腹腔镜可调节胃束带术和胃旁路术后体重减轻失败及再次手术：一项病例匹配队列研究。

Weight Loss Failure and Reoperation After Laparoscopic Adjustable Gastric Banding and Gastric Bypass: a Case-Matched Cohort Study.

作者信息

Bittner James G, Clingempeel Natasha L, Wolf Luke G

机构信息

Department of Surgery, Virginia Commonwealth University School of Medicine, PO Box 980519, Richmond, VA, 23298, USA.

出版信息

Obes Surg. 2017 Nov;27(11):2885-2889. doi: 10.1007/s11695-017-2691-9.

DOI:10.1007/s11695-017-2691-9

PMID:28455801

Abstract

INTRODUCTION

Not long ago, laparoscopic adjustable gastric banding (LAGB) was considered a safe and effective treatment of morbid obesity; however, long-term outcomes revealed significant complication and failure rates. We hypothesized that LAGB has higher rates of weight loss failure, reoperation, and overall failure compared to laparoscopic gastric bypass (LRYGB) at long-term follow-up.

METHODS

A matched case-control study was performed. Patients who underwent primary LAGB or LRYGB at a university hospital between 2004 and 2011 were propensity matched for age, gender, race, body mass index (BMI), and weight-related co-morbidities. Outcomes included demographics, percent excess weight loss (% EWL) and reoperation, weight loss failure (<50% EWL), and overall failure (procedure-related reoperation and/or <50% EWL) at 3- and 5-year follow-up.

RESULTS

In all, 228 LAGB and 228 LRYGB patients matched. LAGB patients had less mean EWL at 3 years (35 vs. 71%, P < 0.05) and 5 years (29.3 vs. 66.7%, P < 0.05). LAGB (11%) and LRYGB (11.5%) patients required procedure-related reoperation. More LAGB patients suffered weight loss failure at 3 years (75 vs. 10.5%, P < 0.05) and 5 years (81.5 vs. 15.4%, P < 0.05). Overall failure rates were higher after LAGB. The most common complication after LAGB was pouch/esophageal enlargement (9.7%) and after LRYGB was internal hernia (4.8%). LAGB patients had higher morbidity (19 vs. 12.7%, P = 0.04) but similar procedure-related mortality (0 vs. 0.4%).

CONCLUSIONS

LAGB has significantly higher rates of weight loss failure compared to LRYGB with similar rates of procedure-related reoperation. Overall failure rates are higher after LAGB. These data suggest the long-term effectiveness of LAGB might be limited.

摘要

引言

不久前，腹腔镜可调节胃束带术（LAGB）被认为是治疗病态肥胖的一种安全有效的方法；然而，长期结果显示其并发症和失败率显著。我们假设，在长期随访中，与腹腔镜胃旁路术（LRYGB）相比，LAGB的体重减轻失败率、再次手术率和总体失败率更高。

方法

进行了一项配对病例对照研究。2004年至2011年期间在一家大学医院接受初次LAGB或LRYGB手术的患者，根据年龄、性别、种族、体重指数（BMI）和与体重相关的合并症进行倾向评分匹配。结局指标包括人口统计学数据、超重减轻百分比（%EWL）和再次手术情况、体重减轻失败（%EWL<50%）以及3年和5年随访时的总体失败情况（与手术相关的再次手术和/或%EWL<50%）。

结果

总共228例LAGB患者和228例LRYGB患者匹配成功。LAGB患者在3年时的平均EWL较低（35%对71%，P<0.05），在5年时也是如此（29.3%对66.7%，P<0.05）。LAGB（11%）和LRYGB（11.5%）患者需要进行与手术相关的再次手术。更多LAGB患者在3年时出现体重减轻失败（75%对10.5%，P<0.05），在5年时也是如此（81.5%对15.4%，P<0.05）。LAGB后的总体失败率更高。LAGB后最常见的并发症是胃囊/食管扩张（9.7%），LRYGB后是内疝（4.8%）。LAGB患者的发病率较高（19%对12.7%，P=0.04），但与手术相关的死亡率相似（0对0.4%）。