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1.
J. Esteban Varela 《Obesity surgery》2010,20(2):244-246
Laparoscopic adjustable gastric banding has become a popular bariatric restrictive procedure in the USA. The increasing popularity
of the laparoscopic adjustable gastric band procedure could, in part, be related to the lower cost and lower morbidity compared
with laparoscopic gastric bypass. Although its placement is related to a lower number of perioperative complications compared
with laparoscopic gastric bypass, its morbidity may be substantial. Barrett’s esophagus or esophageal intestinal metaplasia
is a known complication of chronic gastro-esophageal reflux disease that, in rare occasions, progresses to dysplasia and esophageal
adenocarcinoma. Barrett’s esophagus, after laparoscopic adjustable gastric banding placement, is a rare but not unexpected
complication after gastric band placement. The incidence of Barrett’s esophagus after adjustable gastric banding is not known.
We present a case of Barrett’s esophagus as a result of laparoscopic adjustable gastric banding placement due to a chronically
and highly restrictive gastric band in a former morbidly obese patient. 相似文献
2.
One of the most significant complications of the gastric banding procedure is gastric prolapse. However, pouch necrosis after
gastric prolapse is an extremely rare complication. We present the case of a morbidly obese 41-year-old woman who had had
a laparoscopic adjustable gastric banding procedure 3 years before. She developed a pouch necrosis after a late gastric prolapse.
After failure of conservative treatment, a diagnostic laparoscopy was performed. This resulted in removal of the band and
the diagnosis of pouch necrosis. A laparotomy was indicated and a sleeve gastrectomy was performed. A delay in the diagnosis
of gastric prolapse can lead to major complications. Initial referral to a specialized center is necessary for proper care
of this complication. Failure of conservative treatment mandates early operative intervention. 相似文献
3.
Pantea S Pantea C Duţă C Mureşan C Micluş M Lazăr F Nediglea I Papurică M Bordoş D 《Chirurgia (Bucharest, Romania : 1990)》2011,106(1):109-112
In the last years, laparoscopic gastric banding has become a popular surgical option for morbidly obese patients, because of the minimally invasive and easy surgical technique, its reversibility, and the possibility to calibrate the stoma. Gastric necrosis, as a complication of laparoscopic gastric banding, has been rarely reported. We present the case of a 34 -year-old pregnant patient (18 week pregnancy) with 5 days history of abdominal pain. She had undergone laparoscopic adjustable gastric banding 24 months earlier with a body mass index (BMI) of 43 kg/m2. Diagnostic workup was very difficult because the patient was pregnant and we can use only ultrasonography and clinically signs. After initial conservative management, the patient underwent urgent surgery and we found an anterior gastric prolapse through the band with necrosis of the herniated stomach. A longitudinal (sleeve) gastrectomy was performed. The postoperative evolution was god and the patient left our clinic after 9 day. Emergency sleeve gastrectomy could represent a good option to treat, in a safe way. 相似文献
4.
A leak after an esophagectomy can lead to significant morbidity and mortality. The treatment options for postoperative leaks include reoperation with pleural drainage and placement of T-tube drainage catheter to control the gastrointestinal leak or complete gastrointestinal diversion, depending on the extent of the leak and tissue viability of the gastric conduit. Both these options require an invasive reoperation. In selected cases, endoscopic deployment of a covered esophageal stent may be an effective minimally invasive option in the management of an esophageal leak. This report describes the indications and techniques for management of an esophageal leak using the natural orifice for drainage of a mediastinal abscess and deployment of an esophageal stent. 相似文献
5.
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
6.
In this case report, we present an 18-year-old morbidly obese male with complicating hypertensive cardiomyopathy who underwent
laparoscopic adjustable gastric band surgery. The patient had multiple comorbidities associated with his obesity, including
obstructive sleep apnea, systemic hypertension, asthma, and depression. Given the severity of his underlying cardiac pathology
and multiple previously unsuccessful attempts at weight loss with conventional medical and behavioral therapy, the patient
opted to proceed with surgical intervention. We present this laparoscopic adjustable gastric banding surgical case to demonstrate
the impact of surgical weight reduction on cardiac risk factors in a morbidly obese adolescent, highlighting the viability
of this surgery for patients with existing cardiac dysfunction. 相似文献
7.
Laparoscopic vertical banded gastroplasty 总被引:1,自引:0,他引:1
Nocca D Aggarwal R Blanc P Gallix B Di Mauro GL Millat B Seguin des De Hons C Deneve E Rodier JG Tincani G Pierredon MA Fabre JM 《Surgical endoscopy》2007,21(6):870-874
Background The commonest surgical procedure for management of morbid obesity in Europe is laparoscopic adjustable gastric banding (LAGB),
even though laparoscopic vertical banded gastroplasty (LVBG) is still considered to be a gold standard restrictive option
in bariatric surgery. A multicenter prospective study was designed to to assess the efficacy of LVBG in terms of weight loss
and complication rates for obese patients who have indications for a restrictive procedure.
Patients and methods Two-hundred morbidly obese patients (84.5% female) with a mean age of 41 years and mean body mass index (BMI) of 43.2 kg/m2 underwent LVBG as described by MacLean. Five trocars were placed in standard positions as per laparoscopic upper gastrointestinal
surgery. A vertical gastric pouch (30 ml) was created with circular (21 or 25mm) and endolinear stapling techniques, enabling
definitive separation of the two parts of the stomach. The gastric outlet was calibrated with either a polypropylene mesh
(5.5 cm in length and 1cm in width) or a nonadjustable silicone band. The median follow-up period was 30 months (range, 1–72
months).
Results One case had to be converted to open surgery (gastric perforation) and there was one death secondary to peritonitis of unknown
etiology. The morbidity rate was 24%, comprising the following complications: gastric outlet stenosis (8%); staple line leak
(2.5%); food trapping (1.5%); peritonitis (1%); thrombophlebitis (1.5%); pulmonary embolism (0.5%); and gastroesophageal reflux
(9%). The excess weight loss achieved was 56.7% (1 year), 68.3% (2 years), and 65.1% (3 years).
Conclusions Laparoscopic vertical banded gastroplasty is an effective procedure for the surgical management of morbid obesity, especially
for patients who present hyperphagia but are unable to manage the constraints of adjustable gastric banding. Laparoscopic
vertical banded gastroplasty is safe, as demonstrated by an acceptable complication rate, of which gastric outlet stenosis,
staple line leakage, and gastroesophageal reflux predominate. 相似文献
8.
G. PAPADIMITRIOU K. VARDAS G. KYRIAKOPOULOS K. ALFARAS P. ALFARAS 《Il Giornale di chirurgia》2015,36(2):70-73
Laparoscopic adjustable gastric band (LAGB) is one of the most popular bariatric surgical procedures both in Europe and United States, because it is considered to be a safe and effective way of treating morbid obesity. This minimally invasive frequently employed bariatric procedure has many reported complications, but only a few cases of esophageal perforation have been reported. We present a case of iatrogenic esophageal perforation in an 18-year-old patient occurring during attempt to place an adjustable gastric band laparoscopically, which was diagnosed intraoperatively. Conversion to open sleeve gastrectomy with primary suturing of the perforation and drainage were performed. On the early postoperative period leak from the intra-abdominal part of the esophagus was diagnosed and treated with endoscopic placement of a self-expandable metal stent.After 2-years of follow-up the patient continues to have no sequelae from the perforation or symptoms of dysphagia, while Excess Weight Loss is 74%. 相似文献
9.
A morbidly obese 42-year-old woman presented with a 1-week history of left chest pain. She had undergone laparoscopic adjustable
gastric banding 16 months earlier with a body mass index (BMI) of 49.2 kg/m2. Diagnostic workup revealed a large left pleural empyema and ruled out band slippage. At left thoracotomy, a misdiagnosed
type II paraesophageal strangulated hernia with gastric necrosis and large perforation of the fundus was evident. At laparotomy,
the band was removed, the stomach was reduced into the abdomen, and a sleeve gastrectomy was performed. Her postoperative
course was uneventful, and 6 months after surgery, her BMI is 31 kg/m2. Emergency sleeve gastrectomy could represent a good option to treat, at the same time and in a safe way, both gastric necrosis
and paraesophageal hernia, improving the good results in terms of weight loss after gastric restriction from gastric banding. 相似文献
10.
A. Segalin L. Bonavina M. Lazzerini F. De Ruberto C. Faranda A. Peracchia 《Surgical endoscopy》1996,10(9):928-932
The endoscopic management of four selected patients with inveterate esophageal perforations or leaks is presented. One patient had a perforation of the cervical esophagus following endoscopic removal of a foreign body already treated with surgical drainage; two patients had a leak following diverticulectomy and esophagogastrostomy, respectively, persistent after multiple surgical repairs; the last patient had a spontaneous perforation of the thoracic esophagus persistent after two transthoracic repairs. The mean time elapsed between the diagnosis of perforation and the endoscopic treatment was 19 days. In one patient, transesophageal drainage of a mediastinal abscess was performed. In the other three patients, a stent was placed to seal the leak in combination with gastric and esophageal aspiration. Two of these patients underwent endoscopy in critical condition and could have not been candidates for major surgical procedures. All patients received enteral nutrition. No morbidity or mortality related to the endoscopic procedure was recorded; the treatment was effective in all patients who recovered and resumed oral feeding within 3 weeks. We conclude that endoscopic transesophageal drainage and stenting are effective procedures in the management of patients with inveterate esophageal perforations or leaks. 相似文献
11.
In the last decade, laparoscopic gastric banding has become an increasingly popular surgical option for morbidly obese patients,
because of the minimally invasive and easy surgical technique, its reversibility, and the possibility to calibrate the stoma.
Gastric necrosis, as a complication of laparoscopic gastric banding, has been only rarely reported. Herein described is the
case of a 45-year-old obese patient with gastric necrosis occurring 2 years after the placement of the band. After initial
conservative management, the patient underwent urgent surgery. A huge anterior gastric prolapse through the band was found
to be responsible for necrosis of the herniated stomach. An upper polar gastrectomy was performed. The mechanisms responsible
for this life-threatening complication are discussed. 相似文献
12.
Laparoscopic Sleeve Gastrectomy: Standardized Technique of a Potential Stand-alone Bariatric Procedure in Morbidly Obese Patients 总被引:2,自引:0,他引:2
Kueper MA Kramer KM Kirschniak A Königsrainer A Pointner R Granderath FA 《World journal of surgery》2008,32(7):1462-1465
BACKGROUND: The aim of this study was to define a standardized technique for laparoscopic sleeve gastrectomy in the morbidly obese patient. METHODS: There are several surgical options for the morbidy obese patient. In general, there are the restrictive procedures [e.g., laparoscopic adjustable gastric banding (LAGB)] and the malabsorptive procedures [e.g. laparoscopic Roux-en-Y gastric bypass (LRYGBP)]. Those techniques are already standardized. The laparoscopic sleeve gastrectomy (LSG) seems to have some advantages over both procedures, but it is not standardized yet, and so there can be no comparison between the different techniques. In our center we have standardized the LSG technique with respect to abdominal access and narrowness of the gastric sleeve. After dissection of the greater omentum and the short gastric vessels, the greater curvature is resected along a 34-Fr gastric tube using the Endo-GIA. The remaining gastric sleeve has a volume of about 100 ml. RESULTS: The standardized LSG procedure is presented step by step. A comparison of operative data and early outcome with a matched group of patients with adjustable gastric banding showed no difference between the two techniques with respect to operating time, surgical complications, and weight loss 6 months after surgery. CONCLUSION: With our standardized LSG technique it is possible to evaluate the positive aspects of the LSG compared with other standardized bariatric procedures like LAGB or LRYGBP. 相似文献
13.
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
14.
Gelisgen R Zengin K Kocael A Baysal B Kocael P Erman H Taskın M Uzun H 《Obesity surgery》2012,22(2):299-305
Background
It has been proposed that laparoscopic adjustable gastric banding (LAGB) procedure might play a role in modulation of fundic ghrelin production. To test this hypothesis, we examined plasma and tissue concentrations of acylated ghrelin in morbidly obese patients before and 6 months after LAGB. Baseline levels of acylated ghrelin in morbidly obese patients were also compared with those in age-matched, healthy, non-obese controls. 相似文献15.
Background: Laparoscopy in severely obese patients is a surgical challenge due to the deep operative field, massive visceral
fat, hypertrophic and steatotic liver and inadequate instrumentation. However, performing bariatric surgery by laparoscopy
permits a minimally invasive procedure in patients who are usually considered high risk because of their morbid obesity.The
challenge was to overcome technical difficulties of laparoscopy in the morbidly obese. Method: We needed to develop a new
surgical protocol for the gastric approach in severely obese patients. The existing silicone band could not be used for laparoscopy,and
a new prototype of the silicone band for laparoscopic use was designed. Because of ethical reasons, we began this work on
the animal model. In an animal lab program using pigs, we refined the surgical technique of the laparoscopic approach. A new
design of the adjustable silicone band for laparoscopic use was developed. Results: After a 1-year animal lab program and
approval by the ethics committee, we performed our first human laparoscopic adjustable gastric banding on September 1st, 1993.
Conclusion: The development of the Lap-Band? from concept to animal lab, ending in clinical application, has been an advance in bariatric surgery. 相似文献
16.
Subhashini M. Ayloo Mario A. Masrur Gianmarco Contino Mohamed El Zaeedi Pier C. Giulianotti 《Surgery for obesity and related diseases》2013,9(5):696-700
BackgroundIn an effort to provide better cosmesis for patients, there has been a surge recently in the use of laparoendoscopic single-site adjustable gastric banding. Few data, however, are available on the long-term wound complications resulting from this technique. We conducted a retrospective review of patients to identify the extent of wound complications found during a minimum follow-up period of 2 years after laparoendoscopic single-site adjustable gastric banding. The complications evaluated included infection, hernia rates, and port and tubing complications. All the laparoendoscopic single-site adjustable gastric banding cases were performed at University of Illinois Medical Center by a single surgeon.MethodsTwenty-five patients underwent single-site laparoscopic adjustable gastric banding from March 2009 to January 2010, and the data were reviewed retrospectively. The single incision was made with multifascial trocar placement using conventional laparoscopic instruments. The patients were followed up during band adjustments and clinic visits and by telephone interview.ResultsSix months after surgery, 1 patient required port removal because of port site infection with internalization of the tubing. A second patient experienced a foul-smelling, clear discharge and was treated with antibiotics, with no additional consequences. No incisional hernias or flipped ports were noted.ConclusionIn our experience, laparoendoscopic single-site adjustable gastric banding produced a low rate of port and wound site complications in patients during a minimum follow-up period of 2 years. We believe this is a valid alternative to the standard procedure, providing cosmetic advantages and a low wound complication rate in morbidly obese patients. 相似文献
17.
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
18.
Carlos Zerrweck Robert Caiazzo Laurent Arnalsteen Guélareh Dezfoulian Henry Porte François Pattou 《Obesity surgery》2009,19(5):667-670
Laparoscopic adjustable gastric banding is one of the most frequently performed bariatric procedures because of its low operative
risk and morbidity. Postoperative chylothorax has never been reported following bariatric surgery. We present the case of
a 41-year-old woman who developed a massive right chylothorax after a laparoscopic gastric banding, whose lymphogram showed
thoracic duct disruption. Good outcome was achieved after thoracoscopy approach with duct ligation. Although rare, chylothorax
is a severe complication, and surgeons must be aware of anatomic landmarks. Chyle leak could be under-diagnosed in postoperative
uncomplicated pleural effusions. 相似文献
19.
Band Erosion Following Gastric Banding: How to Treat It 总被引:3,自引:3,他引:0
Lattuada E Zappa MA Mozzi E Fichera G Granelli P De Ruberto F Antonini I Radaelli S Roviaro G 《Obesity surgery》2007,17(3):329-333
Background Intragastric band migration is an unusual but major long-term complication of gastric banding: its frequency ranges from 0.5–3.8%
and always requires removal of the band. Different laparoscopic, laparotomic or endoscopic methods are currently used for
band removal.
Methods 571 morbidly obese patients underwent adjustable gastric banding from February 1998 to July 2006. Band erosion occurred in
3 patients (0.52%). In addition, 6 such patients were referred to our Department from other hospitals. To remove the migrated
band, in most patients we used an endoscopic approach with a device designed to cut the band: the Gastric Band Cutter (AMI,
Agency for Medical Innovation).
Results In 7 of the 9 patients, we used the gastric band cutter to remove the band endoscopically. It was able to cut the band successfully
in all cases except one, where twisting of the cutting wire required conversion from endoscopy to laparoscopy. In another
case, the band, after being cut, was locked in the gastric wall and required laparotomic removal. In 2 patients, we had to
remove the band surgically – in one case for port-site infection with subphrenic abscess, and in the other case for complete
band migration into the jejunum associated with acute pancreatitis, cholelithiasis and choledocholithiasis.
Conclusion The Gastric Band Cutter, when used, was successful in dividing the band in all cases except one, although we could not always
complete the procedure endoscopically. Endoscopic removal seems to be the procedure of choice for band erosion, because it
allows earlier patient discharge and avoids a surgical operation. It is advisable to perform the endoscopic removal in the
operating theater, because of possible complications of the procedure. 相似文献
20.
Background It has already been demonstrated that laparoscopic adjustable gastric banding (LAGB) is a safe and effective alternative to
other permanent bariatric surgery techniques. Although clinical complications have been managed through improvements in surgical
techniques, port-related complications and adjustment process inefficiencies have persisted. To reduce and manage these issues,
a new type of gastric band has been developed which uses telemetric technology to eliminate the use of hydraulic ports and
simplify the overall gastric band adjustment procedure.
Methods From June 2005 to October 2005, 37 patients were implanted in two German academic centers with the Easyband? telemetrically
adjustable gastric band (Endoart S.A., Lausanne, Switzerland), using standard gastric banding laparoscopic technique. Prospective
data was collected and analyzed for a minimum of 6 months on all morbidly obese patients who underwent laparoscopic telemetrically
adjustable gastric banding.
Results Data on 37 patients was analyzed.The mean percent excess weight loss was 10.2% at 1 month, 21.6% at 3 months, and 29.4% at
6 months. In 12 hypertensive patients, the systolic blood pressure decreased from 143 ± 24 mmHg at baseline to 131 ± 10 mmHg
after 6 months. Diastolic pressure did not change significantly. In all 5 patients with diagnosed type 2 diabetes, the fasting
blood glucose normalized after 6 months (135 mg/dl at baseline, 81 mg/dl at month 6).
Conclusion These early results of the new telemetrically adjustable gastric banding device indicate clinical safety and efficacy comparable
to that achieved by other commercially available gastric bands. Additional multi-center studies with long-term followup are
recommended to confirm the benefits of telemetrically adjustable gastric banding. 相似文献