Juodeikis Zygimantas, Brimienė Vilma, Brimas Gintautas
Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.
Wideochir Inne Tech Maloinwazyjne. 2019 Jan;14(1):79-85. doi: 10.5114/wiitm.2018.77269. Epub 2018 Jul 24.
Laparoscopic adjustable gastric banding (LAGB) is considered to be the least invasive, reversible, and the safest bariatric operation regarding mortality and morbidity, and its application to high-risk superobese (SO) individuals seems rational.
There are differing viewpoints regarding the effectiveness of LAGB in superobese (BMI > 50 kg/m) patients. The aim of this study was to compare the safety and efficacy of LAGB in SO and non-superobese (NSO) patients in the long term (> 5 years).
We undertook a prospective single-center study to compare the safety and efficacy of LAGB in SO and NSO patients after 5 years. One hundred and three morbidly obese patients underwent LAGB in the period from January 2009 to January 2010. Sixty-four of the patients were NSO and 39 SO. After 5 years, we evaluated their weight loss, comorbidities, complications, and quality of life.
A total of 90 of 103 patients (87.3%) completed the 5-year follow-up. The percentage excess weight loss was 50.4% in the NSO and 38.8% in the SO group (p = 0.072). The proportion of patients who lost > 50% excess weight was significantly larger in the NSO group (p = 0.045). There were significantly more patients in the NSO group whose metabolic syndrome had resolved (p < 0.001). There were no differences regarding the resolution of other comorbidities and postoperative complications.
This study suggests that LAGB can lead to substantial and long-lasting weight loss after 5 years. Our study found that SO patients demonstrate inferior weight loss results, and lower overall BAROS scores; thus we do not support the primary use of LAGB in SO patients.
腹腔镜可调节胃束带术（LAGB）被认为是创伤最小、可逆且在死亡率和发病率方面最安全的减肥手术，将其应用于高危超级肥胖（SO）个体似乎是合理的。
关于LAGB在超级肥胖（BMI>50kg/m²）患者中的有效性存在不同观点。本研究的目的是比较LAGB在SO和非超级肥胖（NSO）患者中长期（>5年）的安全性和疗效。
我们进行了一项前瞻性单中心研究，以比较LAGB在SO和NSO患者5年后的安全性和疗效。2009年1月至2010年1月期间，103例病态肥胖患者接受了LAGB手术。其中64例为NSO患者，39例为SO患者。5年后，我们评估了他们的体重减轻情况、合并症、并发症和生活质量。
103例患者中有90例（87.3%）完成了5年随访。NSO组的超重减轻百分比为50.4%，SO组为38.8%（p=0.072）。体重减轻超过50%的患者比例在NSO组显著更高（p=0.045）。NSO组代谢综合征缓解的患者明显更多（p<0.001）。在其他合并症的缓解和术后并发症方面没有差异。
本研究表明，LAGB术后5年可导致显著且持久的体重减轻。我们的研究发现，SO患者的体重减轻效果较差，总体BAROS评分较低；因此，我们不支持在SO患者中首选LAGB。
