Shewmaker Grant S, Leeds Steven G, Aladegbami Bola, Wang Christine Y, Ward Marc A
Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA.
Center for Advanced Surgery, Baylor Scott and White Health, 3417 Gaston Avenue, Suite 965, Dallas, TX, USA.
Surg Endosc. 2025 Jun 30. doi: 10.1007/s00464-025-11953-5.
There is a high rate of long-term complications and persistent symptoms of food intolerance following Vertical Banded Gastroplasty (VBG). This prompts many patients to undergo difficult revisional bariatric surgery due to inflammation, scarring, and adhesions. Here, we demonstrate the outcomes of treating diet intolerance due to nonadjustable gastric bands (NAGBs) using a stepwise algorithm developed at our institution progressing from endoscopic removal using induced mucosal erosion with a stent (IMES) to a minimally invasive septotomy.
Retrospective chart review was performed on symptomatic patients undergoing stent placement to remove NAGBs at our single institution from 1/1/2018 to 5/6/2024. Patient symptom types and demographic and surgical data were recorded from patient clinical encounters preoperatively and one month after stent removal. Patients with persistent symptoms following NAGB removal were offered restoration of their anatomy via endoscopy-assisted laparoscopic septotomy per our institution's protocol.
Twenty-four patients underwent endoscopic stent placement for gastrointestinal symptoms attributable to a NAGB. One patient did not tolerate stent placement and required stent removal on postoperative day one. Stents were removed between 12 and 28 days for all other patients. Six patients with persistent symptoms after IMES subsequently underwent endoscopy-assisted laparoscopic septotomy without complication and none required additional revisional surgery. The remaining 17 patients (71%) had improvement in their preoperative symptoms and were tolerating a regular diet at one-month follow-up without requiring an additional abdominal operation, which is similar to other published data on endoscopic methods of NAGB removal. There were no complications from stent removal or septotomy.
Our stepwise treatment of gastrointestinal symptoms secondary to NAGBs is safe and effective. For patients with persistent food intolerance following IMES, there is a safe minimally invasive option in endoscopy-assisted laparoscopic septotomy to avoid more extensive revisional procedures.
垂直束带胃成形术（VBG）后食物不耐受的长期并发症和持续症状发生率很高。这促使许多患者因炎症、瘢痕形成和粘连而接受困难的减重修复手术。在此，我们展示了使用我们机构开发的逐步算法治疗不可调节胃束带（NAGB）引起的饮食不耐受的结果，该算法从使用带支架的诱导黏膜糜烂（IMES）进行内镜下移除，逐步过渡到微创胃间隔切开术。
对2018年1月1日至2024年5月6日在我们单一机构接受支架置入以移除NAGB的有症状患者进行回顾性病历审查。术前和支架移除后1个月，从患者临床诊疗记录中记录患者的症状类型、人口统计学和手术数据。根据我们机构的方案，对于NAGB移除后仍有持续症状的患者，通过内镜辅助腹腔镜胃间隔切开术恢复其解剖结构。
24例患者因NAGB导致的胃肠道症状接受了内镜下支架置入。1例患者不耐受支架置入，术后第1天需要移除支架。所有其他患者在12至28天之间移除了支架。6例IMES后仍有持续症状的患者随后接受了内镜辅助腹腔镜胃间隔切开术，无并发症发生，且均无需额外的修复手术。其余17例患者（71%）术前症状有所改善，在1个月随访时能够耐受正常饮食，无需额外的腹部手术，这与其他关于内镜下移除NAGB方法的已发表数据相似。支架移除或胃间隔切开术均无并发症发生。
我们对NAGB继发胃肠道症状的逐步治疗方法是安全有效的。对于IMES后仍有持续食物不耐受的患者，内镜辅助腹腔镜胃间隔切开术是一种安全的微创选择，可避免更广泛的修复手术。
