腹腔镜可调节胃束带移除术及后续减重手术修正的结果：对214例连续患者的回顾性研究

Laparoscopic adjustable gastric band removal and outcome of subsequent revisional bariatric procedures: A retrospective review of 214 consecutive patients.

作者信息

Kirshtein Boris, Kirshtein Anna, Perry Zvi, Ovnat Amnon, Lantsberg Leonid, Avinoach Eliezer, Mizrahi Solly

机构信息

Department of Surgery, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

出版信息

Int J Surg. 2016 Mar;27:133-137. doi: 10.1016/j.ijsu.2016.01.068. Epub 2016 Jan 22.

DOI:10.1016/j.ijsu.2016.01.068

PMID:26808324

Abstract

BACKGROUND

Laparoscopic adjustable gastric band (LAGB) removal is required in cases of slippage, erosion, infection, intolerance, or failure in weight loss. The aim of the study was to follow up the patients who underwent band removal and analyze the outcome of subsequent revisional bariatric procedures.

PATIENTS AND METHODS

A retrospective review of consecutive patients who underwent LAGB removal during 3.5 years. All patients underwent a phone interview in early 2015. Patients were divided to three groups following band removal: without additional surgery, laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en Y gastric bypass (LRYGB), and Redo LAGB(Re-LAGB). Outcome of different revisional procedures was compared according to causes and symptoms before band removal, patient satisfaction, weight loss, quality of life (QOL) questionnaire, and the bariatric analysis and reporting outcome system II (BAROSII) score.

RESULTS

Overall 214 patients (73.8% females) with mean age of 41.9 years were enrolled in the study. The mean time between LAGB placement and removal was 81.0 months. Mean % estimated weight loss (%EWL) was 29.6 at time of band removal. There was no difference between groups in patient age, gender, BMI before LAGB, and most co-morbidities. Patients with 1-5 outpatient visits preferred additional surgery. Patients suffering from vomiting from 1 to 10 times per week preferred revision as LSG or LRYGB. Patients with lower BAROS score underwent LSG or LRYGB. Most of the patients with band intolerance underwent conversion to another bariatric procedure, while patients with band erosion and infected band preferred Re-LAGB. Most of the patients without band gained weight. There was a significant improvement in %EWL (39.9 vs 29.6), QOL (1.08 vs 0.07), and BAROS(2.82 vs-0.11) in patients who underwent additional bariatric surgery before and after band removal irrespective of surgery type.

CONCLUSIONS

Patient selection for different revisional bariatric procedures after LAGB removal is a main point for surgery success. This results in high patient satisfaction, EWL, and QOL. All options (Re-LAGB, LSG, LRYGB) are feasible and safe.

摘要

背景

在出现胃束带滑脱、侵蚀、感染、不耐受或减重失败的情况下，需要移除腹腔镜可调节胃束带（LAGB）。本研究的目的是对接受胃束带移除手术的患者进行随访，并分析后续减重手术修正术的结果。

患者与方法

回顾性分析3.5年间连续接受LAGB移除手术的患者。2015年初对所有患者进行了电话访谈。胃束带移除后，患者被分为三组：不进行额外手术、接受腹腔镜袖状胃切除术（LSG）或腹腔镜Roux-en-Y胃旁路术（LRYGB），以及再次进行LAGB手术（Re-LAGB）。根据胃束带移除前的病因和症状、患者满意度、体重减轻情况、生活质量（QOL）问卷以及减重分析与报告结果系统II（BAROSII）评分，比较不同修正手术的结果。

结果

本研究共纳入214例患者（73.8%为女性），平均年龄41.9岁。LAGB放置与移除之间的平均时间为81.0个月。胃束带移除时，平均预计体重减轻百分比（%EWL）为29.6。患者年龄、性别、LAGB手术前的BMI以及大多数合并症在各组之间无差异。有1 - 5次门诊就诊的患者更倾向于接受额外手术。每周呕吐1至10次的患者更倾向于选择LSG或LRYGB进行修正手术。BAROS评分较低的患者接受了LSG或LRYGB手术。大多数胃束带不耐受的患者转为接受其他减重手术，而胃束带侵蚀和感染的患者更倾向于再次进行LAGB手术。大多数未使用胃束带的患者体重增加。无论手术类型如何，接受胃束带移除前后额外减重手术的患者在%EWL（39.9对29.6）、QOL（从1.0下降至0.07）和BAROS（2.82对 -0.11）方面均有显著改善。