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1.
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
2.
Background: Postoperative follow-up after bariatric surgery is important. Because of the need for adjustments, follow-up after
gastric banding may have a greater impact on weight loss than after Roux-en-Y gastric bypass.We reviewed all patients at 1
year after these two operations. Methods: During the first year after surgery, laparoscopic adjustable gastric banding (LAGB)
patients were followed every 4 weeks and Roux-en-Y gastric bypass (RYGBP) patients were followed at 3 weeks postoperatively
and then every 3 months.The number of follow-up visits for each patient was calculated, and 50% compliance for follow-up and
weight loss was compared. Results: Between October 2000 and September 2002, 216 LAGB and 139 RYGBP operations were performed.
Of these patients, 186 LAGB patients and 115 RYGBP patients were available for 1-year follow-up. Age and BMI were similar
for each group. Overall excess weight loss (EWL) after LAGB was 44.5%. 130 (70%) returned 6 or less times in the first year
and achieved 42% EWL. 56 patients (30%) returned more than 6 times and had 50% EWL (P=0.005). Overall %EWL after RYGBP was
66.1%. 53 patients (46%) returned 3 or less times in the first year, achieving 66.1% EWL. 62 patients (54%) returned more
than 3 times after surgery and achieved 67.6% EWL (P=NS). Conclusion: Patient follow-up plays a significant role in the amount
of weight lost after LAGB, but not after RYGBP. Patient motivation and surgeon commitment for long-term follow-up is critical
for successful weight loss after LAGB surgery. 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.
Skroubis G Anesidis S Kehagias I Mead N Vagenas K Kalfarentzos F 《Obesity surgery》2006,16(4):488-495
Background: In the non-superobese population, an agreement has not been made as to the optimal bariatric operation. The present
study reports the results of a prospective comparison of Roux-en-Y gastric bypass (RYGBP) and a variant of biliopancreatic
diversion (BPD) in a non-superobese population. Methods: From a cohort of 130 patients with BMI 35 to 50 kg/m2, 65 patients were randomly selected to undergo RYGBP and 65 to undergo BPD. All patients underwent complete follow-up evaluation
at 1, 3, 6, and 12 months postoperatively and every year thereafter. Results: Patients in both groups have completed their
second postoperative year. Mean % excess weight loss (%EWL) was significantly better after BPD at all time periods (12 months,
P=0.0001 and 24 months, P=0.0003), and the %EWL was >50% in all BPD patients compared to 88.7% in the RYGBP patients at 2-year follow-up. No statistically
significant differences were observed between the 2 groups in early and late non-metabolic complications. Hypoalbuminemia
occurred in only 1 patient (1.5%) after RYGBP and in 6 patients after BPD (9.2%). Only 1 patient from each group was hospitalized
and received total parenteral nutrition. Glucose intolerance, hypercholesterolemia, hypertriglyceridemia and sleep apnea completely
resolved in all patients in both groups, although mean total cholesterol level was significantly lower in BPD patients at
the second year follow-up (t-test, P<0.0001). Diabetes completely resolved in all BPD patients and in 7 of the 10 diabetic RYGBP patients. Conclusion: Both RYGBP
and BPD were safe and effective procedures when offered to non-superobese patients. Weight loss after BPD was consistently
better than that after RYGBP, as was the resolution of diabetes and hypercholesterolemia. Because the nutritional deficiencies
that occurred following this type of BPD were not severe and were not significantly different between the 2 operations, both
may be offered to non-superobese patients, keeping in mind the severity and type of preoperative co-morbidities as well as
the desired weight loss. 相似文献
5.
The Decrease in Plasma Ghrelin Concentrations following Bariatric Surgery Depends on the Functional Integrity of the Fundus 总被引:7,自引:3,他引:4
Frühbeck G Diez-Caballero A Gil MJ Montero I Gómez-Ambrosi J Salvador J Cienfuegos JA 《Obesity surgery》2004,14(5):606-612
Background: Gastric bypass surgery, which involves the production of a reduced stomach pouch,has been shown to markedly suppress
circulating ghrelin concentrations. Since bypassing the ghrelin-producing cell population may be relevant to the disruption
of fundic-derived factors participating in food intake signaling, the effect of weight loss induced by either adjustable gastric
banding (AGB), Roux-en-Y gastric bypass (RYGBP) or biliopancreatic diversion (BPD) was studied. Methods: 16 matched obese
patients [35.0 + 2.4 years; initial body weight 124.8 ± 5.7 kg; body mass index (BMI) 47.1 ± 2.2 kg/m2] in whom similar weight loss had been achieved by either AGB (n=7), RYGBP (n=6) or BPD (n=3) were studied. Blood was obtained
for biochemical and hormonal analyses. Body composition was assessed by air-displacement-plethysmography. Results: Comparable
weight loss (AGB: 26.1 ± 5.1 kg; RYGBP: 32.1 ± 5.0; BPD: 31.7 ± 6.1; P=NS) and decrease in percentage body fat (AGB: 10.0 ± 1.5%; RYGBP: 14.2 ± 2.8; BPD: 10.3 ± 1.0; P=NS) induced by bariatric surgery exerted significantly different (P=0.004) effects on plasma ghrelin concentrations, depending on the surgical procedure applied (AGB: 480 ± 78 pg/ml; RYGBP:
117 ± 34; BPD: 406 ± 86). Without significant differences in BMI, body fat, glucose, triglycerides, cholesterol, insulin and
leptin levels, patients who had undergone the RYGBP exhibited statistically significant diminished circulating fasting plasma
ghrelin concentrations compared with the other two bariatric techniques which conserve direct contact of the fundus with ingested
food (P=0.003 vs AGB and P=0.020 vs BPD). Conclusion: Fasting circulating ghrelin concentrations in patients undergoing diverse bariatric operations
depend on the degree of dysfunctionality of the fundus. 相似文献
6.
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
7.
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
8.
Franco Favretti David Ashton Luca Busetto Gianni Segato Maurizio De Luca 《World journal of surgery》2009,33(10):2039-2048
The advent of laparoscopic adjustable gastric banding (LAGB) during the latter part of the 20th century represents a watershed
in the management of chronic obesity. In this paper we provide an overview of LAGB with respect to its development, clinical
outcomes, and future role. We also address current controversies, including a comparison of LAGB with Roux-en-Y gastric bypass
(RYGBP). At present LAGB seems to be increasing in popularity in the United States, whereas in Europe there seems to be a
trend away from gastric banding toward RYGBP. Optimal outcomes after LAGB are a function of correct laparoscopic technique,
an experienced surgical team, a well-engineered device, and intensive long-term follow-up. The majority of studies show that
LAGB is an extremely safe and effective procedure, with an operative mortality of 0–0.1% and excess weight loss (%EWL) of
50–60%. Commensurate with this degree of weight loss, almost all studies show substantial improvements in obesity-related
co-morbidities, such as hypertension, type II diabetes, and dyslipidemia. In addition, LAGB has been shown to be both safe
and effective in the super-obese, in adolescents, and in older patients and can be delivered as an ambulatory procedure. Operative
mortality and early complication rates are significantly higher for RYGBP and, whilst gastric bypass results in greater weight
loss than LAGB in the first 2 years, at 3 years and beyond the difference appears to be less marked. Overall, LAGB provides
a safe, effective intervention for obese patients and remains our first-choice procedure for bariatric surgery. 相似文献
9.
Background: Open or laparoscopic Roux-en-Y gastric bypass (RYGBP) is the most common operation for treatment of morbid obesity
in USA. The laparoscopic adjustable gastric band (LAGB) has been the most common bariatric operation performed worldwide.
The LapBand? was approved for use in USA in July 2001. Since then, several US surgeons have adopted one procedure preferentially over
the other, and several have reported patient outcomes. We added the option of the LAGB to the RYGBP in our practice in July
2001. We hypothesized that both procedures will provide similar weight loss and co-morbidity reduction if followed for a sufficient
length of time. To enhance weight loss, we adopted a patient behavioral program that is easy to remember, in an attempt to
ensure a reduction in caloric intake and reduce hunger regardless of the operation performed. Methods: A case-controlled matched-pair
cohort study was conducted. All patients who presented to the Surgical Weight Control Center of Las Vegas between Aug 2001
and Aug 2004 for LAGB were placed into one group, and a matched-pair RYGBP cohort group was created. Patients in the RYGBP
cohort were matched for age, sex, date of surgery, and BMI. All patients were evaluated on an intention to treat basis. Data
were collected prospectively and analyzed retrospectively. All patients were subjected to the same preoperative education
regarding calorie reduction behaviors and diet change, and received the same postoperative counseling regarding long-term
eating behavior and food choices. Results: During this period, 208 patients underwent LAGB and 600 underwent RYGBP. Of the
208 LAGB patients, 181 had suitable open or laparoscopic RYGBP matches. The two groups were similar in terms of age, sex,
BMI, and co-morbidities. There were no deaths in either group. Resolution of co-morbidities statistically favored RYGBP as
did the weight loss, over the study period. Conclusion: When patients are matched with 3-year follow-up according to time
of surgery, age, sex and BMI, LRYGBP provides superior weight and co-morbidity reduction and can be done without severe complications.
However, the LAGB is an effective weight loss tool and not every patient wishes to have the LRYGBP. 相似文献
10.
Background: Controversy exists regarding the best surgical treatment for super-obesity (BMI >50 kg/m 2 ). The two most common
bariatric procedures performed worldwide are laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric
bypass (LRYGBP). We undertook a retrospective single-center study to compare the safety and efficacy of these two operations
in super-obese patients. Methods: 290 super-obese patients underwent laparoscopic bariatric surgery: 179 LAGB and 111 LRYGBP.
Results: There were one death in both groups. The early complication rate was higher in the LAGB group (10% vs 2.8%, P<0.01). Late complication rate was higher in the LAGB group (26% vs 15.3%, P<0.05). Operating time and hospital stay were significantly higher in the LRYGBP group. LRYGBP had significantly better excess
weight loss than LAGB (63% vs 41% at 1 year, and 73% vs 46% at 2 years), as well as lower BMI than LAGB (35 vs 41 at 18 months).
Conclusion: LRYGBP results in significantly greater weight loss than LAGB in super-obese patients, but is associated with
a higher early complication rate. 相似文献
11.
Background: Morbid obesity is now an epidemic with considerable associated morbidity for which bariatric surgery has been
the only effective treatment. Despite its success, occasional patients require revision because of weight regain or mechanical
complications. The impact of multiple prior bariatric operations on complications and weight loss after revision to Roux-en-Y
gastric bypass (RYGBP) was evaluated. Methods: All patients undergoing revisional surgery to RYGBP by the senior author from
1997 through 2004 were retrospectively reviewed at a multi-center academic institution. Patients who had previously undergone
multiple revisional operations (MR) were compared to patients who had undergone primary ("first-time") revision (PR). Demographics,
indications for revision, complications, and weight loss were reviewed. Results: 66 patients underwent open revision to RYGBP
after failed bariatric operations, with 12 in the MR group and 54 in the PR group. Mean preoperative BMI was 46.1 and 45.2
(P=0.8), respectively. Operative time (227 vs 162 min, P=0.07), blood loss (517 vs 313 ml, P=0.09) and hospital length of stay (11.5 vs 6.7 days, P=0.2) were higher in the MR group. Major perioperative complications occurred in 16.7% of MR patients compared to 9.3% of
PR patients (P=0.6). Percent of excess weight loss (%EWL) has been 54.3% in the MR group and 60.6% in the PR group (P=0.6). Average follow-up is 26 and 23 months, respectively. Conclusion: Although operative times, blood loss, and LOS were
greater in MR patients, RYGBP can be performed in patients with multiple previous bariatric operations with acceptable weight
loss and complication rates. 相似文献
12.
Roux-en-Y divided gastric bypass results in the same weight loss as duodenal switch for morbid obesity 总被引:4,自引:0,他引:4
Deveney CW MacCabee D Marlink K Welker K Davis J McConnell DB 《American journal of surgery》2004,187(5):655-659
BACKGROUND: The 2 weight loss procedures most commonly performed in the United States are Roux-en-Y gastric bypass (RYGBP) and lateral gastrectomy with duodenal switch (BPD/DS). RYGB is a restrictive procedure, whereas BPD/DS relies on mild restriction of intake as well as malabsorption. Many physicians believe that weight loss is greater after BPD/DS than after RYGBP. However, these procedures have not been compared using groups of patients operated on by the same surgeons at the same institution. METHODS: We compared weight loss (expressed as percent of excess body weight [%EBW]) after 1 and 2 years in patients who underwent open RYGB or BPD/DS at our institution. RESULTS: Average length of stay was longer in BPD/DS patients than in those undergoing RYGBP (8.7 vs. 5.9 days, P <0.05). Anastomotic leaks were higher after BPD/DS (6% vs. 3%), but the difference did not achieve statistical significance. Mortality did not differ between the 2 groups (0.8% vs. 0.9%). In the group of patients followed-up for 1 to 2 years, age and distribution of men and women did not differ. Those patients undergoing BPD/DS had higher body mass index (59 vs. 55, P <0.05). Weight loss expressed as %EBW was similar between the 2 groups: 54% versus 53% at 1 year and 67% versus 64% at 2 years. CONCLUSIONS: Our data suggested that weight loss expressed as %EBW is similar between patients undergoing RYGBP and those undergoing BPD/DS. However, BPD/DS was associated with a longer hospital stay. 相似文献
13.
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
14.
Jane Garb Garry Welch Sofija Zagarins Jay Kuhn John Romanelli 《Obesity surgery》2009,19(10):1447-1455
Bariatric surgery has emerged as an important tool in the fight against morbid obesity. However, reviewers have noted that
there is a scarcity of long-term clinical surveillance data for bariatric surgery beyond 1-year follow-up and that a high
percentage of patients are lost to follow-up, raising questions regarding the accuracy of current outcomes estimates. A meta-analysis
of clinical reports providing bariatric surgery weight loss outcomes for morbidly obese patients was conducted over the period
2003–2007. Studies included were randomized controlled trials, nonrandomized controlled trials, and consecutive case series
involving patients receiving either laparoscopic adjustable gastric banding (LAGB) or laparoscopic gastric bypass (LGB) surgery.
Included studies involved n = 7,383 patients and were largely academic hospital-based (78.6%) and retrospective in design (71.4%). Weight loss outcome
was defined by percent excess weight loss (%EWL). Composite estimates showed a significantly greater %EWL for LGB surgery
(62.6%) compared to LAGB (49.4%). The superiority of LGB persisted at all three postsurgical time points examined (1, 2, and
>3 years). Problems were identified regarding incomplete or suboptimal data reporting in many studies reviewed, and high patient
attrition was evident at 2-year (49.8% LAGB, 75.2% LGB) and >3-year (82.6% LAGB, 89% LGB) end points. This meta-analysis confirms
the superiority of LGB to LAGB in %EWL found in earlier studies. Although problems in study quality raised significant concerns
regarding the validity of current weight loss estimates in this area, there was no evidence of publication bias. 相似文献
15.
Background: Laparoscopic adjustable gastric banding is a popular bariatric operation. Unfortunately, long-term complications such as
slippage, infection, and intragastric migration (erosion) may occur. With erosion, band removal is mandatory. Options to prevent
weight regain are delayed implantation of a new band, or conversion to another bariatric procedure such as Roux-en-Y gastric
bypass (RYGBP) or biliopancreatic diversion. We present our experience with band erosion and immediate or delayed conversion
to RYGBP. Methods: With a multidisciplinary team approach and prospective data collection, a comparison was made between patients with and
without band erosion. The patients who were converted to RYGBP for band erosion were analyzed. Results: Gastric banding was performed on 347 patients between 1995 and 2002. Median follow-up is 52 months. Band erosion developed
in 24 patients (6.8 %).The latter were heavier before gastric banding (BMI 45.9 vs 43.3, P <0,01). No band had ever been overinflated.
Band erosion was diagnosed after a mean of 22.5 months (3-51). At time of diagnosis, mean BMI of 33.5 kg/m2 (22.5-48) and average excess weight loss (EWL) of 52.9% (25-97) did not differ from that of the remaining patients at the
respective time interval. The band was removed in all cases. Conversion to RYGBP was performed at the same time in 11, and
a few months later in 2 patients. Operative morbidity included 1 leak (reoperation) and 4 wound infections. All but 1 patient
lost further weight after reoperation, or at least maintained their weight. At last follow-up, mean EWL in relation to the
pre-banding weight was 65.1%, and 69.2% of the patients had an EWL >50%, which compares favorably with the results obtained
after primary RYGBP. Conclusions: In our series with a median follow-up >4 years, band erosion was more common than usually reported. Band removal with immediate
or delayed conversion to RYGBP is feasible with an acceptable morbidity, and prevents weight regain in most cases. These results
support further use of this approach for band erosion. 相似文献
16.
Does Gastric Dilatation Limit the Success of Sleeve Gastrectomy as a Sole Operation for Morbid Obesity? 总被引:6,自引:10,他引:6
Langer FB Bohdjalian A Felberbauer FX Fleischmann E Reza Hoda MA Ludvik B Zacherl J Jakesz R Prager G 《Obesity surgery》2006,16(2):166-171
Background: Sleeve gastrectomy as the sole bariatric operation has been reported for high-risk super-obese patients or as
first-step followed by Roux-en-Y gastric bypass (RYGBP) or duodenal switch (DS) in super-super obese patients. The efficacy
of laparoscopic sleeve gastrectomy (LSG) for morbidly obese patients with a BMI of <50 kg/m2 and the incidence of gastric dilatation following LSG have not yet been investigated. Methods: 23 patients (15 morbidly obese,
8 super-obese) were studied prospectively for weight loss following LSG. The incidence of sleeve dilatation was assessed by
upper GI contrast studies in patients with a follow-up of >12 months. Results: Patients who underwent LSG achieved a mean
excess weight loss (EWL) at 6 and 12 months postoperatively of 46% and 56%, respectively. No significant differences were
observed in %EWL comparing obese and super-obese patients. At a mean follow-up of 20 months, dilatation of the gastric sleeve
was found in 1 patient and weight regain after initial successful weight loss in 3 of the 23 patients. Conclusion: LSG has
been highly effective for weight reduction for morbid obesity even as the sole bariatric operation. Gastric dilatation was
found in only 1 patient in this short-term follow-up. Weight regain following LSG may require conversion to RYGBP or DS. Follow-up
will be necessary to evaluate long-term results. 相似文献
17.
Background Genetics and environment both play a role in weight maintenance. Twin studies may help clarify the influence of nature vs
nurture in weight loss. We present the largest U.S. experience with monozygotic (MZ) twins undergoing bariatric surgery.
Methods We retrospectively reviewed the charts of four sets of MZ twins who underwent Roux-en-Y gastric bypass (RYGBP) surgery and
laparoscopic adjustable gastric band (LAGB) placement at three different institutions. BMI and co-morbidities were examined
pre- and postoperatively, and laboratory values were recorded.
Results All four sets of twins are female, live together, and have similar professions. Twin cohort 1 had near identical weight loss
patterns after open RYGBP surgery in 1996 (preop 146/142 kg; 2 years 82/82; and 10 years 108/107). Twin cohort 1 also both
underwent cholecystectomies within the first year postoperatively. Twin cohort 2 underwent laparoscopic RYGBP surgery and
also required cholecystectomies in the first postoperative year. Cohort 2 also experienced nearly identical weight loss at
1 year (36.7% vs 37.0% BMI loss). Twin cohort 3 underwent LAGB placement with two different surgeons with differing amounts
of weight loss at 6 months (6.5% vs 15.7% BMI loss). Finally, twin cohort 4 underwent laparoscopic RYGBP with 2-year BMI loss
of 39% vs 34%. In twin cohort 4, the twin who lost less weight lived apart from her twin and extended family, and her weight
loss was less than the twin living with her family.
Conclusion Two sets of MZ twins had identical responses to bariatric surgery. The other two sets of identical twins had differential
weight loss results, possibly due to differences in surgical approach and social support. While genetics do exert a strong
influence on weight loss and maintenance, this case series demonstrates the potential effect of social support and postoperative
management upon postoperative weight loss in the presence of identical genetics. 相似文献
18.
Background: Remission of diabetes following Roux-en-Y gastric bypass has been postulated to occur partly by bypass of the
foregut. Laparoscopic adjustable gastric banding (LAGB) also reduces food intake but does not bypass the foregut, and its
effects on diabetes have yet to be elucidated. Methods: Patients with diabetes or a history of diabetes and >6 months follow-up
after LAGB were studied. Follow-up was conducted separately by a surgeon with regard to weight loss and potential morbidity
and by a physician with regard to diabetic control. Results: 14 patients had had gestational diabetes, and diabetes was controlled
by diet in 25, oral hypoglycemics in 38 and insulin in 11 patients. Reduction in body mass index (BMI) and percentage of excess
weight loss (%EWL) were similar in these 4 subgroups, with a median reduction in BMI of 11.7 kg/m2 and %EWL of 51.1% at 24 months. 26 of 38 patients controlled with oral hypoglycemic medication and 6 of 11 insulin-dependent
diabetics had all medication stopped at a median of 6.5 months following LAGB. Univariate and multivariate analyses identified
%EWL ≥ 30.6% at 6 months as the only significant predictor of remission of diabetes. Conclusion:Two-thirds of the diabetic
patients have had remission of diabetes following LAGB. LAGB is an effective treatment for diabetes in obese patients. 相似文献
19.
Laparoscopic Conversion of Laparoscopic Gastric Banding to Roux-en-Y Gastric Bypass: a Review of 70 Patients 总被引:4,自引:1,他引:3
Background: The feasibility and outcomes of conversion of laparoscopic adjustable gastric banding (LAGB) to laparoscopic Roux-en-Y
gastric bypass (LRYGBP) was evaluated. Methods: From November 2000 to March 2004, all patients who underwent laparoscopic
conversion of LAGB to LRYGBP were retrospectively analyzed. The procedure included adhesiolysis, resection of the previous
band, creation of an isolated gastric pouch, 100-cm Roux-limb, side-to-side jejuno-jejunostomy, and end-to-end gastro-jejunostomy.
Results: 70 patients (58 female, mean age 41) with a median BMI of 45±11 (27-81) underwent attempted laparoscopic conversion
of LAGB to an RYGBP. Indications for conversion were insufficient weight loss or weight regain after band deflation for gastric
pouch dilatation in 34 patients (49%), inadequate weight loss in 17 patients (25%), symptomatic proximal gastric pouch dilatation
in 15 patients (20%), intragastric band migration in 3 patients (5%), and psychological band intolerance in 1 patient. 3 of
70 patients (4.3%) had to be converted to a laparotomy because of severe adhesions. Mean operative time was 240±40 SD min
(210-280). Mean hospital length of stay was 7.2 days. Early complication rate was 14.3% (10/70). Late major complications
occurred in 6 patients (8.6%). There was no mortality. Median excess body weight loss was 70±20%. 60% of patients achieved
a BMI of <33 with mean follow-up 18 months. Conclusion: Laparoscopic conversion of LAGB to RYGBP is a technically challenging
procedure that can be safely integrated into a bariatric treatment program with good results. Short-term weight loss is very
good. 相似文献
20.
Averbukh Y Heshka S El-Shoreya H Flancbaum L Geliebter A Kamel S Pi-Sunyer FX Laferrère B 《Obesity surgery》2003,13(6):833-836
Background: The prevalence of obesity is increasing in the United States. Bariatric surgery is the only intervention that
can reliably induce and maintain significant weight loss in obese patients. The association between pre-surgical severity
of depression and success at weight loss following Roux-en-Y gastric bypass (RYGBP) has not yet been fully elucidated. Methods:
145 charts of patients who underwent RYGBP for morbid obesity were reviewed. 47 patients who filled out the Beck Depression
Inventory (BDI) before surgery and completed 1 year of follow-up were studied. The relationship between pre-surgical severity
of depression and success at weight loss was examined through multivariate regression analysis using percent excess weight
loss (%EWL) as a dependent variable and BDI score as one of the predictors. Results: Weight loss at 1 year was significantly
related to the BDI score before surgery (P =0.014). BDI score was also found to be a significant predictor of the amount of weight lost (kg) 1 year after surgery (P =0.027). Age (P =0.03) and initial body mass index (BMI) (P =0.011) were the only other variables with significant independent relations to %EWL. Conclusions: Our data show a positive
correlation between pre-surgical severity of depression as measured by BDI score and the 1-year success at weight loss after
RYGBP as measured by %EWL. More depressed individuals tend to lose greater amounts of weight compared with less depressed
individuals. Future prospective studies should examine possible mechanisms and effects of depression and other psychiatric
disturbances on long-term weight loss after RYGBP. 相似文献