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1.
Gastric bezoars may develop in the proximal pouch after gastric restriction, eg. by laparoscopic adjustable gastric banding
(LAGB). To date, only two centers have reported this rare complication. We report an additional case with band slippage, to
emphasize that bezoars should be considered in the differential diagnosis in patients presenting with new onset nausea and
vomiting after LAGB. 相似文献
2.
Dan E. Azagury Oliver Varban Ali Tavakkolizadeh Malcolm K. Robinson Ashley H. Vernon David B. Lautz 《Surgery for obesity and related diseases》2013,9(1):48-52
BackgroundWe hypothesized that laparoscopic adjustable gastric band (LAGB) placement might result in the development of a hiatal hernia (HH) over time. The objective of our study was to determine whether HHs develop after LAGB in the setting of a university hospital.MethodsWe retrospectively reviewed all outcomes for consecutive LAGB patients in our institutional, longitudinal prospective bariatric surgical database to identify those patients without evidence of a HH at LAGB placement, who subsequently underwent delayed HH repair.ResultsFrom 2005 to 2009, 695 gastric bands were implanted. Twelve patients (1.72%) were identified who had no radiographic or intraoperative evidence of a HH at LAGB placement and who subsequently underwent HH repair at re-exploration. Patients presented 18 ± 10 months after band placement. Of these patients, 75% presented with gastroesophageal reflux disease or food intolerance (50% with gastroesophageal reflux disease alone). Also, 2 presented with acute pain due to band slippage and 1 with chronic pain and vomiting. In 50% of the patients, revision procedures detected the HH at operation despite negative preoperative studies.ConclusionIn our series, a significant HH developed in 1.7% of LAGB patients who had no clinically identifiable HH at LAGB placement. Persistent dysphagia after band deflation requires careful inspection of the hiatus during surgical revision, even in the absence of radiologic depiction of HH, and might represent an underlying etiology of LAGB dysfunction. This complication, along with esophageal dilation and annular pouch dilation, might represent a constellation of conditions with a common etiology. From the results of our small series, we raise the question of the existence of chronic backpressure created by LAGB restriction and accounting for these complications. 相似文献
3.
Laparoscopic band repositioning for pouch dilatation/slippage after gastric banding: disappointing results 总被引:5,自引:0,他引:5
Suter M 《Obesity surgery》2001,11(4):507-512
Background: Pouch dilatation with or without slippage of the band is a serious complication of gastric banding, often attributed
to initial malpositioning of the band. Food intake is increased, and weight regain occurs. Progressive rotation of the band
follows, leading to functional stenosis and dysphagia. Reoperation is necessary in most cases, and may consist of band removal,
band change, band repositioning, or conversion to another bariatric procedure. Material and Methods: The study consisted of
chart review of all patients who underwent laparoscopic repositioning of the band for pouch dilatation/slippage, and long-term
follow-up through regular office visits and phone calls. Results: Among 272 patients who had laparoscopic gastric banding,
20 (7.3 %) developed pouch dilatation and/or slippage, of whom 19 underwent reoperation. Laparoscopic band repositioning was
performed in 9 patients. One of them developed an intraabdominal collection postoperatively and required percutaneous CT-guided
drainage. Recovery was uneventful in the other 8. Follow-up since reoperation varies from 13 to 42 months (mean 20 months).
The result was good in 2 patients who lost further weight, satisfactory in 1 whose weight remained stable, and unsatisfactory
in 6 patients. Weight loss was insufficient in 2, dilatation recurred in 2, and band infection or erosion developed each in
1 patient. 5 patients required further surgery: band removal in 3 and conversion to gastric bypass in 2. Conclusions: Laparoscopic
band repositioning is feasible and safe if pouch dilatation and/or slippage develops after gastric banding.The mid-term results
are disappointing in two-thirds of the patients. In some patients, pouch dilatation could result from poor adjustment to diet
restriction rather than merely from original malplacement. Conversion to gastric bypass may be a better option in these cases. 相似文献
4.
Pouch Dilatation and Slippage after Adjustable Gastric Banding: Is it Still an Issue? 总被引:5,自引:3,他引:2
Dargent J 《Obesity surgery》2003,13(1):111-115
Background: Laparoscopic adjustable gastric banding (LAGB) in France is currently the most common bariatric surgical procedure
for the treatment of severe obesity; its most reported complication is band slippage and/or pouch dilatation, which usually
requires reoperation. It is highly important to assess whether a change in the operation could improve these results. Methods:
From April 1995 to October 2001, 973 patients underwent LAGB in our institution. Since January 1999, our technique changed:
the band was positioned according to the so called "pars flaccida technique", ie. around the gastric vessel instead of close
to the gastric wall. 511 patients had been operated before this period, and 462 after. Other details in the technique did
not change (dissection above the lesser sac, no posterior stitch, three anterior stitches), meaning that potential differences
could not be related to a learning curve. Results: Band slippage occurred in 27 patients of the first group during the first
period of 34 months (5.2%), and 5 more afterwards (total 6.2%). Only 3 patients of the second group (0.6%) had a slippage
during the same period of time. Conclusion: Although the problem of band slippage is not likely to be completely solved, changing
the technique has made it possible to decrease the rate of this complication.The height or the shape of different types of
band also remain under scrutiny. 相似文献
5.
Late band slippage has occurred in nearly 3-10% of patients after laparoscopic adjustable gastric banding (LAGB) with an average delay of 13 months. Band slippage can rarely lead to necrosis of the enlarged pouch, a potentially life-threatening condition. We report a female (BMI 39.92 with co-morbidities) who developed acute outlet obstruction 2 years after LAGB placement. After prompt band deflation, an urgent Gastrografin swallow showed stomach slippage without emptying. At re-operation pouch strangulation was discovered. The pouch appeared to be ill-fated, but as no tear was evident on intra-operative assessment, we decided to simply remove the band and drain. The patient was successfully discharged after 8 days, and the last upper endoscopy showed only a large ulcer in the fundus that was healing. Proper and prompt management of symptomatic patients with stomach slippage, with early operation when acute obstruction is evident, can enable a successful stomach-sparing approach. 相似文献
6.
Background: Re-operations after laparoscopic adjustable gastric banding operation (LAGB) are band-associated or due to complications
of the access-port. Symptoms, diagnostics, operations, and follow-up of patients with re-operations were analyzed. Methods:
Between December 1996 and January 2002, 250 morbidly obese patients were treated with LAGB and prospectively evaluated using
a standardized protocol. Since June 2000 the pars flaccida technique was applied, since October 2000 with the new 11-cm Lap-Band?. All adjustments of the band were done under radiological control. Results: Of 250 patients, 39 had to be re-operated because
of band-associated complications: 27 laparoscopic re-gastric bandings after 12 (3-26) months because of slippage; 6 laparoscopic
removals of the band (band intolerance- 4, pain- 1, pouch dilatation- 1); 12 biliopancreatic diversions with duodenal switch
(BPD-DS) after 29 (18-43) months due to pouch and/or esophageal motility disorders (9) or insufficient weight loss (3), in
6 patients after having already performed a re-banding for slippage. 9 revisions of the access-port were done after 6 (2-53)
months (disconnection- 3, dislocation- 6). The morbidity of the re-operations was 5.3%: 1 hematoma in the abdominal wall and
1 temporary dysphagia after re-banding, 1 pulmonary embolism following BPD-DS. There have been no deaths. In patients with
a minimal follow-up of 3 years (n=92), the yearly re-operation rate was 11-12%. No slippage has occurred with the new 11-cm
Lap-Band?. Conclusion: Re-operations after LAGB for bandassociated complications were frequent but could be performed safely with little
morbidity. When the new 11-cm Lap-Band? was employed, the high slippage rate dropped. 相似文献
7.
Background: Laparoscopic adjustable gastric banding (LAGB) is a safe technique with few direct postoperative complications.
However, long-term complications such as slippage and pouch dilatation are a well-known problem and re-operations are necessary
in a substantial number of patients. In this study, the results of laparoscopic re-operations after LAGB are evaluated. Methods:
33 patients had a re-operation because of failed LAGB. 29 patients had major re-operation and 4 patients minor re-operation
under local anesthesia. The charts of these patients were retrospectively studied. Results: Mean time between the first band
placement and re-operation was 28.1 ± 17.6 months. The cause of band dysfunction was anterior slippage (n=17), band erosion
(n=5), band intolerance (n=3), posterior slippage (n=2) and band leakage (n=2). Symptoms of band dysfunction were vomiting
(n=16), pyrosis (n=13), nausea (n=8), retrosternal pain (n=11) and regurgitation (n=5). Laparoscopic refixation of the band
was performed in 19 patients: the band was replaced in 4 patients while in 1 patient the band was removed; in 3 patients,
the laparoscopic procedure was converted to open surgery; 5 patients underwent conversion to a bypass procedure (biliopancreatic
diversion in 3 and gastric bypass in 2). There were no direct postoperative complications except for wound infections (n=2).
Postoperative follow-up was 100% with a mean period of 34 ± 19 months. BMI decreased further from 37.5 ± 6.4 kg/m2 before re-operation to 33 ± 7 kg/m2. Obesity-related co-morbidity also decreased further or completely dissolved. 3 patients (9%) again developed anterior slippage
and a second laparoscopic re-operation was necessary. Conclusions: A laparoscopic re-operation for band-related complications
after LAGB is safe and feasible. With band slippage, a laparoscopic refixation was possible in 89%. Re-operation leads to
further decrease in BMI and obesity-related co-morbidities. 相似文献
8.
Laparoscopic banding: selection and technique in 830 patients 总被引:13,自引:7,他引:6
Favretti F Cadière GB Segato G Himpens J De Luca M Busetto L De Marchi F Foletto M Caniato D Lise M Enzi G 《Obesity surgery》2002,12(3):385-390
Background: Laparoscopic adjustable gastric banding (LAGB) with the Lap-Band? has been our first choice operation for morbid
obesity since September 1993. Results in terms of complications and weight loss are analyzed. Methods: 830 consecutive patients
(F 77.9%) underwent LAGB. Initial body weight was 127.9 ± SD 23.9 kg, and body mass index (BMI) was 46.4 ± 7.2 kg/m2. Mean age was 37.9 (15-65). Steps in LAGB were: 1) establishment of reference points for dissection (equator of the balloon
inflated with 25 cc air and left crus); 2) creation of a retrogastric tunnel above the bursa omentalis; 3) creation of "virtual"
pouch; 4) embedding the band. Results: Mortality was 0, conversion 2.7%, and follow-up 97%. Major complications requiring
reoperation developed in 3.9% (36 patients). Early complications were 1 gastric perforation (requiring band removal) and 1 gastric slippage (requiring repositioning). Late
complications included 17 stomach slippages (treated by band repositioning in 12 and band removal in 5), 9 malpositions (all
treated by band repositioning), 4 gastric erosions by the band (all treated by band removal), 3 psychological intolerance
(requiring band removal), and 1 HIV positive (band removed). A minor complication requiring reoperation in 91 patients (11%)
was reservoir leakage. 20% of patients who had % excess weight loss <30 had lost compliance to dietetic, psychological and
surgical advice. BMI declined significantly from the initial 46.4 ± 7.2 to 37.3 ± 6.8 at 1 year, 36.4 ± 6.9 at 2 years, 36.8
± 7.0 at 3 years, and 36.4 ± 7.8 at 5 years. Conclusion: LAGB is a relatively safe and effective procedure. 相似文献
9.
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
10.
Dargent J 《Obesity surgery》2005,15(6):843-848
Background: Laparoscopic adjustable gastric banding (LAGB) has become a method of choice worldwide to treat morbid obesity.
Long-term complications such as esophageal dilatation require that a relevant strategy for treatment be defined. Esophageal
dysmotility is commonly described in morbidly obese patients. Methods: 1,232 patients have undergone LAGB over 9 years (1995–2004),
and 162 (13.1%) have had a reoperation for complications (excluding access-port problems): slippage (109), erosion (28), intolerance
(25). 80 patients (6.4%) had their band removed, and 10 had a switch to another procedure. Esophageal dilatation has been
an isolated cause for removal in 2 patients and an associated cause in 6 patients. Results: There was no significant correlation
between esophageal dilatation and insufficient excess weight loss (<25%) after 5 years (37/257:14.3%). 4 stages of dilatation
were identified, with the relevant treatment for each, the ultimate alternative being conversion to a laparoscopic gastric
bypass. We suggest that esophageal dilatation be a separate issue from pouch dilatation and gastric erosion, and that it be
classified as a complication only in severe cases requiring band removal. Most cases can be handled through deflation of the
band under radiological control. Conclusion: LAGB can lead to significant esophageal troubles which must remain under scrutiny
but generally respond to "radiological management", which also makes LAGB more demanding than other operations in terms of
follow-up. 相似文献
11.
Background: The most prevalent long-term complications in patients who undergo laparoscopic adjustable gastric band (LAGB)
surgery are pouch dilatation and gastric prolapse (slippage). Gastric prolapse can be divided into the anterior and posterior
variety. Posterior prolapse is thought to be specific to the perigastric approach due to a lack of posterior band fixation.
We report a series of 3 patients out of 1,104 who underwent LAGB placement using the pars flaccida approach and developed
a posterior prolapse. Methods: Between March 2002 and December 2005, 1,104 patients underwent LAGB insertion using the pars
flaccida approach at our institution. 3 patients (0.27%) developed posterior prolapse requiring reoperation. Results: All
3 patients presented with similar complaints, including solid food intolerance, gastroesophageal reflux and/or regurgitation.
Although identical to those reported with anterior prolapse, diagnosis was definitively made with barium video esophagogram.
All patients were treated with reoperation, but band replacement was impossible in 2 of the 3 cases secondary to extensive
adhesion formation. Conclusion: The finding of 3 patients who experienced posterior prolapse, despite using the pars flaccida
approach, highlights the fact that this complication although diminished, has not been eliminated as previously thought. We
describe the presentation, work-up, and management of this rare but important entity in the modern era of LAGB. 相似文献
12.
A prospective randomized trial of different laparoscopic gastric banding techniques for morbid obesity 总被引:4,自引:3,他引:1
Background: Slippage of the stomach is the most common postoperative complication after laparoscopic adjustable silicone gastric
banding (LASGB) for morbid obesity. Retrogastric placement (RGP) of the band through the lesser sac can cause posterior slippage
Incomplete suturing often is responsible for anterior slippage. A randomized prospective study was constructed to determine
whether laparoscopic esophagogastric placement (EGP) is associated with a lower incidence of postoperative slippage and pouch
dilation than RGP. Methods: Morbid obese patients presenting for LASGB were randomized to undergo either an EGP (n = 50) or
an RGP (n = 51). Patients were blinded to which procedure they underwent, and follow-up date were obtained by a blinded independent
investigator. Standardized clinical and radiologic controls were used to assess pouch enlargement and slippage. Results: Operating
time was similar for the two procedures (54.5 min for EGP vs 58 min for RGP). There was no significant difference in postoperative
weight loss (34 kg after EGP vs 37 kg after RGP within 12 months), esophagus dilation, or postoperative quality of life. There
were two postoperative slippages and one pouch dilation in the RGP group and no postoperative complication in the EGP group.
Conclusions: The placement of a LAP-BAND adjustable gastric banding system by the EGP technique is safe and results in a lower
frequency of postoperative complications than its placement by the RGP technique. Clear anatomic landmarks are a benefit to
education and to the learning curve for LASGB. 相似文献
13.
Background: The appearance of hernia around the access port site after implantation of a laparoscopic adjustable gastric band
(LAGB) is a complication that can limit the beneficial effect of the device. We evaluated the incidence of hernias at the
port-site for band adjustment and propose a technique for its repair. Methods: A retrospective study was conducted of 459
patients who underwent LAGB system implantation for treatment of morbid obesity between January 1999 and July 2001.We recorded
all complications that occurred following LAGB placement, with special emphasis on port site hernia. Results: 3 out of the
459 patients (0.65%) had a hernia at the site where the reservoir had been implanted. The use of a trocar >11 mm should be
avoided to prevent this complication. We describe our technique of repair of the hernia by intraperitoneal detachment and
pulling of the access reservoir into the peritoneal cavity, intraperitoneal repair of the defect with Gore-Tex? Dual mesh, and reimplantation of the reservoir. Conclusions: Our technique successfully repaired the hernia, and enabled
continuation of adjustments to the gastric band. 相似文献
14.
Laparoscopic Adjustable Gastric Banding versus Open Vertical Banded Gastroplasty: A Prospective Randomized Trial 总被引:3,自引:3,他引:0
Background: Laparoscopic adjustable gastric banding (LAGB) and open vertical banded gastroplasty (VBG) are treatment modalities
for morbid obesity. However, few prospective randomized clinical trials (RCT) have been performed to compare both operations.
Methods: 100 patients (50 per group) were included in the study. Postoperative outcomes included hospital length of stay (LOS),
complications, percent excess weight loss (%EWL), BMI and reduction in total comorbidities. Follow-up in all patients was
2 years. Results: LOS was significantly shorter in the LAGB group. 3 LAGB were converted to open (1 to gastric bypass). Directly
after VBG, 3 patients needed relaparotomies due to leakage, of which one (2%) died. After 2 years, 100% follow-up was achieved.
BMI and %EWL were significantly decreased in both groups but significantly more in the VBG group compared to the LAGB group
(31.0 kg/m2 and 70.1% vs 34.6 and 54.9% respectively). Co-morbidities significantly decreased in both groups in time. 2 years after LAGB,
20 patients needed reoperation for pouch dilation/slippage (n=12), band leakage (n=2), band erosion (n=2) and access-port
problems (n=4). In the VBG group, 18 patients needed revisional surgery due to staple-line disruption (n=15), narrow outlet
(n=2) or insufficient weight loss (n=1). Furthermore, 8 VBG patients developed an incisional hernia. Conclusion: This RCT
demonstrates that, despite the initial better weight loss in the VBG group, based on complication rates and clinical outcome,
LAGB is preferred. It had a shorter LOS and less postoperative morbidity. 相似文献
15.
Pouch dilatation with stoma obstruction is a well-known late complication after adjustable gastric banding operations for
morbid obesity. Surgical treatment of this problem usually results in removal of the band, with or without replacement by
another, or in repositioning of the band via laparotomy. We present the case of a patient with late pouch dilatation and stoma
obstruction after placement of a Laparoscopic Adjustable Gastric Banding system (LAGB—Bioenterics) and in whom the adjustable
band was laparoscopically opened, disconnected from the access port, and repositioned more proximally on the stomach. The
postoperative course was uneventful. A postoperative radiographic contrast examination showed a correct repositioning of the
band. The case demonstrates that the LAGB can be successfully opened and repositioned by a minimal invasive procedure. This
is the first time to our knowledge that such a procedure has been reported.
Received: 25 May 1996/Accepted: 26 November 1996 相似文献
16.
BACKGROUND: Adjustable gastric banding is a popular bariatric operation in Europe. About 1500 patients per year undergo a such procedures in Germany. Clinical data on the rate of long-term complications such as pouch dilatation, slippage, and band migration are available in only a few long-term studies with small numbers of patients. Meta-analyses report on comordities and reduction in weight. The rate and management of long-term complications were examined at this inquiry. METHODS: Ninety hospitals were asked about rates of band implantation, follow-up, and complications. Thirty-eight hospitals (42.2%) participated in the study. The management of complications including slippage, pouch dilatation, and band migration was analyzed. RESULTS: At 35 hospitals, 4138 patients underwent gastric banding procedures in 25 hospitals over more than 5 years. The mean follow-up rate is presently 85.3%. Long-term complications were described in 8.6% of the patients. Pouch dilatation occurred in 5.0%, slippage in 2.6%, and band migration in 1.0%. CONCLUSIONS: Laparoscopic adjustable gastric banding can effectively achieve weight loss. However, band-related and functional complications influence late outcome. The rate of long-term complications was equivalent to that already in the literature. 相似文献
17.
Bilio pancreatic diversion following failure of laparoscopic adjustable gastric banding 总被引:1,自引:1,他引:0
Background: This study examines the failure rate with laparoscopic adjustable gastric banding (LABG) and results of band removal with synchronous biliopancreatic diversion without (BPD) or with duodenal switch (BPDDS). Methods: Failure of LAGB was defined as removal of the band due to insufficient weight loss or a complication. Results: The band was removed in 85 of 1,439 patients (5.9%), most commonly for persistent dysphagia and recurrent slippage. The removal rate and slippage rate decreased from 10.8 and 14.2% to 2.8 and 1.3%, respectively, following introduction of the pars flaccida technique. Fifteen of 27 patients with previous open vertical banded gastroplasty (VBG) required removal of the band. Mean percentage excess weight loss 12 months following open BPD, laparoscopic BPD, open BPDDS, and laparoscopic BPDDS was 44, 37, 35, and 28%, respectively. Conclusion: LAGB fails in 6% of patients and removal of the band with synchronous BPD or BPDDS can be performed laparoscopically. Patients with failed primary VBG have a high failure rate with LAGB. 相似文献
18.
Background: Concerns still exist about the long-term effectiveness and rate of retention of the laparoscopic adjustable gastric
band (LAGB). Furthermore, esophageal dilatation has been suggested as a long-term complication for LAGB. We therefore sought
to objectively analyze our follow-up results in patients with LAGB performed in 1998 by perigastric technique and 2000 by
pars flaccida technique. We also offered patients for 1998 a barium esophagram to assess dilatation. Methods: Data on all
2,300 LAGBs performed since 1996 have been prospectively collected in LapBase. This data was accessed for 1998 and 2000, for
follow-up complication, band removal, weight loss and comorbidity reduction. Patients were offered barium esophagrams. Results:
123 patients (mean weight 127 kg, mean BMI 44.5 kg/m2) had LAGB in 1998, and 162 patients (mean weight 123 kg, mean BMI 44) had LAGB in 2000. Follow-up was a mean 67 months in
88% for 1998 and 94% at 34 months for 2000. Mean %EWL for 1998 was 51.2% with mean BMI 31.9. Slippage occurred in 9.5% in
1998 compared to 4.3% in 2000 (P<0.01). 20 of 23 diabetics are off all treatment. 1 of 34 patients had esophageal dilatation on barium esophagram, which resolved
on band deflation. Conclusion: LAGB is a safe and effective at midterm follow-up. Less slippage occurred after the pars flaccida
technique. No evidence of permanent esophageal dilatation was found on barium studies. 相似文献
19.
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
20.
Wouter W. te Riele Hjalmar C. van Santvoort Djamila Boerma Henderik L. van Westreenen Marinus J. Wiezer Bert van Ramshorst 《Obesity surgery》2014,24(4):588-593