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1.
Preparation of Extremely Obese Patients for Laparoscopic Gastric Banding by Gastric Balloon Therapy 总被引:5,自引:3,他引:2
Background: In super, super obese patients (body mass index [BMI] >60), especially those with extreme intra-abdominal fat
deposition, the technical difficulties in laparoscopic procedures increase. The purpose of this study was to evaluate whether
gastric balloon therapy (GBT) can improve the operative conditions for laparoscopic adjustable gastric banding (LAGB) in extremely
obese patients. Materials and Methods: From April 1995 to August 1998, 196 LAGBs were performed. In 15 patients (7 female
and 8 male), median age 38.8 years (range 17-54), who had been selected as suitable candidates for bariatric surgery, preoperative
GBT was studied. Fourteen patients were extremely obese (BMI 60.2 kg/m2 [range 58-72]). One 17-year-old boy with BMI 46.6 kg/m2 was also treated. The Bioenterics Intragastric Balloon (BIB) was used. The placement, the volume modification, and the removal
of the BIB were performed endoscopically. Close follow-up was possible in 14 patients. After balloon removal, 13 patients
underwent LAGB. Results: In 14 of 15 cases, GBT was successful. There was only one ballon dysfunction. The mean weight loss
was 18.1 kg, and the median duration of balloon therapy was 16.8 weeks. After balloon removal, body weight started to increase.
Conclusions: In our experience, the gastric balloon can improve the conditions for laparoscopic surgery in super and in super,
super obese patients. There was no conversion to open surgery. The effect of weight loss is much less than immediately after
LAGB. However, after failure of all conservative treatments to reduce the preoperative body weight, the GBT seems to be the
last possibility. 相似文献
2.
Background: Bariatric surgery is the only currently available, effective, long-term method for controlling morbid obesity.
Gastric banding as one of the possible surgical treatments was repeatedly described during the last 10 years. It is a reversible
surgical procedure which is primarily performed laparoscopically. Methods: From 1993 to 1998 at the 1st Surgical Department Faculty General Hospital Charles University in Prague we performed nonadjustable gastric banding laparoscopically
in 487 patients with morbid obesity (body mass index [BMI] 34 to 49 kg/m2). There were 429 females and 58 males in this group. Results: In 487 patients who underwent laparoscopic nonadjustable gastric
banding (LNGB): early postoperative complications occurred in 29 cases (5.9%)--swelling of the gastric mucosa at the site
of the nonadjustable band. In three cases (0.6%)--gastric perforations, and in two patients (0.4%)-- bleeding from gastric
ulceration at the site of the band. Swelling was treated conservatively with a nasogastric tube and antisecretory and antiedematic
drugs. Bleeding was treated by gastrofibroscopy and gastric perforation by open suture of the lesion. Late complications after
LNGB occurred in eight patients (1.7%)--gastritis or esophagitis (but at the site of the band in only two patients [0.4%]),
and in 13 patients (2.7%)--small upper pouch dilatation. In 24 cases (4.9%), we discovered slippage of the anterior stomach
wall above the band. In three patients (0.6%), the band migrated through the gastric wall in 6-12 months following surgery.
In the majority of cases, treatment of these complications was conservative. In eight patients we removed the band by laparoscopy,
and in three patients we removed the migrating band from the stomach by open gastrotomy. Other complications have been treated
conservatively by correcting the diet, prokinetic drugs, and antisecretory treatment. Conclusions: According to our long-term
results, LNGB by experienced bariatric and laparoscopic surgeons is a viable method with low morbidity. In our 487 patients,
there were major complications (necessitating reoperation) in 3.2% and minor complications (treated conservatively) in 10.4%. 相似文献
3.
De Panfilis C Cero S Torre M Salvatore P Dall'Aglio E Adorni A Maggini C 《Obesity surgery》2007,17(6):792-799
Background The effectiveness of post-surgical weight loss in improving body image disturbance (BID) in morbidly obese patients is still
unclear. Providing multidimensional measures of BID and controlling for the effect of co-morbid eating psychopathology may
help to clarify this issue. This preliminary study explores whether 1) BID improves 1 year after laparoscopic adjustable gastric
banding (LAGB), and whether 2) such improvement is related to post-surgical BMI and/or eating disorder reduction. BID was
multidimensionally assessed by means of the Body Uneasiness Test(BUT).
Methods 35 obese subjects (mean BMI 45.5) were evaluated prior to and 1 year after LAGB using the BUT, and a standardized interview
and questionnaire to assess eating psychopathology. BID and eating habit changes during follow-up were also investigated.
Postoperative BUT values were entered as outcome measures (dependent variables) in a series of stepwise multiple regression
analyses; BMI and binge eating reduction, baseline BUT scores, gender, age, and age of onset of obesity were tested as independent
variables.
Results Some aspects of BID (body image overconcern and related avoidance behaviors, compulsive self-monitoring, and overall severity
of BID) improved following LAGB, while others (weight phobia, depersonalization, and uneasiness toward body parts) did not.
The post-surgical lower levels of the former were predicted by the overall decrease in binge eating symptoms, irrespective
of BMI reduction, age, gender, and age of onset of obesity.
Conclusions LAGB may ameliorate some BID aspects in morbidly obese patients, and an improvement in eating behaviors may contribute to
this effect. 相似文献
4.
Montgomery KF Watkins BM Ahroni JH Michaelson R Abrams RE Erlitz MD Scurlock JE 《Obesity surgery》2007,17(6):711-716
Background Laparoscopic adjustable gastric banding (LAGB) is a safe and effective treatment for morbid obesity that is well suited to
outpatient surgery. Super-obese patients (BMI ≥50) are often viewed as higher risk patients, with their surgical procedures
limited to hospital operating-rooms. We report our experience performing LAGB for super-obese patients in a freestanding ambulatory
surgery center and describe the program elements that make this feasible and safe.
Methods Database records containing 1,780 consecutive patients from program inception (November 2002 to November 2006) were searched
for patients with a BMI >49.9 undergoing an outpatient LAGB and reviewed to identify complications.
Results 320 super-obese patients underwent an outpatient LAGB.Mean preoperative weight was 155.2 kg (range 112.3–220.5 kg), and mean
BMI was 55.4 kg/m2 (range 50.0–71.1 kg/m2). 53 patients (16.6%) had BMI >60. There were no deaths, significant cardiopulmonary complications, significant intraoperative
bleeding, conversion to open laparotomy, or hospital admissions. 3 patients (0.1%) developed gastric edema causing transient
obstruction, and 1 developed a delayed colon perforation from electrocautery incurred during adhesiolysis. No complication
arose or was more difficult to manage as a result of the procedure being done on an outpatient basis.
Conclusions Outpatient LAGB can be safely performed in super-obese patients with a complication rate similar to lower BMI patients. Patient
selection and preoperative preparation are essential to achieve excellent outcomes. The decision to offer an outpatient LAGB
should rest on the overall physiological condition rather than BMI or weight alone. 相似文献
5.
Matar ZS 《Obesity surgery》2008,18(12):1632-1635
Laparoscopic adjustable gastric banding is a commonly performed bariatric operation worldwide. The presence of an anatomical
variation like situs inversus demands preoperative assessment and preparedness on the part of the surgeon. We report a laparoscopic
gastric banding performed on a morbidly obese patient with situs inversus totalis in the Kingdom of Saudi Arabia. 相似文献
6.
Gastric banding as a laparoscopic procedure was performed on 40 morbidly obese patients. This operation matches the advantages
of the gastric banding (efficacy, reversibility and low invasivity) with the advantages of the laparoscopic procedure (low
surgical risk, short hospital stay and less complications in the short and long term). The maximum follow-up is 6 months and
so far the weight loss results are the same as we obtained by the vertical banded gastroplasty of Mason. The greatest problem
of laparoscopic gastric banding is to get the right tightness of the band for a stoma of 12-13 mm. In three patients the band
was replaced due to stenosis, in two of them by a laparoscopic procedure. The adjustable band of Kuzmak should exclude the
risk of stenosis and its use will be tried by the laparoscopic procedure. 相似文献
7.
Quality-of-Life Outcome After Laparoscopic Adjustable Gastric Banding for Morbid Obesity 总被引:3,自引:0,他引:3
Background: The definition of success and failure of a bariatric procedure should include weight loss as well as improvement
of comorbidity and quality-of-life (QoL) assessment. QoL measures changes in physical, functional, mental, and social health
in order to evaluate benefits of new programs and interventions. Material and Methods: From April 1995 until March 1999, 287
patients underwent laparoscopic adjustable silicone gastric banding (LASGB) at Northwest Hospital Frankfurt a.M. (Germany).
In this study, 100 of 287 patients (preoperative mean BMI 48.3 kg/m2; mean age 35.2 years) with a follow-up >18 month were evaluated. All patients underwent anonymous questionnaire (26 questions
with a maximum score of 60) about different aspects of QoL outcome after LSAGB. Results: In this study, 4 of 100 patients
refused to give an answer to the QoL questions. Therefore 96 patients were evaluated. The QoL auto-evaluation of the patients
shows that QoL generally improved after surgery in 92%. Using the scoring system, 44% of patients have excellent, 52% good,
and only 4% bad results. The 4 patients who refused had to be classified as failure. General acceptance of LSAGB is wide,
but gastrointestinal side effects are recognizable in more than 78% of operated patients. Successful weight loss is followed
by an improvement of comorbidities. Conclusions: Safe, effective bariatric procedures increase the quality of life in morbidly
obese patients markedly. Bariatric surgeons are committed to support and help their patients until they reach a new quality
of life after obesity surgery. 相似文献
8.
Favretti F Cadière GB Segato G Bruyns G De Marchi F Himpens J Belluco C Lise M 《Obesity surgery》1995,5(1):71-73
Background: the authors describe a laparoscopic technique for the positioning of stoma adjustable silicone gastric banding
(SASGB), which respects the main steps of the open procedure. Methods: (1) patient position: supine with thighs abducted and
30° reverse Trendelenburg; (2) Four 10 mm trocars (supra-umbilical, sub-xiphoid, right upper quadrant, left upper quadrant)
and an 18 mm trocar (left subcostal); (3) exposure of the subcardial area; (4) measurement of the pouch; (5) dissection of
the lesser and greater curvatures; (6) retrogastric tunnel; (7) introduction and placement of the band; (8) band closure and
stoma calibration; (9) retention sutures. Results: results obtained in a first (1992) series of five patients who underwent
the laparoscopic application of the regular SASGB and results of a second series (1993-1994) of seven patients in whom the
new LAP-ASGB was utilized are reported. Conclusion: this new approach can represent a major achievement in bariatric surgery,
as it combines the minimal invasiveness of the laparoscopic approach with the reversibility of SASGB. 相似文献
9.
Annunziata Lapolla Mariangela Marangon Maria Grazia Dalfrà Gianni Segato Maurizio De Luca Domenico Fedele Franco Favretti Giuliano Enzi Luca Busetto 《Obesity surgery》2010,20(9):1251-1257
Background
Increasing numbers of pregnancies are seen in obese women treated surgically with laparoscopic adjustable gastric banding (LAGB). We compared their maternal and fetal outcomes with obese women without LAGB and normal-weight controls. 相似文献10.
Assessment of the Outcome of Laparoscopic Nonadjustable Gastric Banding and Stoma Adjustable Gastric Banding: Surgeon's and Patient's View 总被引:1,自引:0,他引:1
Background: The results of nonadjustable gastric banding (NAGB) and stoma adjustable gastric banding (SAGB) in the treatment
of morbid obesity are compared. Of 300 patients operated laparoscopically with NAGB since 1993 and of 25 with SAGB since 1994,
65 in the NAGB and 11 in the SAGB group were available for a 3-year follow-up study. Methods: For assessment of the outcome
of our laparoscopic approach in terms of weight loss, length of hospitalization, immediate and late postoperative wound complications,
postoperative changes in the band and pouch area, were compared in patients from both groups. The patient's opinion on the
outcome of the operation and the quality of postoperative digestion was recorded. Results: There was no significant difference
in the length of hospital stay and wound complication rate in the two groups or the weight loss at 36 months after surgery.
There was a statistically significant lower incidence of postoperative food intolerance and vomiting and a lower rate of immediate
and long-term reoperation rate in the SAGB group. Conclusion: SAGB is a method with less postoperative complications in food
intolerance and vomiting in comparison with NAGB. 相似文献
11.
Results and Complications of Laparoscopic Adjustable Gastric Banding: An Early and Intermediate Experience 总被引:4,自引:0,他引:4
Background: Laparoscopic adjustable silicone gastric banding (LASGB) has been performed as the initial procedure for weight
reduction in the authors' institution for the past 22 months. The efficacy and safety of the procedure were studied. Methods:
Patients were followed up prospectively during the perioperative and long-term course and for complications. Results: 391
patients, aged 16-72 years, with a mean body mass index (BMI) of 43.1 (range 33-66) were operated on. The laparoscopic procedure
was completed in all but four. The mean operative time was 78 min (range 36-165), and the mean postoperative hospital stay
was 1.2 days (range 1-8). There were four (1%) intraoperative complications: pneumothorax in one patient, bleeding in two
patients, and injury to the stomach in one. Early postoperative complications were subphrenic abscess in two patients and
band malposition in five. Of the patients operated on, 356 (91%) were available for follow-up. Over an average follow-up period
of 13 months (range 1-22), band slippage occurred in 16 patients (4.1%), resistant port infection in 1, and longstanding pain
in the port area in 9. There were 2 cases of port migration. A total of 26 (6.4%) reoperations were performed: early band
repositioning (5), bleeding port site (1), late band repositioning (13), band removal (5), and local relocation of the port
(2). All abdominal operations were performed laparoscopically. During the 18-month follow-up, the average BMI dropped from
43.1 to 29.8. Conclusion: LASGB is a safe procedure, with low early complication rates. Most reoperations may be performed
laparoscopically, with subsequent low morbidity and short hospitalizations. On intermediate-term follow-up it seems to be
an effective bariatric procedure. 相似文献
12.
13.
Hallberg D 《Obesity surgery》1991,1(2):187-188
The author discusses why he performs adjustable gastric banding. Advantages cited are simplicity, and ability to control weight
loss by adjusting stomal diameter. 相似文献
14.
During preoperative work-up for laparoscopic gastricbypass in a morbidly obese female, gastroscopy visualizedtwo small ulcers
in the antrum. Biopsies diagnosedadenocarcinoma of the diffuse type. Stagingwas performed, and endoscopic ultrasonographyshowed
early gastric cancer. A laparoscopic neartotalgastrectomy with D1 resection and perigastriclymph node dissection and full
omentectomy in combinationwith a gastric bypass, was peformed. Thisapproach respects the oncologic and bariatric principlesand
gives a combined solution for the patient. 相似文献
15.
BACKGROUND: Obesity is considered a low-grade chronic inflammatory condition as reflected by increased C-reactive protein (CRP) levels. Inflammation is emerging as a predictor of cardiovascular disease and it may be a precursor of the metabolic syndrome. Bariatric surgery is commonly performed as a treatment for morbid obesity offering significant reductions in premature myocardial infarction. Laparoscopic sleeve gastrectomy (LSG) is a relatively new bariatric procedure that is currently used as a definitive procedure for weight loss. The aim of this study is to assess the impact of sleeve gastrectomy on CRP levels. METHODS: This study is part of an ongoing, prospective, cohort study to evaluate LSG impact on iron indices. CRP levels were compared preoperatively and 6 months after surgery. Similarly, demographics including body mass index and excess weight were also compared at these same study points. Data were analyzed using Student paired t test and Pearson product moment correlation analysis. RESULTS: Twenty-nine morbidly obese patients were included. There was significant decrease in body mass index (BMI) between the preoperative and 6-month period (50.9 +/- 13.2 and 35.1 +/- 6.85, respectively; P < 0.001). Also CRP levels were statistically significantly lower at 6 months after surgery (preoperative 12.3 +/- 7.53 mg/L and postoperative 5.6 +/- 4.2 mg/L. P < 0.0001). The significant weight loss as reflected by change in BMI was correlated with the difference between preoperative and postoperative CRP levels. CONCLUSIONS: Massive weight loss in morbidly obese patients induced by LSG causes a significant decrease in CRP levels, which could reduce the risk of cardiovascular diseases in these patients. 相似文献
16.
Erik Niville MD Joost Vankeirsbilck MD Anné Dams MD Thierry Anne MD 《Obesity surgery》1998,8(1):39-43
Background: Laparoscopic adjustable gastric banding is an efficient surgical method in the treatment of morbid obesity. In
order to reduce the number of complications, we have modified the technique to what we term ‘laparoscopic adjustable esophagogastric
banding’. Methods: Between December 1994 and July 1997, 126 laparoscopic adjustable banding procedures were carried out. Of
these, 40 underwent a gastric banding operation (group 1), and 86 underwent an esophagogastric banding procedure (group 2).
Results: The percentage loss of excess body weight curve was less rapid in group 2 compared to group 1 due to a different
strategy in band filling. Follow-up to date shows that no problems with the pouch or the stoma have arisen in the esophagogastric
banding group. Conclusions: Laparoscopic adjustable esophagogastric banding is a simpler and safer procedure than laparoscopic
adjustable gastric banding. It also works as a very efficient anti-reflux procedure, at least in the short term. It appears
to be equally efficient as a weight-reducing operation as gastric banding. Further follow-up of the patients involved is necessary
in order to evaluate the results in the longer term. 相似文献
17.
Pinar Cigdem Arica Seval Aydin Ulgen Zengin Ahmet Kocael Anil Orhan Kagan Zengin 《Journal of investigative surgery》2018,31(2):89-95
Background: The aim of this study was to examine the relationship between weight loss and resistin, apelin, chemerin, and visfatin after laparoscopic adjustable gastric banding (LAGB). Methods: The study group consisted of 19 patients who were operated on for morbid obesity (BMI: 48.7 ± 6.6 kg/m2), and 22 healthy, normal-weight (BMI: 22.9 ± 2.5 kg/m2) subjects formed the control group. We obtained blood samples from the study subjects at three different times: before undergoing surgery and at one month and 6 months after surgery. Blood was obtained once from the control group. Results: Significant weight loss was achieved at one and 6 months after surgery. Plasma levels of apelin, resistin, chemerin, and visfatin were higher in morbidly obese patients compared with the control group. Obesity-related peptides decreased one month and 6 months after surgery. Conclusions: Elevated plasma resistin, apelin, chemerin, and visfatin levels in morbidly obese patients are gradually reduced after weight loss. According to these findings, LAGB surgery is found to be an important and efficient means for morbidly obese patients both to lose weight and to develop a better metabolic risk profile in a short time period. 相似文献
18.
Laparoscopic Adjustable Gastric Banding in 1,791 Consecutive Obese Patients: 12-Year Results 总被引:4,自引:0,他引:4
Favretti F Segato G Ashton D Busetto L De Luca M Mazza M Ceoloni A Banzato O Calo E Enzi G 《Obesity surgery》2007,17(2):168-175
Background This study examines 1,791 consecutive laparoscopic adjustable gastric banding (LAGB) procedures with up to 12 years follow-up.
Long-term results of LAGB with a high follow-up rate are not common.
Methods Between September 1993 and December 2005, 1,791 consecutive patients (75.1% women, mean age 38.7 years, mean weight 127.7 ± 24 kg,
mean BMI 46.2 ± 7.7) underwent LAGB by the same surgical team. Perigastric dissection was used in 77.8% of the patients, while
subsequently pars flaccida was used in 21.5% and a mixed approach in 0.8%. Data were analyzed according to co-morbidities,
conversion, shortand long-term complications and weight loss. Fluoroscopy-guided band adjustments were performed and patients
received intensive follow-up. The effects of LAGB on life expectancy were measured in a case/control study involving 821 surgically-treated
patients versus 821 treated by medical therapy.
Results Most common baseline co-morbidities (%) were hypertension (35.6), osteoarthritis (57.8), diabetes (22), dyslipidemia (27.1),
sleep apnea syndrome (31.4), depression (21.2), sweet eating (22.5) and binge eating (18.5). Conversion to open was 1.7%:
due to technical difficulties (1.2) and due to intraoperative complications (0.5).Together with the re-positioning of the
band, additional surgery was performed in 11.9% of the patients: hiatal hernia repair (2.4), cholecystectomy (7.8) and other
procedures (1.7). There was no mortality. Reoperation was required in 106 patients (5.9%): band removal 55 (3.7%), band repositioning
50 (2.7%), and other 1 (0.05%). Port-related complications occurred in 200 patietns (11.2%). 41 patients (2.3%) underwent
further surgery due to unsatisfactory results: removal of the band in 12 (0.7%), biliopancreatic diversion in 5 (0.27%) and
a biliopancreatic diversion with gastric preservation (“bandinaro”) in 24 (1.3%). Weight in kg was 103.7 ± 21.6, 102.5 ± 22.5,
105.0 ± 23.6, 106.8 ± 24.3, 103.3 ± 26.2 and 101.4 ± 27.1 at 1, 3, 5, 7, 9, 11 years after LAGB. BMI at the same intervals
was 37.7 ± 7.1, 37.2 ± 7.2, 38.1 ± 7.6, 38.5 ± 7.9, 37.5 ± 8.5 and 37.7 ± 9.1. The case/control study found a statistically
significant difference in survival in favor of the surgically-treated group.
Conclusions LAGB can achieve effective, safe and stable long-term weight loss. In experienced hands, the complication rate is low. Follow-up
is paramount.
Presented at the 11th World Congress of the International Federation for the Surgery of Obesity, Sydney, Australia, September
1, 2006. 相似文献
19.
Gitana Scozzari Eleonora Farinella Gisella Bonnet Mauro Toppino Mario Morino 《Obesity surgery》2009,19(8):1108-1115
Background Aim of the study is to present long-term results of a prospective randomized single-institution clinical trial comparing laparoscopic
adjustable silicone gastric banding (LASGB) with laparoscopic vertical banded gastroplasty (LVBG) in morbid obesity.
Methods A total of 100 morbidly obese patients (body mass index 40 to 50 kg/m2) were randomized to LASGB (n = 49) or LVBG (n = 51) and followed up for a minimum of 7 years.
Results Mean operative time was 65.4 min in LASGBs and 94.2 min in LVBGs (p < 0.05); mean hospital stay was 3.7 and 6.6 days, respectively (p < 0.05). Late complication rates were 36.7% in LASGBs vs 15.7% in LVBGs at 3 years (p < 0.05), 46.9% vs 43.1% at 5 years (NS), and 55.1% vs 47.1% at 7 years (NS). Late reoperation rates were 28.6% in LASGBs
and 2.0% in LVBGs at 3 years (p < 0.001), 38.8% and 2.0% at 5 years (p < 0.001), and 46.9% and 7.8% at 7 years (p < 0.001). Excess weight loss in LASGBs was 41.8% at 3 years, 33.2% at 5 years, and 29.9% at 7 years; excess weight loss in
LVBGs was 60.9%, 57%, and 53.1%, respectively (p < 0.05).
Conclusions This study demonstrates that in a carefully selected group of patients, LVBG is significantly more effective than LASGB in
terms of late complications, late reoperations, and long-term results on weight loss. 相似文献