Hepatobiliary and Oesophagogastric Unit, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia.
College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
Obes Surg. 2020 Jul;30(7):2469-2474. doi: 10.1007/s11695-020-04610-4.
Erosion of a laparoscopic adjustable gastric band (LAGB) is a devastating problem. There is no clear evidence in literature to guide the choice of revisional procedure following an eroded LAGB. The purpose of this study is to analyse the largest series of erosions following LAGB published to-date with an aim to share our experience with this rare complication and how we managed this cohort of patients following explantation of their LAGB.
This is a retrospective cohort study. Patient data is maintained prospectively in a surgical database. The study period was from January 1996 to January 2019. The outcomes of patients who underwent an erosion of LAGB were studied.
Gastric band erosion was encountered in 4.7% of patients. Sixty patients opted for a revisional procedure which included 37 repeat LAGBs, 6 laparoscopic sleeve gastrectomies (LSG), 7 Roux-en-Y gastric bypasses (RYGB), 1 intragastric balloon, and 9 failed revisional procedures. Re-erosions were noted in 27% of patients who underwent a repeat gastric banding. Median %TWL at a 1-year follow-up was significantly higher in LSG and RYGB groups compared with that in LAGB (P < 0.008 and P < 0.000, respectively). There was no significant difference between the LSG and RYGB groups.
The risk of re-erosion is increased in patients who undergo repeat AGB following a previous episode of erosion. Repeat LAGB should not be offered after a previous erosion. LSG and RYGB should be considered as appropriate revisional procedures in a patient who experience weight regain following explantation of an eroded LAGB.
腹腔镜可调胃束带（LAGB）的侵蚀是一个破坏性的问题。文献中没有明确的证据来指导 LAGB 侵蚀后的修正手术选择。本研究的目的是分析迄今为止发表的关于 LAGB 侵蚀的最大系列，旨在分享我们对这种罕见并发症的经验，以及我们如何在 LAGB 被取出后管理这组患者。
这是一项回顾性队列研究。患者数据在一个外科数据库中进行前瞻性维护。研究期间为 1996 年 1 月至 2019 年 1 月。研究了 LAGB 侵蚀患者的结局。
胃带侵蚀在 4.7%的患者中发生。60 名患者选择了修正手术，其中包括 37 例重复 LAGB、6 例腹腔镜袖状胃切除术（LSG）、7 例 Roux-en-Y 胃旁路术（RYGB）、1 例胃内球囊和 9 例修正失败。在接受重复胃带的患者中，27%出现再侵蚀。LSG 和 RYGB 组的 1 年随访时的%TWL 中位数明显高于 LAGB 组（P<0.008 和 P<0.000，分别）。LSG 和 RYGB 组之间无显著差异。
在先前发生过侵蚀的患者中，重复 AGB 后再次发生侵蚀的风险增加。在先前发生侵蚀后，不应再提供重复 LAGB。在 LAGB 被取出后体重增加的患者中，LSG 和 RYGB 应被视为适当的修正手术。
