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1.
Results and Complications after Laparoscopic Adjustable Gastric Banding in Super-obese Patients,using the Swedish Band 总被引:1,自引:1,他引:0
Background: Laparoscopic adjustable gastric banding is effective in inducing weight loss, as well as being minimally invasive,
totally reversible, and adjustable to the patient's needs. The aim of this study was to assess the efficacy and safety of
adjustable gastric banding with the Swedish band (SAGB) in super-obese patients. Patients and Methods: Between January 1996
and December 2003, 682 patients (570 women, 112 men) underwent SABG implantation. In these patients, there were 60 super-obese
patients with a BMI ≥ 50 kg/m2. Two groups of patients were analyzed: Group 50 (n = 30 patients) with a BMI 50-54 kg/m2 and Group 55 (n = 30 patients) with a BMI ≥ 55 kg/m2. 13 different surgeons (9 general and 4 bariatric surgeons) performed the SAGB. All data (demographic and morphologic data,
operative data, and follow-up data) were prospectively collected in a computerized data bank. Results: 60 patients (8.8%)
out of 682 were super-obese and entered the study. Mean %EWL was 39.2 at 1 year and 60.4 at 4 years, BMI fell from 55.5 to
34.7 at 4 years. The complication rate was 26.7% (16/60). General surgeons 12/60 (20%) had more complications than bariatric
surgeons 4/60 (6.7%). In Group 50, mean %EWL was 42.1 at 1 year, 55.9 at 2 years, 61.5 at 3 years and 59.9 at 4 years. BMI fell from 51.8 to 33.2 at 4 years.
Postoperative complications occurred in 6/30 patients (20%): pouch dilatation (n=2), band migration (n=2) and band leakage
(n=2). In Group 55, mean %EWL was 36.8 at 1 year, 55.3 at 2 years, 55.8 at 3 years, and 59.4 at 4 years. BMI fell from 59.1 to 36.4 at 4 years.
Postoperative complications occurred in 10/30 patients (33.3%): pouch dilatation (n=2), band migration (n=3) and band leakage
(n=5). There was no mortality. Conclusion: SAGB is an effective procedure for the surgical treatment of super-obesity. Because
of the high complication rate, super-obese patients should only be treated by experienced bariatric surgeons. 相似文献
2.
Biliopancreatic Diversion with Duodenal Switch Combined with Laparoscopic Adjustable Gastric Banding
Gabriel SG Karaindros CA Papaioannou MA Tassioulis AA Gabriel SG Sigalas VI Giannakakis PP 《Obesity surgery》2005,15(4):517-522
Background: The authors investigated the usefulness of an approach combining biliopancreatic diversion (BPD) with duodenal
switch (DS) and laparoscopic adjustable gastric banding (LAGB) in morbidly obese patients. Methods: 258 morbidly obese patients
underwent bariatric surgery. 80 underwent gastric bypass (GBP), with an 80-ml pouch, a 120-150-cm common channel and a 350-cm
alimentary limb (Group 1). 178 underwent BPD combined with DS-LAGB (Group 2): an 80cm common channel and a 200-cm alimentary limb were created in 68 patients (Subgroup 2a); a 120-cm common channel and a 300-cm alimentary limb were created in 110 patients (Subgroup 2b). Quality of life was assessed using the Moorehead-Ardelt Quality of Life Questionnaire (MA-QLQ). Results: At 2 years, mean
BMI and %EWL were 27.8 kg/m2 and 77.4 (Group 1), 25.2 kg/m2 and 99.6 (Subgroup 2a), and 27.6 kg/m2 and 79.3 (Subgroup 2b), respectively. 4 GBP patients regained their weight 2 years after surgery. There was 1 death, not
related to surgery in Subgroup 2b. Preoperative MA-QLQ scores were similar between groups; at 2 years, MA-QLQ scores were
higher in Subgroups 2a and 2b compared to Group 1 (+2.49 and +2.59 vs +0.98, respectively). Conclusion: Combination bariatric
surgery is a safe, effective and durable weight loss option for the treatment of morbid obesity. 相似文献
3.
Weiner R Blanco-Engert R Weiner S Matkowitz R Schaefer L Pomhoff I 《Obesity surgery》2003,13(3):427-434
Background: Laparoscopic adjustable gastric banding (LAGB) has been our choice operation for morbid obesity since 1994. Despite
a long list of publications about the LAGB during recent years, the evidence with regard to long-term weight loss after LAGB
has been rather sparse. The outcome of the first 100 patients and the total number of 984 LAGB procedures were evaluated.
Methods: 984 consecutive patients (82.5% female) underwent LAGB. Initial body weight was 132.2 ± 23.9 SD kg and body mass
index (BMI) was 46.8 ± 7.2 kg/m2. Mean age was 37.9 (18-65). Retrogastric placement was performed in 577 patients up to June 1998. Thereafter, the pars flaccida
to perigastric (two-step technique) was used in the following 407 patients. Results: Mortality and conversion rates were 0.
Follow-up of the first 100 patients has been 97% and ranges in the following years between 95% and 100% (mean 97.2%). Median
follow-up of the first 100 patients who were available for follow-up was 98.9 months (8.24 years). Median follow-up of all
patients was 55.5 months (range 99-1). Early complications were 1 gastric perforation after previous hiatal surgery and 1
gastric slippage (band was removed). All complications were seen during the first 100 procedures. Late complications of the
first 100 cases included 17 slippages requiring reinterventions during the following years; total rate of slippage decreased
later to 3.7%. Mean excess weight loss was 59.3% after 8 years, if patients with band loss are excluded. BMI dropped from
46.8 to 32.3 kg/m2. 5 patients of the first 100 LAGB had the band removed, followed by weight gain; 3 of the 5 patients underwent laparoscopic
Roux-en-Y gastric bypass (LRYGBP) with successful weight loss after the redo-surgery. 14 patients were switched to a "banded"
LRYGBP and 2 patients to a LRYGBP during 2001-2002. The quality of life indices were still improved in 82% of the first 100
patients. The percentages of good and excellent results were at the highest level at 2 years after LAGB (92%). Conclusions:
LAGB is safe, with a lower complication rate than other bariatric operations. Reoperations can be performed laparoscopically
with low morbidity and short hospitalizations. The LAGB seems to be the basic bariatric procedure, which can be switched laparoscopically
to combined bariatric procedures if treatment fails. After the learning curve of the surgeon, results are markedly improved.
On the basis of 8 years long-term follow-up, it is an effective procedure. 相似文献
4.
Background: A percentage of all types of bariatric surgery will fail. Our experience with failed biliopancreatic diversion
(BPD) as a primary operation or revision operation for failed laparoscopic adjustable gastric banding (LAGB) convinced us
that uncontrolled hunger is often the underlying cause. To control hunger after failed bariatric surgery,a novel approach
combining LAGB with BPD-duodenal switch (DS) has been tried. Methods: Patients who had failed to lose weight after BPD or
LAGB were considered in 2 groups. Group 1: patients who had failed LAGB underwent laparoscopic BPD-DS without sleeve gastrectomy,
with the LAGB left in-situ. Group 2: patients who had failed primary (subgroup 2a) or revision (subgroup 2b) BPD had a LAGB
placed with no other revision of their surgery. Results: 11 patients have undergone this form of revision surgery with little
morbidity. Mean age at the original operation was 45 years, mean (range) BMI was 45.3 (38-62) kg/m2. After the reoperation, at 3 months (9 patients) mean BMI was 30 kg/m2 and at 6 months (4 patients) mean BMI was 27 kg/m2. Conclusion: In this small study, combination surgery was safe and effective for failed BPD or LAGB. LAGB failure may be
best managed with DS malabsorption without gastric resection. 相似文献
5.
Background: Adolescent obesity has undesirable short- and long-term effects. Laparoscopic adjustable gastric banding has been
considered a procedure of choice for adolescent morbid obesity. We retrospectively evaluated our single-team banding experience
in the adolescent population. Methods: We reviewed the medical and clinic records and conducted telephone questionnaire interviews,
to evaluate the results of banding using the Swedish adjustable gastric band (SAGB?) in the 60 adolescents at our institution who had been followed ≥3 years. Results: An average of 39.5 months of follow-up
has been conducted in the patients who have been followed ≥3 years. Mean age at the time of the operation was 16 years (9
to 18). 60% reported a family history of obesity. Associated co-morbidities included hypertension, diabetes, sleep apnea and
asthma. Mean preoperative BMI was 43 (35-61) kg/m2. Mean postoperative BMI after 39.5 months follow-up was 30 (20-39) kg/m2. No co-morbidities have existed after the operation. 6 patients (10%) underwent band repositioning and 2 patients underwent
band removal, due to slippage; 7 of the 8 slippages occurred with an earlier perigastric technique which transgressed lesser
sac. There was no mortality. Average postoperative hospital stay was 24 hours. Conclusions: Gastric banding in adolescents
is a safe, satisfactory and reversible weight reduction procedure. 相似文献
6.
Laparoscopic Bariatric Surgery in Super-obese Patients (BMI>50) is Safe and Effective: A Review of 332 Patients 总被引:2,自引:2,他引:0
Background: Bariatric surgery in super-obese patients (BMI >50 kg/m2) can be challenging because of difficulties in exposure of visceral fat, retracting the fatty liver, and strong torque applied
to instruments, as well as existing co-morbidities. Methods: A retrospective review of super-obese patients who underwent
laparoscopic adjustable gastric banding (LAGB n=192), Roux-en-Y gastric bypass (RYGBP n=97), and biliopancreatic diversion
with/without duodenal switch (BPD n= 43), was performed. 30day peri-operative morbidity and mortality were evaluated to determine
relative safety of the 3 operations. Results: From October 2000 through June 2004, 331 super-obese patients underwent laparoscopic
bariatric surgery, with mean BMI 55.3 kg/m2. Patients were aged 42 years (13-72), and 75% were female. When categorized by opertaion (LAGB, RYGBP, BPD), the mean age,
BMI and gender were comparable. 6 patients were converted to open (1.8%). LAGB had a 0.5%, RYGBP 2.1% and BPD 7.0% conversion
rate (P=0.02, all groups). Median operative time was 60 min for LAGB, 130 min for RYGBP and 255 min for BPD (P<0.001, all groups). Median length of stay was 24 hours for LAGB, 72 hours for RYGBP, and 96 hours for BPD (P <0.001). Mean %EWL for the LAGB was 35.3±12.6, 45.8±19.4, and 49.5±18.6 with follow-up of 87%, 76% and 72% at 1, 2 and 3
years, respectively. Mean %EWL for the RYGBP was 57.7±15.4, 54.7±21.2, and 56.8±21.1 with follow-up of 76%, 33% and 54% at
1, 2 and 3 years, respectively. Mean %EWL for the BPD was 60.6±15.9, 69.4±13.0 and 77.4±11.9 with follow-up of 79%, 43% and
47% at 1, 2 and 3 years, respectively. The difference in %EWL was significant at all time intervals between the LAGB and BPD
(P<0.004). However, there was no significant difference in %EWL between LAGB and RYGBP at 2 and 3 years. Overall perioperative
morbidity occurred in 27 patients (8.1%). LAGB had 4.7% morbidity rate, RYGBP 11.3%, and BPD 16.3% (P=0.02, all groups). There were no deaths. Conclusion: Laparoscopic bariatric surgery is safe in super-obese patients. LAGB,
the least invasive procedure, resulted in the lowest operative times, the lowest conversion rate, the shortest hospital stay
and the lowest morbidity in this high-risk cohort of patients. Rates of all parameters studied increased with increasing procedural
complexity. However, the difference in %EWL between RYGBP and LAGB at 2 and 3 years was not statistically significant. 相似文献
7.
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
8.
Ma Y Pagoto SL Olendzki BC Hafner AR Perugini RA Mason R Kelly JJ 《Obesity surgery》2006,16(9):1227-1231
Background: Weight loss after bariatric surgery varies and depends on many factors, such as time elapsed since surgery, baseline
weight, and co-morbidities. Methods: We analyzed weight data from 494 patients who underwent laparoscopic Roux-en-Y gastric
bypass (RYGBP) by one surgeon at an academic institution between June 1999 and December 2004. Linear regression was used to
identify factors in predicting % excess weight loss (%EWL) at 1 year. Results: Mean patient age at time of surgery was 44
± 9.6 (SD), and the majority were female (83.8%). The baseline prevalence of co-morbidities included 24% for diabetes, 42%
for hypertension, and 15% for hypercholesterolemia. Baseline BMI was 51.5 ± 8.5 kg/m2. Mean length of hospital stay was 3.8 ± 4.6 days. Mortality rate was 0.6%. Follow-up weight data were available for 90% of
patients at 6 months after RYGBP, 90% at 1 year, and 51% at 2 years. Mean %EWL at 1 year was 65 ± 15.2%. The success rate
(≥50 %EWL) at 1 year was 85%. Younger age and lower baseline weight predicted greater weight loss. Males lost more weight
than females. Diabetes was associated with a lower %EWL. Depression did not significantly predict %EWL. Conclusion: The study
demonstrated a 65 %EWL and 85% success rate at 1 year in our bariatric surgery program. Our finding that most pre-surgery
co-morbidities and depression did not predict weight loss may have implications for pre-surgery screening. 相似文献
9.
Jenny Choi Mary Digiorgi Luca Milone Beth Schrope Lorraine Olivera-Rivera Amna Daud Dan Davis Marc Bessler 《Surgery for obesity and related diseases》2010,6(4):367-371
BackgroundThe current National Institutes of Health guidelines have recommended bariatric surgery for patients with a body mass index (BMI) >40 kg/m2 or BMI >35 kg/m2 with significant co-morbidities. However, some preliminary studies have shown that patients with a BMI that does not meet these criteria could also experience similar weight loss and the benefits associated with it.MethodsAn institutional review board-approved protocol was obtained to study the effectiveness of laparoscopic adjustable gastric banding in patients with a low BMI. A total of 66 patients with a BMI of 30–35 kg/m2 and co-morbidities (n = 22) or a BMI of 35–40 kg/m2 without co-morbidities (n = 44) underwent laparoscopic adjustable gastric banding. These patients were compared with 438 standard patients who had undergone laparoscopic adjustable gastric banding who met the National Institutes of Health criteria for bariatric surgery. The excess weight loss at 3, 6, 12, and 18 months and the status of their co-morbidities were compared between the 2 groups.ResultsThe average BMI for the study group was 36.1 ± 2.6 kg/m2 compared with 46.0 ± 7.3 kg/m2 for the control group. Both groups had significant co-morbidities, including hypertension, diabetes, hyperlipidemia, arthritis, gastroesophageal reflux disease, stress incontinence, and obstructive sleep apnea. The mean percentage of excess weight loss was 20.3% ± 9.0%, 28.5% ± 14.0%, 44.7% ± 19.3%, and 42.2% ± 33.7% at 3, 6, 12, and 18 months, respectively. This was not significantly different from the excess weight loss in the control group, except for at 12 months. Both groups showed similar improvement of most co-morbidities.ConclusionModerately obese patients whose BMI is less than the current guidelines for bariatric surgery will have similar weight loss and associated benefits. Laparoscopic adjustable gastric banding is a safe and effective treatment for patients with a BMI of 30–35 kg/m2. 相似文献
10.
Buddeberg-Fischer B Klaghofer R Krug L Buddeberg C Müller MK Schoeb O Weber M 《Obesity surgery》2006,16(3):321-330
Background: Morbidly obese patients show high somatic and psychiatric co-morbidity. Bariatric surgery is accepted as the obesity
treatment with the greatest long-term success. There is growing evidence that follow-up studies should address somatic as
well as psychosocial conditions of patients undergoing bariatric surgery and non-operatively treated patients. This study
investigates the physical and psychosocial outcomes of patients with and without bariatric surgery. Methods: A sample of 131 morbidly obese patients applying for bariatric surgery underwent somatic and
psychological assessment (T0). A first follow-up study (T1) was conducted 2 years after T0 in 119 patients. The present second follow-up (T2) was carried out 4? years after T0 and 3.2 years after potential bariatric surgery. Psychological/psychosocial measures were collected in the 93 patients, 63
of whom were treated surgically, via the Psychosocial Stress and Symptom Questionnaire (PSSQ) and a telephone interview covering
BMI, employability, medication, doctor consultations, eating behavior, and physical/psychological well-being. Results: Patients
with and without bariatric surgery showed a BMI reduction, which was significantly greater in those who underwent surgery
(P<.001). The average percentage of excess weight loss (%EWL) between T0 and T2 was 11.5% in patients with no bariatric surgery, 36.0% in patients with laparoscopic gastric banding, and 52.8% in patients
with laparoscopic gastric bypass (%EWL between T0 and T2 in patients of all groups significant, P<.001). Patients with and without surgical treatment showed significant improvement with regard to depressive symptoms and
binge-eating behavior. Three-quarters of the surgically-treated and two-thirds of the non-treated patients rated their physical,
psychological, and psychosocial well-being as "good" at T2. Conclusion: After 3 to 4 years, all of the patients have adapted well to their weight and body appearance, regardless of
whether they have undergone surgery. Weight loss is, however, greater for operated patients, which strongly decreases the
risk of developing obesity-related co-morbidities. 相似文献
11.
Patient Characteristics Impacting Excess Weight Loss following Laparoscopic Adjustable Gastric Banding 总被引:5,自引:5,他引:0
Background: Weight loss is more variable after laparoscopic adjustable gastric banding (LAGB) than after gastric bypass. Subgroup
analysis of patients may offer insight into this variability. The aim of our study was to identify preoperative factors that
predict outcome. Methods: Demographics, co-morbid conditions and follow-up weight were collected for our 1st 200 LapBand ?
patients. Linear regression determined average %EWL. Logistic regression analysis identified factors that impacted %EWL. Result:
200 patients returned for 778 follow-up visits. Median age was 44 years (21-72) and median BMI 45 kg/m2 (31-76). 140 (80%) were women. Average %EWL was y % = 0.007 %/day (days since surgery) + 0.12% (correlation coef. 0.4823;
P<0.001). %EWL at 1 year was 37%. The best-fit logistic regression model found 7 factors that significantly changed the odds
of achieving average %EWL. Older patients, diabetic patients and patients with COPD had greater odds of above average %EWL.
Female patients, patients with larger BMIs, asthmatic patients and patients with hypertension had increased odds of below
average %EWL. Conclusion: Specific patient characteristics and comorbid conditions significantly altered the odds of achieving
satisfactory %EWL following gastric banding. 相似文献
12.
Foletto M Bernante P Busetto L Pomerri F Vecchiato G Prevedello L Famengo S Nitti D 《Obesity surgery》2008,18(9):1099-1103
BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) slippage with pouch dilation is one the most serious long-term complications and requires reoperation in most cases. It is still controversial whether banding should be offered again or a different procedure should be chosen. We report the results of synchronous de-rebanding on a prospective series of patients treated at our institution for slippage with pouch dilation. METHODS: From January 2000 to May 2007, 29 consecutive patients underwent laparoscopic de-rebanding for slippage with pouch dilation. The mean age at primary operation was 38.9 +/- 8.2 years and the mean BMI was 46.4 +/- 8 kg/m(2). Twenty-eight had previous LAGB, while one had previous open gastric banding, the perigastric technique being used at that time. All the redo procedures were successfully carried out under laparoscopy, via the pars flaccida technique, and all the patients were followed-up according to the usual schedule. RESULTS: The mean time from the original LAGB was 45.3 +/- 30.3 months, and the mean follow-up after rebanding was 26.9 +/- 20.6 months. At rebanding, the mean BMI was 34.3 +/- 7.6, percent excess weight loss (%EWL) 54.5 +/- 31, and percent excess BMI loss (%EBL) 58.3 +/- 33, respectively. After 1 year, BMI was 36.3 +/- 7.9, %EWL 40.8 +/- 30.5, and %EBL 43.9 +/- 32.7, respectively. After 2 years, BMI was 37.13 +/- 7.4, %EWL 36.9 +/- 29.4, and %EBL 39.6 +/- 31.6, respectively, and after 3 years, BMI was 33.5 +/- 5.6, %EWL 51.9 +/- 24.3, and %EBL 55.7 +/- 25.7, respectively. One patient had re-rebanding after 6 months for a new slippage, two had band removal with refusal to switch to another procedure, one had biliopancreatic diversion for slippage recurrence, and one underwent sleeve gastrectomy for insufficient weight loss after 6 months. CONCLUSIONS: Although this is a limited series, our results show that good outcomes can be expected after rebanding in properly assessed patients with slippage and pouch dilation. Larger series and longer follow-up are needed to confirm these findings. 相似文献
13.
Samuel Sultan Manish Parikh Heekoung Youn Marina Kurian George Fielding Christine Ren 《Surgical endoscopy》2009,23(7):1569-1573
Background Many mildly to moderately obese individuals with a body mass index (BMI) lower than 35 kg/m2 have serious diseases related to their obesity. Nonsurgical therapy is ineffective in the long term, yet surgery has never
been made widely available to this population.
Methods Between 2002 and 2007, 53 patients with a BMI lower than 35 kg/m2 underwent laparoscopic adjustable gastric banding at our institution. Data on all these patients were collected prospectively
and entered into an institutional review board–approved electronic registry. The study parameters included preoperative age,
gender, BMI, presence of comorbidities, percentage of excess weight loss (%EWL), and resolution of comorbidities.
Results The mean preoperative age of the patients was 46.9 years (range, 16–68 years), and the mean preoperative BMI was 33.1 kg/m2 (range, 28.2–35.0 kg/m2). Of the 53 patients, 49 (92%) had at least one obesity-related comorbidity. The mean BMI decreased to 28.1 ± 2.4 kg/m2, 25.8 ± 2.9 kg/m2, and 25.8 ± 3.1 kg/m2 and mean %EWL was 48.3 ± 17.6, 69.9 ± 28.0, and 69.7 ± 31.7 at 0.5, 1, and 2 years, respectively. Substantial improvement
occurred for the following comorbidities evaluated: hypertension, depression, diabetes, asthma, hypertriglyceridemia, obstructive
sleep apnea, hypercholesterolemia, and osteoarthritis. There was one slip, two cases of band obstruction (from food), two
cases of esophagitis, and two port leaks, but no mortality.
Conclusion The authors are very encouraged by this series of low-BMI patients who underwent laparoscopic adjustable gastric banding.
Their weight loss has been excellent, and their complications have been acceptable. Their comorbidities have partially or
wholly resolved. With further study, it is reasonable to expect alteration of the weight guidelines for bariatric surgery
to include patients with a BMI lower than 35 kg/m2. 相似文献
14.
Complications after Laparoscopic Adjustable Gastric Banding for Morbid Obesity: Experience with 1,000 Patients over 7 Years 总被引:5,自引:4,他引:1
Chevallier JM Zinzindohoué F Douard R Blanche JP Berta JL Altman JJ Cugnenc PH 《Obesity surgery》2004,14(3):407-414
Background: Laparoscopic adjustable gastric banding (LAGB) is considered the least invasive surgical option for morbid obesity. It is
less efficient than gastric bypass in weight loss, but has the advantage of being potentially reversible and can improve the
quality of life if mortality and morbidity are low. Methods: Between 1996 and 2003, 1,000 patients underwent LAGB. There were 896 women and 104 men with mean age 40.4 years (16.3-66.3).
Preoperative mean BMI was 44.3 kg/m2. Results: There were no deaths. Cumulative rate of complications was 192 (19.2%). 12 were life-threatening (1.2%): gastric perforation
(n=4), acute respiratory distress (n=2), pulmonary embolism (n=2), migration (n=3), and gastric necrosis (n=1). 111 patients
required an abdominal reoperation (11.1%) for perforation (n=2), slippage (n=78), migration (n=3), necrosis (n=1), esophageal
dilatation (n=2), incisional hernias (n=4) and port problems (n=21). Before October 2000, we used the perigastric technique,
and the slippage rate was 24% (91 / 378 ).Then, we changed to the pars flaccida approach and the slippage rate fell to 2%
(13 / 622). The pars flaccida approach demonstrated safety in relation to both risks of perforation and slippage. Conclusion: The cumulative complication rate increased to 3-4 years, and then decreased with experience and technical improvement. Concerns
of long-term follow-up should be migration and esophageal dilatation, which seem to be rare at 3 years. 相似文献
15.
Angrisani L Lorenzo M Borrelli V Giuffré M Fonderico C Capece G 《Obesity surgery》2006,16(9):1135-1137
Background: The use of the Bio-Enterics intra-gastric balloon (BIB) has been shown to be a safe and effective procedure for
the temporary treatment of morbid obesity. We conducted a retrospective comparative analysis of the weight loss in patients
that after BIB removal underwent bariatric surgery and those who did not wish surgery. Methods: From January 2000 to March
2004, 182 BIBs were positioned in 175 patients (104 F / 71 M; mean age 37.1±11.6 years, range 16-67; mean BMI 54.4 ± 8.1 kg/m2, range 39.8-79.5; mean %EW 160.8±32.9% range 89-264). Patients were excluded from this study who had emergency BIB removal
for balloon rupture (n=2, 1.1%) and for psychological intolerance (n=7, 7.8%). All patients were scheduled for a bariatric
operation, before BIB positioning. After BIB removal, a number of patients now declined surgery. Consequently, patients were
allocated into 2 groups: Group A in whom BIB removal was followed by bariatric surgery (Lap-Band?, laparoscopic gastric bypass, duodenal switch) (n=86); Group B patients who after BIB removal refused any surgical procedure
(n=82). Both groups were followed for a minimum of 12 months. Results were reported as mean BMI and %EWL ± SD. Statistical
analysis was done by Student t-test or Fisher's exact test, with P<0.05 considered significant. Results: Mean BMI and mean %EWL in the 166 patients at time of removal were 47.3 ± 8.1 kg/m2 and 32.1±16.6%, respectively. At the same time, mean BMI was 47.6±6.9 and 48.1±6.5 kg/m2 in group A and B (P=NS). At 12 months follow-up (100%), mean BMI was 35.1 kg/m2 in Group A (BIB + surgery) and 51.7 kg/m2 in Group B (BIB alone) (P<0.001). Conclusions: After BIB removal, half (49.4%) of the patients scheduled for surgery refused a bariatric operation.
These patients returned to their mean initial weight at 12 months follow-up. Therefore, bariatric surgery after BIB removal
is highly recommended. 相似文献
16.
Background: The advantages of laparoscopy over open surgery are well known. The aim of this study was to compare our results
with Swedish adjustable gastric banding (SAGB) with other laparoscopically performed bariatric procedures (gastric bypass,
LapBand?, vertical banded gastroplasty). Methods: Between January 1996 and December 2001, 454 patients (381 women, 73 men) underwent
laparoscopic SAGB. All data (demographic and morphologic, co-morbidities, operative, and follow-up) were prospectively collected
in a computerized databank. Results: Mean follow-up was 30 months (range 1-66). Average total weight loss was 35.5 kg after
1 year, reaching an average total of 54 kg after 3 years. Mean excess weight loss was 72% after 3 years, and the BMI decreased
from 46.7 to 28.1 kg/m2. Patients with co-morbidities reported marked improvement of their accompanying diseases. Complications requiring reoperation
occurred in 7.9%. There was no mortality. The clinical outcome compared with the other laparoscopic bariatric procedures showed
no significant difference. Conclusion: All laparoscopically performed bariatric procedures are very promising. The great advantage
of laparoscopic adjustable gastric banding is that this operation is minimally invasive to the stomach, totally reversible
and adjustable to the patients' needs. 相似文献
17.
Use of Adjustable Silicone Gastric Banding for Revision of Failed Gastric Bariatric Operations 总被引:3,自引:0,他引:3
Background: Revision of gastric bariatric operations is sometimes technically difficult and may fail to achieve prolonged
weight reduction. The use of the adjustable silicone gastric banding (ASGB) offers a new approach for these revisions. Methods:
ASGB was performed as a revisional procedure on 37 patients whose initial bariatric operations were as follows: silastic ring
vertical gastroplasty (21), gastric bypass (12), horizontal gastroplasty (3) and vertical banded gastroplasty (1). Results:
The length of the procedure varied from 55 to 145 minutes (mean 83 minutes). Intraoperative complications included two fundic
tears which were sutured without any postoperative sequelae. Five patients needed reoperation during the first postoperative
year due to gastric volvulus (1), tubing tear (1) and development of postoperative ventral hernia (3). BMI fell from 44.8
± SD 8.07 to 33.4 ± 6.9 kg/m2 for patients operated with BMI higher than 35 kg/m2 and from 29.2 ± 3.32 to 25.4 ± 2.8 kg/m2 for patients operated with BMI lower than 35 kg/m2. Conclusions: ASBG can be performed with revisions with an acceptable complication rate and post-operative weight reduction. 相似文献
18.
Egyptian Experience in Laparoscopic Adjustable Gastric Banding (Technique, Complications and Intermediate Results) 总被引:2,自引:0,他引:2
Nowara HA 《Obesity surgery》2001,11(1):70-75
Background: Surgery can provide effective longterm treatment for morbid obesity. The purpose of this study is to present an
Egyptian experience of laparoscopic adjustable silicone gastric banding (LASGB) as a safe and effective treatment. Methods:
108 morbidly obese patients having body mass index (BMI) > 40 kg/m2 were studied. 26 patients had a BMI > 50 kg/m2 and < 60 kg/m2, while 21 patients had a BMI ≥ 60 kg/m2.The procedure was performed through a 4 or 5 trocar technique. Results: Mean age was 32.3 years. Mean BMI was 48.9 kg/m2.
All except two procedures were completed by laparoscopy. Mean hospital stay was 2.2 days. Mean BMI after 12 months was 37.2
kg/m2 and after 24 months was 34.3 kg/m2. Mean follow-up was 2.1 years and included 87 patients (81%). Complications included: gastric perforation (1), pleural injury
(1), liver injury (1), port complications (6), periband sepsis (1) and slippage (3).There were no mortalities in this series.
Conclusions: LASGB proved to be safe and effective for the treatment of morbid obesity in Egyptian patients. 相似文献
19.
Dineros H Sinamban R Siozon M Llido LO Yumang E Gregorio AE Cacas R 《Obesity surgery》2007,17(1):82-87
Background Information on experience in bariatric surgery in the Asia-Pacific region is minimal: hence the need for more reports from
this area.
Methods The procedures of bariatric surgery and outcome as part of a weight management program in a tertiary care private hospital
in the Philippines is reported from years 2002 to 2004. 50 patients were included, of which 60% underwent laparoscopic adjustable
gastric banding (LAGB) and 40% Roux-en- Y gastric bypass (RYGBP).
Results There were more females than males (64% vs 36%) with the mean age 38 ± 13.1 years. Initial mean BMI was 46.2 kg/m2, which
decreased to 27.0 kg/m2 in 1 year. Initial mean weight was 126.7 ± 25.4 kg, of which the 1 year weight loss was 32.3 kg for the morbidly obese and
58.0 kg for the super obese. %EWL at 1 year was 30.2%. There was greater weight loss with RYGBP compared to LAGB at 1 year
(43.5 kg vs 30.2 kg). There was no mortality, and early complications were: wound infection (2/50 or 4%), and 1/50 or 2% each
for pneumonia, dehydration, gastritis, and leakage. Late complications were: band slippage (2/20 or 10%), stomal stenosis
(1/20 or 5%), and ventral hernia (1/5 or 20%).
Conclusion Bariatric surgery is safe with a low complication rate and the outcome was similar to the reported data from Asia and the
western world. 相似文献
20.
Giusti V De Lucia A Di Vetta V Calmes JM Héraïef E Gaillard RC Burckhardt P Suter M 《Obesity surgery》2004,14(9):1241-1246
Background: During the last 5 years, the performance of bariatric operations has doubled via our outpatient obesity clinic.
Currently, 52% of the patients presenting for weight loss are interested in bariatric surgery. Gastric banding and Roux-en-Y
gastric bypass are the two laparoscopic procedures proposed. The aim of this study was to evaluate the impact of preoperative
teaching on the patients' surgical option. Methods: All the candidates for bariatric surgery were submitted to preoperative
teaching and those between February 2001 and December 2002 are the subject of this study. The teaching consisted of 3 weekly
interactive 2-hour sessions. During the first session, the patients were asked about the type of operation that they had in
mind: gastric banding, gastric bypass, or not yet decided. The same questions were repeated at the end of the third session,
with an additional possible answer: no surgery. Results: 297 consecutive patients with a BMI >35 kg/m2 with at least one severe co-morbidity, were submitted to preoperative teaching. 80% of the patients were women. Median age
was 41 years. Before teaching, 68 patients (23%) were uncertain, 100 (34%) favored gastric banding, and 129 (43%) wanted a
gastric bypass. After education, only 3 patients (1%) remained uncertain, 45 (15%) changed their surgical option, and 27 (9%)
declined surgery. The proportion of patients opting for gastric banding decreased from 34% to 20%, whereas those electing
bypass increased from 43% to 70%. Conclusions: Preoperative training provides an informed and better patient selection for
bariatric surgery. It helps the patients understand the various surgical options, and makes their decision easier. 相似文献