wiitm.2017.66671. Epub 2017 Mar 22.
Laparoscopic adjustable gastric banding (LAGB) used to be one of the most popular bariatric procedures.
To present our institution's experience with LAGB, its complications, causes of failure and revisional bariatric procedures, in a long-term follow-up.
Records of patients who underwent pars flaccida LAGB from 2003 to 2006 were gathered. We selected data on patients with a history of additional bariatric procedures. Their initial demographic data, body mass index and causes of revision were gathered. We analyzed length of stay and early perioperative complications.
60% of patients (n = 57) who underwent LAGB in our institution between 2003 and 2006 had their band removed (out of 107, 11% lost to follow-up). Median time to revisional surgery was 50 months. The main reasons for removal were: weight regain (n = 23; 40%), band slippage (n = 14; 25%), and pouch dilatation (n = 9; 16%). Thirty (53%) patients required additional bariatric surgery, 10 (33%) of which were simultaneous with band removal. The most popular procedures were: laparoscopic Roux-en-Y gastric bypass (LRYGB) (n = 15; 50%), open gastric bypass (n = 8; 27%), and laparoscopic sleeve gastrectomy (LSG) - (n = 3; 10%). Mean length of stay (LOS) was 5.4 ±2.0. One (3%) perioperative complication was reported.
The results show that LAGB is not an effective bariatric procedure in long-term follow-up due to the high rate of complications causing band removal and the high rate of obesity recurrence. Revisional bariatric surgery after failed LAGB may be performed in a one-stage approach with band removal.
腹腔镜可调节胃束带术（LAGB）曾是最流行的减肥手术之一。
在长期随访中展示我们机构开展LAGB的经验、其并发症、失败原因及减肥修正手术。
收集2003年至2006年接受松弛部LAGB手术患者的记录。我们选取了有其他减肥手术史患者的数据。收集他们的初始人口统计学数据、体重指数及修正原因。分析住院时间和早期围手术期并发症。
2003年至2006年在我们机构接受LAGB手术的患者中，60%（n = 57）的束带被移除（107例中，11%失访）。修正手术的中位时间为50个月。移除束带的主要原因是：体重反弹（n = 23；40%）、束带滑脱（n = 14；25%）和胃囊扩张（n = 9；16%）。30例（53%）患者需要额外的减肥手术，其中10例（33%）在移除束带的同时进行。最常用的手术是：腹腔镜Roux-en-Y胃旁路术（LRYGB）（n = 15；50%）、开放式胃旁路术（n = 8；27%）和腹腔镜袖状胃切除术（LSG）（n = 3；10%）。平均住院时间（LOS）为5.4±2.0天。报告了1例（3%）围手术期并发症。
结果表明，由于导致束带移除的并发症发生率高以及肥胖复发率高，LAGB在长期随访中不是一种有效的减肥手术。LAGB失败后的减肥修正手术可在移除束带的一期手术中进行。
