共查询到20条相似文献,搜索用时 15 毫秒
1.
Adjustable Gastric Banding as a Revisional Bariatric Procedure after Failed Gastric Bypass 总被引:3,自引:0,他引:3
Background: Inadequate weight loss after proximal gastric bypass presents a clinical challenge to bariatric surgeons. Pouch
size, stoma size and limb length are the variables that can be surgically altered. Aside from conversion to distal bypass,
which may have significant negative nutritional sequelae, revisional surgery for this group of patients has not often been
reported. The addition of adjustable silicone gastric banding (ASGB) to Roux-en-Y gastric bypass (RYGBP) may be a useful revision
strategy because it has potential safety benefits over other revisional approaches. Materials and Methods: We report on 8
patients who presented with inadequate weight loss or significant weight regain after proximal gastric bypass. All patients
underwent revision with the placement of an ASGB around the proximal gastric pouch. Bands were adjusted at 6 weeks postoperatively
and beyond as needed. Complications and weight loss at the most recent follow-up visit were evaluated. Results: Mean age and
body mass index (BMI) at the time of revision were 39 ± 9.9 years and 44.0 ± 4.5 kg/m2 respectively. No patients were lost to follow-up, and they lost an average of 38.1 ± 10.4% and 44.0 ± 36.3% of excess weight
and 49.1 ± 20.9% and 52.0 ± 46.0% of excess BMI in 12 and 24 months respectively. Patients lost an average of 62.0 ± 20.5%
of excess weight from the combined surgeries in 67 (48–84) months. The only complication was the development of a seroma overlying
the area of the port adjustment in one patient. There have been no erosions or band slippages to date. Conclusions: These
results indicate that the addition of an ASGB causes significant weight loss in patients with poor weight loss outcome after
RYGBP. The fact that no anastomosis or change in absorption is required may make this an attractive revisional strategy. Long-
term evaluation in a larger population is warranted. 相似文献
2.
Background: Gastric pacing has gained popularity as an effective and safe minimally invasive procedure to treat morbid obesity.
This study evaluates the outcome of gastric pacing as a bariatric re-do procedure in patients who developed failure after
adjustable gastric banding (AGB) due to band migration. Methods: 8 patients were enrolled in this analysis. After implantation
of an AGB, they had developed band failure due to band migration. The implantable gastric stimulator (IGS) was implanted laparoscopically
as a second-line operation after gastroscopic removal of the band. Results: Median time (range) from AGB complication to implantation
of the IGS was 42 (10.3-50.3) months. During that time, all 8 patients had regained significant weight. All IGS devices could
be implanted laparoscopically, without intra- or perioperative complications. The minimal body weight following IGS implantation
was reached after 5 (0-12) months. The median observation time was 23 (11.3-27.5) months. 1 year after IGS implantation (n=7),
median weight was 116 (98-165) kg, equivalent to a median BMI of 41.1 (36.055.8) kg/m2, which is not statistically different to preoperative values and therefore prompted us to stop our ongoing trial. In all
but 2 patients, the IGS device was explanted. During the same procedure, patients underwent a gastric sleeve resection (n=4)
or a Roux-en-Y gastric bypass (n=2). Conclusion: The implantation of an IGS was an ineffective second-line operation after
AGB migration. 相似文献
3.
Revision of Failed Laparoscopic Adjustable Gastric Banding to Roux-en-Y Gastric Bypass 总被引:3,自引:3,他引:0
Background: The most common bariatric surgical operation in Europe, laparoscopic adjustable gastric banding (LAGB), is reported
to have a high incidence of long-term complications. Also, insufficient weight loss is reported. We investigated whether revision
to Roux-en-Y gastric bypass (RYGBP) is a safe and effective therapy for failed LAGB and for further weight loss. Methods:
From Jan 1999 to May 2004, 613 patients underwent LAGB. Of these, 47 underwent later revisional Roux-en-Y gastric bypass (RYGBP).
Using a prospectively collected database, we analyzed these revisions. All procedures were done by two surgeons with extensive
experience in bariatric surgery. Results: All patients were treated with laparoscopic (n=26) or open (n=21) RYGBP after failed
LAGB. Total follow-up after LAGB was 5.5±2.0 years. For the RYGBP, mean operating time was 161±53 minutes, estimated blood
loss was 219±329 ml, and hospital stay was 6.7±4.5 days. There has been no mortality. Early complications occurred in 17%.
There was only one late complication (2%) – a ventral hernia. The mean BMI prior to any form of bariatric surgery was 49.2±9.3
kg/m2, and decreased to 45.8±8.9 kg/m2 after LAGB and was again reduced to 37.7±8.7 kg/m2 after RYGBP within our follow-up period. Conclusion: Conversion of LAGB to RYGBP is effective to treat complications of LAGB
and to further reduce the weight to healthier levels in morbidly obese patients. 相似文献
4.
Zappa MA Micheletto G Lattuada E Mozzi E Spinola A Meco M Roviaro G Doldi SB 《Obesity surgery》2006,16(2):132-136
Background: The major long-term complication of laparoscopic adjustable gastric banding (LAGB) is dilatation of the gastric
pouch, that is reported with a frequency ranging from 1 to 25%, and often requires removal of the band. In addition to the
usual recommendations of bariatric surgery centers and dietetic advice to prevent this complication, over the last 4 years
we introduced a technical modification of the procedure. Methods: From Nov 1993 to Dec 2004, 684 morbidly obese patients underwent
adjustable gastric banding, 83 patients by open surgery and 601 patients by laparoscopy. The first 323 patients (group A)
were operated by the perigastric approach, and 57 patients (group B) were operated by the pars flaccida approach. Since Dec
2000, 304 patients (group C) were operated with a modified pars flaccida technique, which consisted in suturing the gastric
lesser curvature below the band with one or two stitches to the right phrenic crus to secure the band in place. Results: In
group A, the most important late complication was irreversible dilatation of the gastric pouch, which occurred in 35 patients
(10.8%), and required removal of the band in 30 cases and replacement in 5. In group B, there were 3 pouch dilatations (5.2%).
In group C, only 4 dilatations occurred (1.31%), which required 3 band removals and 1 band replacement. Conclusion: Dilatation
of the gastric pouch appears to be dramatically reduced by our minor technical modification of band placement. 相似文献
5.
Background: Laparoscopic adjustable gastric banding is a popular bariatric operation in Europe. However, the long-term complication
rate and weight loss are still unclear. Methods: 824 patients underwent a laparoscopic Swedish Adjustable Gastric Banding
(SAGB) in a 5-year period. Preoperative data, postoperative weight loss and long-term complications were prospectively obtained
for analysis. Results: Mean age of the 824 patients was 43 ± 1 years, with mean preoperative BMI 43 ± 1 kg/m2. No intra- or postoperative death occurred in the first 30 postoperative days. Intraoperative conversion rate was 5.2%. Peri-operative
complication rate was 1.2%. 97% of the patients were available for follow-up (maximum 5 years). Long-term complications occurred
in 191 patients (23.2%). 135 complications (16.4%) were related to the band, and 56 (6.8%) to the access-port or to the tube.
Mean excess weight loss was 30, 41, 49, 55 and 57 % after 1, 2, 3, 4 and 5 years respectively. 82.9% of the patients obtained
>50% EWL after initial treatment. Conclusions: The results of this study suggest that laparoscopic SAGB can achieve an effective
weight loss, with an acceptable mortality and morbidity rate. 相似文献
6.
Background: Laparoscopic adjustable gastric banding (LAGB) was started in Hungary in 1998. We used Lap-Band and SAGB devices.
In this study we present our experience through the learning curve. Methods: From Jan 1999 to Dec 2002, 54 patients underwent
laparoscopic surgery for morbid obesity in our department, using the Lap-Band? and SAGB. There were 33 men and 21 women, with
median age 42 (range 20-64), and preoperative BMI 50 kg/m2 (range 41-66). All underwent LAGB, except one patient who had laparoscopic vertical banded gastroplasty.The procedures used
the 4-trocar technique. Results: The first patient required reoperation because of gastric rupture from drinking sparkling
mineral water despite of our advice. Excluding this, we had no intraoperative or short-term postoperative complications. Mean
operating time was 82 minutes (range 55-192), and hospital stay was 3 days. Followup ranges from 1 to 36 months. Mean weight
loss was 47 kg at 12 months and 67 kg at 36 months. Mean BMI fell to 29 kg/m2. Conclusion:With its safety and effectiveness, LAGB has been a good choice for handling morbidly obese patients in our early
experience. 相似文献
7.
Weiss HG Nehoda H Labeck B Peer-Kuehberger R Oberwalder M Aigner F Wetscher GJ 《Obesity surgery》2002,12(4):573-578
Background: Adjustable gastric banding and esophagogastric banding may affect the function of the lower esophageal sphincter
(LES) and esophageal motility in the long-term. Both methods were evaluated in a prospective randomized trial. Materials and
Methods: Group 1 comprised 28 patients who underwent laparoscopic adjustable gastric banding and Group 2 consisted of 24 patients
in whom adjustable esophagogastric banding was performed. Swedish Adjustable Gastric Bands? were used in all patients. Body
mass index (BMI), perioperative complications and reflux symptoms were assessed and upper gastrointestinal endoscopy, esophageal
barium studies, esophageal manometry and 24-hour esophageal pH-monitoring were performed pre- and postoperatively. 18 (Group
1) and 14 (Group 2) patients completed the postoperative follow-up procedure after a median of 23 and 24 months, respectively.
Results: Postoperatively the median BMI dropped equally in both groups. Perioperative complications requiring re-intervention
were significantly more frequent in Group 2 than in Group 1. Heartburn improved equally in both groups following surgery;
however, regurgitation and esophagitis were significantly more common in Group 2 than in Group 1.24-hour esophageal pH-monitoring
and the LES resting pressure improved equally in both groups, but there was a significant impairment of the LES relaxation
and the esophageal peristalsis, which was more pronounced in Group 2 than in Group 1. This caused significant esophageal stasis
as shown by barium studies. Conclusions: Both techniques, gastric and esophagogastric banding, provide effective weight loss
in morbidly obese patients but affect the esophagogastric junction. Although both procedures strengthen the antireflux-barrier,
LES relaxation becomes impaired, thus promoting esophageal dilatation and esophageal stasis. This is more pronounced following
esophagogastric banding than following the classic procedure. Since the esophagogastric banding results in more complications
requiring re-intervention, we believe that this procedure should not be used any more. 相似文献
8.
Watkins BM Montgomery KF Ahroni JH Erlitz MD Abrams RE Scurlock JE 《Obesity surgery》2005,15(7):1045-1049
Background: We report our early experience with 343 consecutive patients who underwent laparoscopic adjustable gastric banding
(LAGB) as an outpatient procedure in a self-standing ambulatory surgery center. Methods: Between Apr 2003 and Feb 2005, data
was collected prospectively on 343 consecutive patients who underwent LAGB as an outpatient. Results: There were 305 females
(88.9%) and 38 males (11.1%), with mean age 43.5 years (±SD 9.9, range 19-67) and mean BMI 44.5 kg/m 2 (±SD 6.1, range 32.7-62.7).
Mean operating-room time was 52.9 (±16.3) minutes. 10 complications occurred in 9 patients (2.8%): 5 stoma occlusion, 3 port
problems requiring port replacement, 1 superficial wound infection, and 1 colon perforation associated with adhesiolysis requiring
band removal. 3 patients required admission to the hospital: 1 for nausea, 1 for observation after bloody nasogastric tube
drainage, and 1 for dysphagia due to esophageal spasm. All 9 patients with complications recovered fully. 1-year weight loss
data was available in 91 patients; mean percent excess weight lost (%EWL) at 1 year was 45.4% (±17.6). Conclusions: LAGB has
become an appropriate outpatient procedure in select patients. 相似文献
9.
Laparoscopic Adjustable Gastric Banding for Severe Obesity 总被引:1,自引:0,他引:1
Background: Morbid obesity is an increasingly common condition with serious associated morbidity and decreased life expectancy.
The only treatment with long-term efficacy for this condition is surgical intervention. Laparoscopic adjustable gastric banding
(LAGB) is a procedure increasingly performed in European centres and recently approved by the FDA in USA. This article reviews
its effectiveness and complications. Methods: A literature search identified relevant articles. Results: LAGB results in approximately
60% (43-78%) excess weight loss at 3 years with improvement in co-morbidities, with perioperative mortality <0.5%. Potential
complications include prolapse or pouch dilatation, and port-related complications. Less common complications are intra-operative
gastric perforation and band erosion. Rate of reoperation varies greatly between series, and is usually needed for band repositioning
or port-related procedures, many of the latter performed under local anesthesia. Conclusion: The available data demonstrate
that LAGB is a safe bariatric procedure, and is effective in the short- and medium-term. Results of long-term follow-up are
awaited. 相似文献
10.
Background: The reporting on outcome following bariatric procedures should include changes in comorbid conditions and quality
of life (QOL), in addition to weight loss. The Bariatric Analysis and Reporting Outcome System (BAROS) appears to provide
the means to fulfil these requests. We have re-evaluated our previously published, initial results of laparoscopic adjustable
gastric banding, using BAROS. Methods: Our first 60 consecutive patients were treated laparoscopically between the years 1996
and 1999, using the Swedish Adjustable Gastric Band (SAGB). After a minimum follow-up of ≥ 17 months (median follow-up 28
months, range 17-61 months), a postal questionnaire concerning QOL, medical condition and excess weight loss (BAROS) was sent
to the patients. In addition, the patients' opinion regarding the operation was evaluated as well as the extent that the band
had caused the patients any of the more common side-effects. Results: 87% of the patients returned the questionnaire properly
answered. According to BAROS, the outcome was regarded as VERY GOOD in 12% of patients, GOOD in 38%, FAIR in 29% and FAILURE
in 21%. Not one had an EXCELLENT outcome. 23% of the patients were disappointed with their operation. The incidence of band-related
side-effects was high. Conclusion: Our results are comparable with other published series including the learning curve. In
our opinion, BAROS should be widely adopted. 相似文献
11.
Background: From 1993 to 1999, 172 patients underwent adjustable silicone gastric banding (ASGB) or laparoscopic adjustable
silicone gastric banding (LASGB). In 109 patients the adjustable band was placed via laparoscopy; in the other patients it
was placed via laparotomy (prelaparoscopic era, conversions from other bariatric operations, conversions for laparoscopic
failure). The conversion rate from laparoscopy to laparotomy was 9.3%, occurring in the early part of our experience. Methods:
Mean age was 37.9 years, weight 135 ± 14.8 kg (82-218) and BMI 46.3 ± 5.4 (35.1-69.5). All patients had multiple band adjustments,
temporary antisecretive, electrolyte and vitamin therapy, and follow-up per routine. Results: Weight loss at 3 years was 30.2%;
mean percent loss of excess weight was 62.5%.There was no mortality.The most important technical complications were: gastric
pouch dilatation that required band replacement or removal (5.8 %); mild gastric pouch dilatation reversible with adequate
dietary and pharmacological treatment (4.6%); intraoperative gastric perforation (2.3%); band migration (0.6%).The band was
removed in 2.3%, with conversion to another bariatric procedure in 1.1%. Conclusions: Results have been satisfactory thus
far. 相似文献
12.
Feasibility of Laparoscopic Sleeve Gastrectomy as a Revision Procedure for Prior Laparoscopic Gastric Banding 总被引:8,自引:1,他引:8
Bernante P Foletto M Busetto L Pomerri F Pesenti FF Pelizzo MR Nitti D 《Obesity surgery》2006,16(10):1327-1330
Background: Laparoscopic sleeve gastrectomy (LSG), initially described by Gagner's group as the first stage of the laparoscopic
duodenal switch in super-obese patients, is now gaining wide diffusion among bariatric surgeons as a new restrictive operation.
Methods: From January 2005 to January 2006, 8 obese patients with BMI 37-74 kg/m2 underwent LSG for conversion from a prior complicated or failed laparoscopic adjustable gastric banding (LAGB). Three patients
had severe symptomatic esophageal dilation, while 5 patients had unsuccessful weight loss with poor "band compliance". After
de-banding, LSG was calibrated upon a 34-Fr gastric bougie, and blue and green linear staplers were used. The staple-line
was buttressed by placing a sero-serosal running suture in all but one patient, and methylene blue dye was used to test for
leaks. All the patients underwent upper GI series with water-soluble contrast medium 2 days after the surgery. Results: The
average operating-time for LSG was 90 minutes (range 60-120 min). The average hospital stay was 4 days (range 3-7). There
were no perioperative complications, no conversion, and no mortality. No intraoperative or postoperative blood transfusions
were required. Conclusions: LSG proved to be feasible and safe after LAGB. Longer follow-up and larger series are needed to
assess weight loss results. 相似文献
13.
A 42-year-old woman presented with intractable crampy abdominal pain continuing for 1 year. The pain worsened after eating
and improved when walking. She had undergone laparoscopic adjustable gastric banding 4 years previously, with re-banding 18
months later because of anterior band slippage. The patient underwent numerous examinations, all with normal findings. A scintigraphy
finally showed some tracer enrichment in the terminal ileum, which led to the assumption that a Meckel's diverticulum was
causing her discomfort. Subsequent diagnostic laparoscopy showed no Meckel's diverticulum but instead displaced tubing, which
was wrapped around the mesenteric root. The mesenteric root showed scarred alterations from chronic strangulation. After replacing
the tubing from the band the abdominal pain immediately vanished. In retrospect, the contrast study of the gastric band shows
unnatural traction of the tubing towards the lower abdomen, allowing suspicion of the intraoperative findings. 相似文献
14.
Gastric bezoars may be formed in the normal stomach as a result of foreign body consecrations of various objects with inability
to pass through the pylorus. Classically, most bezoars occur as a complication of gastric surgery which creates a low acid
environment, decreased peristalsis, and abnormal pyloric function. Bariatric surgery has been associated with a low incidence
of bezoar formation. However, to date there has been no documentation of bezoars occurring after laparoscopic adjustable gastric
banding, which is one of the surgical options available for the treatment of morbid obesity. We report a case of a gastric
bezoar that occurred 8 months after gastric banding. 相似文献
15.
Adjustable Gastric Banding: Assessment of Safety and Efficacy of Bolus-Filling during Follow-Up 总被引:1,自引:0,他引:1
Kirchmayr W Klaus A Mühlmann G Mittermair R Bonatti H Aigner F Weiss H 《Obesity surgery》2004,14(3):387-391
Background: Individual band-filling on demand of the morbidly obese patient is a major advantage of adjustable gastric banding. An increasing
number of patients results in an enormous amount of outpatient follow-up visits, which inspired us to compare a stepwise band-filling
strategy with a single bolus injection 4 weeks after the operative procedure. Methods: 40 consecutive patients were prospectively randomized in 2 groups. 20 patients (Group A) had stepwise band-filling during
6 monthly ambulant visits. 20 patients (Group B) had a bolus-filling 4 weeks postoperatively and had the next follow-up after
another 5 months. Weight loss, complications and procedural costs during follow-up were compared. Results: Patients of both groups did not differ in age, gender or preoperative BMI.There was no significant difference postoperatively
in excess weight lost (EWL) after 9 months. Postoperative complications did not differ significantly.By means of bolus-filling,
a 60% and 53% reduction in outpatient clinical work was achieved within the 6 and 9 months, respectively. Conclusion: Postoperative management after gastric banding takes advantage of a single bolus-filling during the first postoperative
6 months due to sufficient weight loss, low complication rate but significant reduction of personal, financial and logistic
efforts. 相似文献
16.
Background: Leakage of a laparoscopically placed Swedish adjustable gastric band (SAGB) was observed 2 1/2 years after placement.
The band was evaluated for mechanical inaccuracies by a laboratory. Methods: The ruptured SAGB was investigated microscopically
and wall thicknesses were measured. An unused SAGB was tested, both empty and filled, for mechanical deformity after exposure
to saline solution. Results: A permanent transformation of the silicone rubber was found, caused by bowing of the device.
2 tears were present at the end of a kink.The mean wall thickness was within acceptable limits. Exposure of the gastric band
to saline solution did not cause any sign of permanent deformity of the silicone rubber. Conclusion:The rupture of the gastric
band did not seem to be caused by a production error. Long-term deformity, in combination with a continuous dynamic load,
may increase the risk of tearing. Long-term follow up is recommended for patients treated with this device. 相似文献
17.
Pregnancies after Adjustable Gastric Banding 总被引:4,自引:0,他引:4
Helmut G Weiss MD Hermann Nehoda MD Burkhard Labeck MD Katherine Hourmont MD Christian Marth MD PhD Franz Aigner MD 《Obesity surgery》2001,11(3):303-306
Background: We evaluated outcome of pregnancies of morbidly obese women who are within the first 2 years after laparoscopic
adjustable gastric banding. Methods: 215 morbidly obese women of reproductive potential (age 18-45 years), who had agreed
to remain on reliable contraceptives for 2 years after surgery, were retrospectively analyzed following bariatric surgery.
Results: 7 unexpected pregnancies were observed. 5 pregnancies were full-term (3 vaginal and 2 cesarean deliveries). The birth
weights ranged from 2110 g to 3860 g. 2 women had first trimester miscarriages. All gastric bands were completely decompressed
due to nausea and vomiting, resulting in further weight gain. 2 serious band complications were observed (1 intragastric band
migration and 1 balloon defect), which required re-operation. Conclusions: Pregnancy in morbidly obese women soon after adjustable
gastric banding may occur unexpectedly during a period of weight loss. Prophylactic fluid removal from the band eliminates
the efficacy of the obesity treatment. Moreover, this cohort shows an increased incidence of spontaneous abortions and band-related
complications. 相似文献
18.
Ventienen B Vaneerdeweg W D'Hoore A Hubens G Chapelle T Eyskens E 《Obesity surgery》2000,10(5):474-476
Intragastric erosion of the adjustable silicone gastric band (ASGB) is a rare but severe complication of gastric banding,
often leading to reoperation. We describe our experience with 4 cases referred to us. The best timing of removal and the choice
of another bariatric procedure is still controversial. We advise to wait until migration of the band into the lumen is complete.
With removal of the ASGB if another weight reduction procedure is advisable, conversion to a biliopancreatic diversion is
possible. 相似文献
19.
Rutledge R 《Obesity surgery》2006,16(4):521-523
Background: Although laparoscopic adjustable gastric banding (LAGB) has been found to be a generally successful weight loss
operation, there are reports of occasional LAGB failure. The results of rescue procedures for these patients are important.
The mini-gastric bypass (MGB) is a safe and effective alternative to other bariatric surgical procedures. We report the results
of conversion of 3 failed LAGB procedures to MGB. Methods: In a series of 2,595 patients who underwent MGB, 3 had previously
undergone an LAGB that failed to sustain weight loss. Results: Average operative time was 54 minutes in LAGB conversions to
MGB (compared to 37.5 minutes in primary MGB), and length of stay was 1 day. There were no complications in the patients converted
MGB. The weight loss in converted MGB patients was similar to the weight loss in primary MGB patients, with a mean weight
loss at 1 year of 60 kg (79% of excess weight) Conclusion: Conversion of failed LAGB to MGB was a safe procedure that added
∼20 minutes to the short MGB operating time. Patient satisfaction was high, recovery was rapid, and weight loss was very good. 相似文献
20.
Pouch Dilatation after Gastric Banding Causing Gastric Necrosis 总被引:1,自引:1,他引:0
Werner Kirchmayr MD Karlheinz Ammann MD Franz Aigner MD Helmut G Weiss MD Hermann Nehoda MD 《Obesity surgery》2001,11(6):770-772
Background: Early or late pouch dilatations account for a moderate complication rate after restrictive bariatric operations.
Various strategies were developed to prevent or treat pouch dilatations. Methods: A case of necrosis of gastric wall in a
concentric dilated pouch following laparoscopic adjustable gastric banding is reported as a severe complication of a conservative
treatment attempt. Results: Emergency laparotomy resulted in band removal, partial gastric resection and prolonged hospital
stay. Conclusion: Conservative strategies in the treatment of pouch dilatations bear the risk of complications, with both
failure of the bariatric procedure and critical clinical course. Indication for early operative reintervention is recommended. 相似文献