Patel Roshani Vijaykumar, Woodburn Patrick, Skipworth James R A, Smellie William James Buchanan
Department of Bariatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK.
Hillingdon Hospitals NHS Trust, Pield Heath Road, Uxbridge, UB8 3NN, UK.
Obes Surg. 2018 May;28(5):1377-1384. doi: 10.1007/s11695-017-3032-8.
A lack of clarity remains over the optimal strategy for the management of laparoscopic adjustable gastric band (LAGB) slippage, which, although rare (around 3% in our experience), can when acute result in obstruction, gastric erosion or ischaemia. Typically, slipped bands are removed acutely. The aim of this study was to explore outcomes following immediate or delayed resiting of slipped LAGBs in a single centre, comparing simple repositioning with retunnelling and replacement.
A retrospective analysis of computerised records, notes and prospectively maintained bariatric databases was undertaken to identify all patients with a slipped LAGB in a single centre.
Thirty-two patients required operative intervention following a diagnosis of slipped LAGB (median time from initial LAGB insertion to slippage 2.9 years). Two (6%) patients underwent band removal and 30 (94%), band revision surgery (25 immediately and five at a planned but expedited procedure).Twenty-four (77%) patients underwent insertion of a new LAGB via a de novo retrogastric tunnel, five (21%) of which required further future operative intervention; whereas, six (23%) patients underwent repositioning of the existing LAGB within the same tunnel, five (83%) of which underwent further operative intervention (log-rank test p = 0.0001). Following LAGB revision, there was no significant further change in BMI (median + 1 kg/m; range - 13 to + 10 kg/m).
Resiting of slipped LAGBs is safe and maintains weight loss. Although a significant risk of future operative intervention remains, this can be reduced via the creation of a de novo retrogastric tunnel for band resiting.
腹腔镜可调节胃束带（LAGB）滑脱的最佳管理策略仍不明确，尽管这种情况很少见（根据我们的经验约为3%），但急性滑脱时可能导致梗阻、胃糜烂或缺血。通常，滑脱的束带会被紧急移除。本研究的目的是在单一中心探讨LAGB滑脱后立即或延迟重新放置的结果，比较简单重新定位与重新隧道化及更换的效果。
对计算机记录、病历和前瞻性维护的减肥数据库进行回顾性分析，以确定单一中心所有LAGB滑脱的患者。
32例患者在诊断为LAGB滑脱后需要手术干预（从最初植入LAGB到滑脱的中位时间为2.9年）。2例（6%）患者接受了束带移除，30例（94%）接受了束带修复手术（25例立即进行，5例按计划但加快的程序进行）。24例（77%）患者通过重新建立胃后隧道插入新的LAGB，其中5例（21%）需要进一步的手术干预；而6例（23%）患者在同一隧道内对现有LAGB进行重新定位，其中5例（83%）接受了进一步的手术干预（对数秩检验p = 0.0001）。LAGB修复后，BMI没有显著进一步变化（中位值 +1 kg/m²；范围 -13至 +10 kg/m²）。
LAGB滑脱后重新放置是安全的，并能维持体重减轻。尽管未来仍有显著的手术干预风险，但通过创建新的胃后隧道进行束带重新放置可以降低这种风险。
