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1.
Laparoscopic adjustable gastric banding 总被引:3,自引:0,他引:3
Cadière GB Himpens J Hainaux B Gaudissart Q Favretti S Segato G 《Seminars in laparoscopic surgery》2002,9(2):105-114
The introduction of laparoscopic adjustable silicone gastric banding (LASGB) has recently revolutionized gastric restrictive procedures in the treatment of morbid obesity. We analysed the short and long term results of this minimally invasive bariatric procedure. A total of 652 patients with a body mass of (median) 45 kg/m(2) were treated. There were only minor preoperative incidents. One patient died more than one month after the procedure. Early postoperative complications included 2 gastric perforations caused by a nasogastric tube and one early slipping of the band. Late complications occurred in 7% of the patients: 25 patients suffered a pouch dilation, 2 patients had gastric erosion by the band; 18 patients had port complications requiring reoperation. Loss of excess weight was 62% at 2 years. Laparoscopic adjustable gastric banding is a safe and effective treatment for morbid obesity. The most frequent complication is pouch dilation. Further study is warranted for the evaluation of long term results. 相似文献
2.
Retrospective Analysis of Laparoscopic Gastric Banding Technique: Short-term and Mid-term Follow-up 总被引:2,自引:0,他引:2
F Berrevoet MD P Pattyn MD PhD A Cardon MD F de Ryck U J Hesse MD PhD B de Hemptinne MD PhD 《Obesity surgery》1999,9(3):272-275
Background: Although adjustable gastric banding shows good results concerning weight loss, several complications such as excessive
vomiting, total dysphagia, and slipping of the stomach through the band with pouch dilatation may occur rather frequently.
Different types of adjustable bands are available to prevent these short- and mid-term complications. Methods: In this retrospective
study, 120 consecutive laparoscopic adjustable gastric bandings were performed. In group I, 50 patients were treated with
adjustable silicone gastric banding (ASGB) by an intragastric balloon calibration technique. Group II (n = 29) received the
same band by a surgical technique with tunneling behind the esophagus toward the angle of His. Group III (n = 41) received
Swedish adjustable gastric banding (SAGB) by the same technique as in Group II. Results: Weight loss was approximately 15%
of the excess weight after 3 months, 30% after 6 months, and 45% after 12 months in all groups. Total dysphagia was significantly
more frequent in Groups I and II. The incidence of slipping of the band and pouch dilatation was more frequent in Group II.
Conclusion: The diameter of the ASGB band is rather small and can cause total dysphagia independently of surgical technique.
The SAGB is easy to perform and seems less vulnerable to complications like dysphagia and slipping of the band, probably because
of the individual adjustment of the stoma diameter during surgery and good fixation of both band and ventral pouch with separate
posterolateral sutures. 相似文献
3.
Background: Gastric banding is one of the simplest surgical procedures for the treatment of morbid obesity. We performed more
than 150 ‘laparotomy’ (open) gastric bandings and more than 50 ‘laparoscopic’ bandings in the last 10 years. Methods: In most
procedures we used non-adjustable bands, but since the beginning of 1995 we have used adjustable silicone banding. Results:
The 5- and 10-year follow-up weight loss results are encouraging. The average long-term weight loss was 35.5 kg. Since 1993,
we performed all the procedures laparoscopically, and the postoperative complications decreased from 18.5% in the ‘laparotomy’
group to 9.5% in the ‘laparoscopic’ group, with the majority being esophagitis and outlet area irritation. Conclusion: Gastric
banding itself and especially the minimally invasive laparoscopic approach is an easy technical procedure. The long-term weight
loss results and the reoperation rate are acceptable for bariatric surgery criteria. 相似文献
4.
David Chiapaikeo Molly Schultheis Bogdan Protyniak Paul Pearce Frank J. Borao Steven J. Binenbaum 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2014,18(4)
Background and Objectives:
Laparoscopic adjustable gastric banding is considered the least invasive surgical option for the treatment of morbid obesity. Its initial popularity has been marred by recent long-term studies showing high complication rates. We sought to examine our experience with gastric banding and factors leading to reoperation.Methods:
We reviewed retrospective data of 305 patients who underwent laparoscopic adjustable gastric banding between 2004 and 2011 at a single institution, 42 patients of whom required a reoperation, constituting 13.8%. Patients undergoing elective reoperations for port protrusion from weight loss as a purely cosmetic issue were excluded (n = 10). Patients'' demographic data, weight loss, time to reoperation, and complications were analyzed.Results:
Of 305 patients, 42 (13.8%) required reoperations: 26 underwent band removal (8.5%) and 16 underwent port revision (5.2%). The mean weight and body mass index for all patients who underwent reoperations were 122.6 kg and 45.0 kg/m2, respectively. The most common complication leading to band removal was gastric prolapse (n = 14, 4.6%). The most common indication for port revision was a nonfunctioning port (n = 10, 3.3%).Conclusion:
Laparoscopic adjustable gastric banding was initially popularized as a minimally invasive gastric-restrictive procedure with low morbidity. Our study showed a 13.8% reoperation rate at 3 years'' follow-up. Most early reoperations (<2 years) were performed for port revision, whereas later reoperations (>2 years) were likely to be performed for band removal. Laparoscopic adjustable gastric banding is associated with high reoperation rates; therefore bariatric surgeons should carefully consider other surgical weight-loss options tailored to the needs of the individual patient that may have lower complication and reoperation rates. 相似文献5.
Background: From 1993 to 1999, 172 patients underwent adjustable silicone gastric banding (ASGB) or laparoscopic adjustable
silicone gastric banding (LASGB). In 109 patients the adjustable band was placed via laparoscopy; in the other patients it
was placed via laparotomy (prelaparoscopic era, conversions from other bariatric operations, conversions for laparoscopic
failure). The conversion rate from laparoscopy to laparotomy was 9.3%, occurring in the early part of our experience. Methods:
Mean age was 37.9 years, weight 135 ± 14.8 kg (82-218) and BMI 46.3 ± 5.4 (35.1-69.5). All patients had multiple band adjustments,
temporary antisecretive, electrolyte and vitamin therapy, and follow-up per routine. Results: Weight loss at 3 years was 30.2%;
mean percent loss of excess weight was 62.5%.There was no mortality.The most important technical complications were: gastric
pouch dilatation that required band replacement or removal (5.8 %); mild gastric pouch dilatation reversible with adequate
dietary and pharmacological treatment (4.6%); intraoperative gastric perforation (2.3%); band migration (0.6%).The band was
removed in 2.3%, with conversion to another bariatric procedure in 1.1%. Conclusions: Results have been satisfactory thus
far. 相似文献
6.
Müller MK Attigah N Wildi S Hahnloser D Hauser R Clavien PA Weber M 《Surgical endoscopy》2008,22(2):448-453
BACKGROUND: Over the last decade, more than 130,000 laparoscopic adjustable gastric bandings (LAGB) have been performed for the treatment of morbid obesity. Nowadays, longer follow-up data are available in the literature and increasing numbers of late complications and treatment failures of gastric banding have been reported. The aim of the present study was the long-term evaluation of two different rescue operations after failed LAGB: conversion to laparoscopic Roux-en-Y bypass (LRYGB) versus laparoscopic gastric rebanding. METHODS: Between January 1997 and November 2002, 74 consecutive patients underwent either laparoscopic gastric rebanding (n = 44) or LRYGB (n = 30) after failed LAGB. There were 14 men and 60 women, with a median age of 42 (23-60) years. The indication for reoperation was an increasing body mass index (BMI) and band-related complications such as pouch dilatation, band slippage, and penetration after LAGB. Rebandings were done by preference during the initial period of the study and LRYGB was the treatment of choice during the latter period. The success of the rescue operation was assessed by postoperative changes in the BMI, improvements of co-morbidities, and the need for further reoperations (secondary failure). The median follow-up was 36 months (range, 24-60 months). RESULTS: Patients who underwent LRYGB had a significantly better weight loss than patients with a rebanding operation (mean -6.1 versus +1.5 BMI points). In addition, the LRYGB patients showed a significantly better control of serum cholesterol during the long term follow-up (-0.6 versus +0.1 mmol/l). Almost half of the patients (45%) in the rebanding group needed a further operative revision, whereas only 20% underwent reoperation after rescue LRYGB. Thus, the secondary failure rate in the rebanding group was significantly higher compared to the bypass group (p = 0.028). CONCLUSIONS: The present long-term study confirms our previous finding that LRYGB is a better treatment than rebanding after failed laparoscopic gastric banding regarding weight loss and treatment of co-morbidities. During the long-term follow-up the reoperation rate due to secondary failure became significantly higher in the rebanding group. We therefore recommend that LRYGB should be preferred as rescue procedure after failed laparoscopic adjustable gastric banding. 相似文献
7.
Cadière GB Himpens J Vertruyen M Germay O Favretti F Segato G 《Seminars in laparoscopic surgery》2000,7(1):55-65
Until now, for treatment of morbid obesity in the long term, surgery remained as the final option. For 40 years, surgeons looked at the best procedure. Among the restrictive procedures (gastroplasty), the laparoscopic adjustable silicone banding is the least invasive surgical treatment of morbid obesity. Between October 1992 and January 1998, we performed this procedure on 652 patients. Median body mass index was 45 (range, 35-65). Median hospital stay was 3 days (range, 2-10 days). The mean operative time was 80 minutes (range, 40-240 minutes). Four patients (0.6%) presented early complications: bleeding (1 patient), gastric perforation (2 patients), and pneumonia (1 patient). Forty-seven (7.2%) patients presented late complications and needed to be reoperated. There is one case of mortality. Loss of mass body weight was 62% in 2 years. According to these results, laparoscopic adjustable silicone gastric banding seems to be a safe and efficient technique. 相似文献
8.
Conversions and complications in 185 laparoscopic adjustable silicone gastric banding cases 总被引:9,自引:3,他引:6
E. Chelala G. B. Cadiére F. Favretti J. Himpens M. Vertruyen J. Bruyns L. Maroquin M. Lise 《Surgical endoscopy》1997,11(3):268-271
Background: Kuzmak's gastric silicone banding technique is the least invasive operation for morbid obesity. The purpose of this study
was to analyze the complications of this approach.
Methods: Between September 1992 and March 1996, 185 patients underwent laparoscopic gastroplasty by the adjustable silicone band technique.
A minimally invasive procedure using five trocars was performed.
Results: In 11 patients exposure of the hiatus was impeded because of hypertrophy of the left liver lobe which led to conversion in
eight patients and abortion of the procedure in three other patients. Anatomical complications: We observed two gastric perforations
and one band slippage at the early stage, one infection and three rotations of the access port. Functional complications:
There were eight (4%) cases of irreversible total food intolerance resulting in pouch dilation and eight cases (4%) of esophagitis.
One fatality on the 45th day in a patient with a Prader-Willi syndrome.
Conclusion: The most disturbing complications of gastric banding technique are gastric perforation and pouch dilation. Their incidence
may be reduced by improving the technique and by considering pitfalls of the procedure.
Received: 28 May 1996/Accepted: 25 July 1996 相似文献
9.
BACKGROUND: Adjustable silicone gastric banding is an effective and safe treatment for morbid obesity. Migration of the band through the stomach wall is a long-term complication. The causes, clinical symptoms, timing, and incidence of band migration have not yet been investigated. METHODS: We report our experience over 9 years. Between February 1995 and February 2004, we performed adjustable silicone gastric banding in 161 patients, with follow-up of about 90.5% of cases. Mean follow-up time was 60.4 months. Cases of erosion were studied retrospectively. RESULTS: Eight patients (4.9%) developed band migration. In seven, the migration occurred between 30 and 86 months after band implantation. In one case, the migration occurred 10 months after laparoscopic repositioning of the band to avoid pouch dilatation. In all cases, the bands were removed. CONCLUSION: Band migration is a late complication after gastric banding that requires band removal. Various symptoms and complications of band migration influence the kind of band removal. The causes of band migration and its treatment are discussed. 相似文献
10.
Laparoscopic gastric banding: a minimally invasive surgical treatment for morbid obesity: prospective study of 500 consecutive patients 总被引:10,自引:0,他引:10
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Zinzindohoue F Chevallier JM Douard R Elian N Ferraz JM Blanche JP Berta JL Altman JJ Safran D Cugnenc PH 《Annals of surgery》2003,237(1):1-9
OBJECTIVE: To evaluate early and late morbidity of laparoscopic adjustable gastric banding for morbid obesity and to assess the efficacy of this procedure by analyzing its results. SUMMARY BACKGROUND DATA: Laparoscopic adjustable gastric banding is considered the least invasive surgical option for morbid obesity. It is effective, with an average loss of 50% of excessive weight after 2 years of follow-up. It is potentially reversible and safe; major morbidity is low and there is no mortality. METHODS: Between April 1997 and June 2001, 500 patients underwent laparoscopic surgery for morbid obesity with application of an adjustable gastric band. There were 438 women and 62 men (sex ratio = 0.14) with a mean age of 40.4 years. Preoperative mean body weight was 120.7 kg and mean body mass index (BMI) was 44.3 kg. m. RESULTS: Mean operative time was 105 minutes, 84 minutes during the last 300 operations. Mean hospital stay was 4.5 days. There were no deaths. There were 12 conversions (2.4%), 2 during the last 300 operations. Fifty-two patients (10.4%) had complications requiring an abdominal reoperation. Forty-nine underwent a reoperation for minor complications: slippage (n = 43, incisional hernias (n = 3), and reconnection of the catheter (n = 3). Three patients underwent a reoperation for major complications: gastroesophageal perforation (n = 2) and gastric necrosis (n = 1). Seven patients had pulmonary complications and 36 patients experienced minor problems related to the access port. At 1-, 2-, and 3-year follow-up, mean BMI decreased from 44.3 kg. m to 34.2, 32.8, and 31.9, respectively, and mean excess weight loss reached 42.8%, 52%, and 54.8%. CONCLUSIONS: Laparoscopic adjustable gastric banding is a beneficial operation in terms of excessive weight loss, with an acceptably low complication rate. It can noticeably improve the quality of life in obese patients. Half of the excess body weight can be effortlessly lost within 2 years. 相似文献
11.
Background: From December 1997 to December 1998, 25 laparoscopic adjustable silicone gastric banding (LASGB) procedures were
done without previous experience in bariatric surgery. Body mass index (BMI) ranged from 37 to 57 kg/m2 (average 45.5 kg/m2). Methods: Retrospective analysis of the 1-year experience was done. Operating time was measured, and BMI and complications
were reviewed. Results: Five complications were observed. There was a complication rate of 20%. On two occasions, it was gastric
wall slippage, and both were corrected laparoscopically. In one patient, the intususception of the gastric wall through the
band resulted after profuse vomiting. Removal of the band was necessary, with conversion to an open procedure. On two occassions,
the infection of the port-site was observed, in one of these patients, port removal was necessary. No antibiotic prophylaxis
was used. Conclusion: Despite lack of experience in bariatric surgery in these laparoscopic surgeons, the complications with
LASGB appear to be acceptable. Although prior bariatric surgical experience is preferable. 相似文献
12.
Luca Busetto Claudia Pisent Gianni Segato Francesco De Marchi Franco Favretti Mario Lise Giuliano Enzi 《Obesity surgery》1997,7(6):505-512
Objective: To evaluate the effects of a new timing strategy of band adjustment on the short-term outcome of obese women operated
with adjustable silicone gastric banding. Subjects: The outcome of 30 women without binge-eating disorder operated with laparoscopic
adjustable silicone gastric banding with a wider intraoperatory band calibration (LAP-BAND) was compared to that of 30 body
mass index-matched women without binge-eating disorder previously operated with adjustable silicone gastric banding (ASGB)
applied by laparotomy with the usual intraoperatory band calibration. The patients were evaluated 3, 6 and 12 months after
surgery. Measurements: (1) weight loss; (2) total daily energy intake; (3) percent as liquid, soft or solid food; (4) vomiting
frequency; (5) rate of postoperative percutaneous band adjustments; (6) rate of band-related complications. Results: Both
the weight loss and the daily energy intake did not differ between patients with LAP-BAND and patients with ASGB. After surgery,
the patients with LAP-BAND ate more solid food and less liquid food than the patients with ASGB. Vomiting frequency was higher
in patients with ASGB than in patients with LAP-BAND. The total number of percutaneous band adjustments was higher in women
with LAP-BAND than in women with ASGB. Band inflation because of weight stabilization was performed in six (20.0%) women with
ASGB and in 19 (63.3%) women with LAP-BAND. Neostoma stenosis occurred in one women with ASGB, but in none of the women with
LAP-BAND. One patient with LAP-BAND presented band slippage. Conclusions: The wider intraoperatory band calibration performed
in patients with LAP-BAND did not reduce the short-term efficacy of adjustable silicone gastric banding. This new timing strategy
of band adjustment required more postoperative percutaneous band inflations, but it improved the eating pattern of the patients
(low vomiting frequency and high intake of solid food). 相似文献
13.
Sandeep Randhawa Puneet Ghai Sunil Bhoyrul 《Surgery for obesity and related diseases》2013,9(2):296-299
BackgroundLaparoscopic adjustable gastric banding surgery is one of the most popular procedures for patients with morbid obesity. Although it is one of the least invasive surgical treatments for obesity, the most common reasons for reoperation are complications arising from the subcutaneous reservoir (port) used to adjust the band. Mesh fixation of the port, in which the port is sutured to a piece of mesh and then placed without anchoring sutures onto the fascia is a method of securing the port. The purpose of the present study was to review the experience of a single surgeon (S.B.) with mesh fixation in >500 patients during a 4-year period and to assess the safety and efficacy of this technique in private practice in United States.MethodsA total of 564 patients underwent laparoscopic gastric banding during a 4-year period from January 2007 to January 2011. During these operations, the subcutaneous port was affixed to the fascia by suturing the port to a small piece of polypropylene mesh and then placing the port onto the fascia without any additional anchoring sutures or staples.ResultsOf 564 patients, only 2 required reoperation to reposition the subcutaneous port, for a .3% port flip rate. We also report the findings during elective reoperation for plastic surgery or revision surgery.ConclusionMesh fixation of the subcutaneous port is simple, inexpensive, and highly effective and has an extremely low complication rate. 相似文献
14.
Role of a minimally invasive approach in the management of laparoscopic adjustable gastric banding postoperative complications 总被引:2,自引:0,他引:2
Silecchia G Perrotta N Boru C Pecchia A Rizzello M Greco F Genco A Bacci V Basso N 《Archives of surgery (Chicago, Ill. : 1960)》2004,139(11):1225-1230
HYPOTHESIS: Complications after laparoscopic adjustable gastric banding as treatment for morbid obesity may require a major reintervention. A minimally invasive approach represents an attractive management alternative for such complications. DESIGN: Prospective case series. SETTING: Major academic medical and surgical center. PATIENTS: From January 1996 to July 2003, 47 patients who had undergone laparoscopic adjustable gastric banding were operated on again. Considering the causes for reoperation, the patients were divided into 4 groups: group A had major complications (n = 26); group B, minor complications (n= 11); group C, psychological problems (n=6); and group D, insufficient weight loss (n=4). INTERVENTIONS: Forty-three procedures, 38 using general anesthesia (groups A, C, and D) and 5 using local anesthesia (group B), were performed. MAIN OUTCOME MEASURES: Feasibility, safety, and effectiveness of a minimally invasive approach in the treatment of laparoscopic adjustable gastric banding complications. RESULTS: In group A, 9 of 10 patients with irreversible gastric pouch dilatation and 15 of 16 with intragastric band migrations were treated laparoscopically. In group B, 5 ports were substituted and 2 reconnections of the catheter-port system were performed. In group C, 6 laparoscopic band removals were carried out. In group D, 4 laparoscopic revision procedures for insufficient weight loss were performed. The operative mortality was nil. The most frequent cause of reoperation was intragastric migration (37.2%). A minimally invasive approach was adopted in 94.7% of cases. CONCLUSION: Laparoscopy is safe and effective, even as a second operative procedure. 相似文献
15.
Labeck B Nehoda H Kühberger-Peer R Klocker J Hourmont K Aigner F Weiss HG 《Surgical endoscopy》2001,15(10):1193-1196
Background: Pouch volume and stoma diameter are believed to have a significant impact on the efficacy of restrictive bariatric
surgery. However, it is not clear whether the pouch is compulsory in stoma-adjustable gastric and esophagogastric banding.
Methods: Between April 1997 and April 1998, we performed 26 esophagogastric and 109 gastric bandings using the Swedish Adjustable
Gastric Band (SAGB). The patients were assigned to four groups defined according to the initial of the volume pouch (as determined
radiologically): esophagogastric banding (no pouch), gastric banding <7.5 ml, gastric banding 7.5-15 ml, and gastric banding
15-30 ml. weight loss, increase in pouch volume, symptoms, and complications were recorded 6 and 12 months postoperatively.
results: all but one patient achieved significant weight reduction; there were no significant differences among the study
groups. increase in pouch volume was observed in 0-31.8% of patients. preexisting heartburn and regurgitation improved postoperatively
in all groups, but dysphagia developed in the esophagogastric banding group postoperatively. two band migrations occurred
in the esophagogastric banding group, and two pouch dilatations were observed in the gastric banding groups. conclusions:
pouch volume is a negligible factor in terms of weight reduction and complications following adjustable esophagogastric or
gastric banding. postoperative dysphagia represents a drawback of esophagogastric banding. 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.
Gianfranco Silecchia Vincenzo Bacci Sabrina Bacci Giovanni Casella Mario Rizzello Mariachiara Fioriti Nicola Basso 《Surgery for obesity and related diseases》2008,4(3):430-436
BACKGROUND: To assess the rates and causes of reoperations in a long-term follow-up of a cohort of morbidly obese patients treated by laparoscopic adjustable gastric banding. METHODS: A retrospective study was performed to evaluate a cohort of 498 consecutive patients who had undergone laparoscopic adjustable gastric banding since 1996. The first 50 patients were excluded to avoid the learning curve bias. A perigastric technique was used until 2002 (37% of patients) and was then rapidly replaced by a pars flaccida approach. The patients who underwent band removal or port reposition/removal were considered, respectively, as having required a major or minor reoperation. RESULTS: Of the 448 patients (83% women) followed up for an average of 3.2 +/- 2.2 years, 79 (mean age 37.7 years, mean body mass index 44.0 kg/m(2)) underwent repeat surgery between 1997 and 2006. Of these procedures, 29 were minor and 59 were major reoperations. Ten patients underwent band removal after a port complication developed. The main causes were pouch dilation (37%), insufficient weight loss (20%), erosion (20%), and psychological (15%). Ten patients underwent revisional surgery. A 13% incidence of major reoperations was observed for the entire group; the rate of major and minor reoperations was 4.1 and 2.1 interventions per 100 persons-years, respectively. In patients with follow-up >5 years (perigastric technique), the cumulative incidence reached 24%. CONCLUSION: The need for a major reoperation appears to be substantial in patients who have undergone laparoscopic adjustable gastric banding, particularly when the long-term follow-up data are considered, and can occur at any point after surgery. More severe obesity (body mass index >50 kg/m(2)) seems to carry a greater risk of reoperation. These findings highlight the need for lifelong multidisciplinary management and surveillance for these patients. 相似文献
18.
BACKGROUND: Since 1983 gastric banding has become a proven operative method, which reduces effectively excess weight in morbid obesity. Gastric banding has been popularized as a minimally invasive, completely reversible surgical treatment for morbid obesity. We report here our 4 year experiences of gastric banding with special reference to complications. PATIENTS AND METHODS: There were 109 patients in total, of whom 92 were women. Median age was 41.5 years (range 17-62 years) and median body-mass-index (BMI) was 49.6 kg/m2 (range 36.7-82.6 kg/m2). From February 1995 to June 1997 39 patients were operated upon with the open technique. In June 1997 we started the laparoscopic gastric banding. 70 patients were treated with this method from June 1997 to February 1999. RESULTS: The weight loss 6 months postoperatively after gastric banding was 35.3% and 12 months after the operation 43.0% of the overweight. In 17 cases a re-operation was necessary. Indications for re-operations included pouch dilatation in 4 cases, slippage in 3 cases and complications connected with the port system. The operation technique and the kind of band fixation influenced the frequency of complications. CONCLUSIONS: A lot of complications especially after laparoscopic gastric banding can be prevented by a strong indication. Using the laparoscopic technique complications like pouch dilatation are diminished compared to the open technique. A standardized operation technique decreases the complication and re-operation rate. Conversions to the open technique were mostly necessary during the learning curve of LASGB (laparoscopic adjustable silicone gastric banding). 相似文献
19.
Zieren J Menenakos C Paul M Müller JM 《Journal of laparoendoscopic & advanced surgical techniques. Part A》2004,14(2):77-79
In a consecutive series of 138 laparoscopic adjustable gastric bandings (LAGB) we observed disconnection of the gastric band catheter at the site of the port connector in 17 patients. During operative revision we established a new port position with a minimal distance of 10 cm between the connector and the entrance of the catheter to the abdominal cavity. Using this technique no complications and no catheter disruptions occurred during a median followup period of 25 months. 相似文献
20.
Chih-Kun Huang Chi-Hsien Lo Asim Shabbir Chi-Ming Tai 《Surgery for obesity and related diseases》2012,8(1):41-45
BackgroundThe laparoscopic adjustable gastric band has been widely accepted as 1 of the safest bariatric procedures to treat morbid obesity. However, because of variations in the results and the complications that tend to arise from port adjustment, alternative procedures are needed. We have demonstrated, in a university hospital setting, the safety and feasibility of a novel technique, laparoscopic adjustable gastric banded plication, designed to improve the weight loss effect and decrease gastric band adjustment frequency.MethodsWe enrolled 26 patients from May 2009 to August 2010. Laparoscopic adjustable gastric banded plication was performed using 5-port surgery. We placed Swedish bands using the pars flaccida method, divided the greater omentum, and performed gastric plication below the band to 3 cm from the pylorus using a single-row continuous suture. The data were collected and analyzed pre- and postoperatively.ResultsThe mean operative time was 87.3 minutes without any intraoperative complications. The average postoperative hospitalization was 1.33 days. The mean excess weight loss at 1, 3, 6, 9, and 12 months after surgery was 21.9%, 31.9%, 41.3%, 55.2%, and 59.5%, respectively. The mean follow-up time was 8.1 months (range 2–15), and the gastric band adjustment rate was 1.1 times per patient during this period. Two complications developed: gastrogastric intussusception and tube kinking at the subcutaneous layer. Both cases were corrected by reoperation. No mortality was observed.ConclusionLaparoscopic adjustable gastric banded plication provides both restrictive and reductive effects and is reversible. The technique is safe, feasible, and reproducible and can be used as an alternative bariatric procedure. Comparative studies and long-term follow-up are necessary to confirm our findings. 相似文献