Department of Surgical Sciences, University of Torino, Corso A. M. Dogliotti 14, 10126, Turin, Italy.
Obes Surg. 2018 Nov;28(11):3380-3385. doi: 10.1007/s11695-018-3373-y.
The number of laparoscopic adjustable gastric banding (LAGB) removal has increased throughout the years. The aim of the study was to evaluate the outcomes in patients undergoing LAGB removal with or without further bariatric surgery.
Data prospectively collected from consecutive patients undergoing LAGB removal from 2008 to 2016 at our institution were retrospectively analyzed. Obesity-related comorbidities, complications, and body mass index (BMI) before removal and at 1-year follow-up were evaluated.
A total of 156 patients were included in the study. Seventy-six patients had further surgery (SURG group): 55 underwent laparoscopic sleeve gastrectomy (LSG) and 21 laparoscopic Roux-en-Y gastric bypass (LRYGB). Eighty patients underwent only LAGB removal (No-SURG group). The mean BMI was lower in the No-SURG group (33.9 vs 36.3 kg/m, p = 0.0055). Reasons for removal were different in the two groups: dysphagia, frequent vomiting, and LAGB-related complications requiring urgent treatment occurred more commonly in the No-SURG group (p < 0.05): 71.3 vs 51.3%, 67.5% vs. 38.2%, 28.8% vs. 6.6%, respectively. At 1-year follow-up, 96.3% of No-SURG patients regained weight after LAGB removal; two (2.5%) patients showed new-onset comorbidities, four (5%) needed adjustments in pharmacological therapy, and four (5%) complained from persistence of GERD symptoms. Additional surgery provided significant weight loss: the mean %TWL was 23.7% after LSGs and 27.2% after LRYGBs.
LAGB is associated with a high rate of reoperation. Further bariatric surgery after LAGB removal should be considered due to weight regain, persistence of GERD symptoms, and new-onset comorbidities.
腹腔镜可调节胃束带（LAGB）的移除数量逐年增加。本研究旨在评估在我院接受 LAGB 移除手术且是否进一步行减重手术的患者的结局。
本研究回顾性分析了 2008 年至 2016 年我院连续接受 LAGB 移除手术的患者的数据。评估了肥胖相关合并症、并发症以及移除前和 1 年随访时的体重指数（BMI）。
共纳入 156 例患者。76 例患者进一步接受了手术（SURG 组）：55 例行腹腔镜胃袖状切除术（LSG），21 例行腹腔镜 Roux-en-Y 胃旁路术（LRYGB）。80 例患者仅行 LAGB 移除（No-SURG 组）。No-SURG 组的平均 BMI 较低（33.9 比 36.3kg/m，p=0.0055）。两组患者移除的原因不同：吞咽困难、频繁呕吐和 LAGB 相关并发症需要紧急治疗在 No-SURG 组更常见（p<0.05）：71.3%比 51.3%、67.5%比 38.2%、28.8%比 6.6%。在 1 年随访时，No-SURG 组 96.3%的患者在 LAGB 移除后体重恢复；2 例（2.5%）患者出现新发合并症，4 例（5%）需要调整药物治疗，4 例（5%）抱怨持续存在 GERD 症状。进一步的手术提供了显著的减重效果：LSG 术后平均体重减轻百分比（%TWL）为 23.7%，LRYGB 术后为 27.2%。
LAGB 与较高的再手术率相关。由于体重反弹、GERD 症状持续存在和新发合并症，LAGB 移除后应考虑进一步行减重手术。
