The Royal Brisbane and Women's Hospital (RBWH), Brisbane, Queensland, Australia.
The Royal Brisbane and Women's Hospital (RBWH), Brisbane, Queensland, Australia.
Surg Obes Relat Dis. 2020 Apr;16(4):485-491. doi: 10.1016/j.soard.2019.11.015. Epub 2019 Dec 16.
The rates of primary laparoscopic adjustable gastric banding (LAGB) have declined in the last 5 years due to band removal secondary to complications and the subsequent weight regain that requires revisional procedures.
This study aimed to present medium-term weight loss results and the safety profile of converting LAGB to Roux-en-Y gastric bypass in patients with body mass index (BMI) <35.0 kg/m who presented with LAGB intolerance or complications. Many health services do not permit such procedures on low BMI patients.
Single-surgeon series, including public and private practice, Brisbane, Australia.
A prospectively maintained database was reviewed and retrospectively analyzed for LAGB patients with a BMI <35.0 kg/m who underwent conversion to Roux-en-Y gastric bypass by a single surgeon. Indications for conversion, weight loss data, and early (30 d postoperative) and late complications were recorded with follow-up out to 5 years.
One hundred thirty-two adult patients with a BMI <35.0 kg/m underwent conversion from 2009 to 2016. The main indications for conversion were reflux and band complications. Median BMI at bypass was 32.8 kg/m (23.1-35.0). Median percentage excess weight loss was 77%, 90%, 73%, 47%, 49%, and 44% at 1, 2, 3, 4, and 5 years, respectively among patients who were eligible and present at follow-up. Median BMI was <30.0 kg/m (29.1-40.9) at 5 years with only 1 subject exceeding >35.0 kg/m. Mortality was 0%. Early morbidity occurred in 31.8% of patients. The most common late complication was gastrojejunostomy stricture requiring endoscopic dilation.
In combination with our 2014 study showing morbidity data in the short-term period being comparable to patients with BMI >35.0 kg/m, our study demonstrates that converting LABG to Roux-en-Y gastric bypass in low BMI patients is a feasible and safe option that avoids weight regain and maintains adequate weight loss at 5 years, with acceptable morbidity and no mortality.
由于带并发症的移除和随后需要进行修订手术的体重反弹，腹腔镜可调胃束带术（LAGB）的初次手术率在过去 5 年内下降。
本研究旨在介绍将 LAGB 转换为 Roux-en-Y 胃旁路术在 BMI<35.0kg/m2 且 LAGB 不耐受或有并发症的患者中的中期减重效果和安全性。许多医疗服务机构不允许对低 BMI 患者进行此类手术。
包括公共和私人实践在内的单外科医生系列，澳大利亚布里斯班。
对单外科医生进行的 LAGB 患者进行前瞻性维护数据库并进行回顾性分析，这些患者的 BMI<35.0kg/m2 且接受了 Roux-en-Y 胃旁路术转换。记录转换的适应症、减重数据以及早期（术后 30d）和晚期并发症，随访时间最长为 5 年。
2009 年至 2016 年，共有 132 名 BMI<35.0kg/m2 的成年患者接受了转换。转换的主要指征是反流和带并发症。旁路时的中位 BMI 为 32.8kg/m2（23.1-35.0）。中位百分比体重减轻率分别为 77%、90%、73%、47%、49%和 44%，分别为 1 年、2 年、3 年、4 年和 5 年时符合条件且接受随访的患者。5 年后 BMI 低于<30.0kg/m2（29.1-40.9），仅有 1 例患者超过>35.0kg/m2。死亡率为 0%。31.8%的患者出现早期发病率。最常见的晚期并发症是胃空肠吻合口狭窄，需要内镜扩张。
结合我们 2014 年的研究表明，短期的发病率数据与 BMI>35.0kg/m2 的患者相当，我们的研究表明，将 LABG 转换为 Roux-en-Y 胃旁路术在低 BMI 患者中是一种可行且安全的选择，可避免体重反弹，并在 5 年内保持足够的减重效果，发病率可接受，无死亡。
