腹腔镜胃束带术后并发症的治疗经验与教训

目的 分析腹腔镜胃束带术后并发症发生的原因、治疗方法及经验教训.方法 回顾性分析302例接受腹腔镜胃束带手术肥胖患者的临床资料,对体重指数、超重体重减少百分比、手术时间、术中出血量、术后并发症的种类及处理方法等进行总结.结果 本组均无中转开腹手术,总的并发症发生率为6.3％,包括2例胃壁损伤,5例胃束带滑脱,均经过手术处理痊愈.未发生胃壁胃束带腐蚀、注水管破裂渗漏、肺栓塞、微量元素缺乏、死亡等并发症,97％的手术患者超重体重减少百分比达到有效以上.结论 本组多数患者满意手术治疗效果,但仍有不能忽视的并发症发生.严格掌握手术适应证、规范手术操作、充分医患沟通是预防和减少腹腔镜胃束带术并发症的关键.     

Postoperative complications of laparoscopic adjustable gastric banding

Background: The primary aim was to determine the rate and nature of late postoperative complications in relation to the type of band used and the route through which it encircled the stomach in a retrospective review of postoperative complications that necessitated reoperation in 500 consecutive cases of laparoscopic adjustable gastric banding (LAGB) conducted over the past 48 months. Methods: The four study groups were: (A) Lap‐Band^® perigastric route, 186 cases; (B) Lap‐Band^® pars flaccida route 73 cases; (C) SAGB perigastric 70 cases, and (D) SAGB pars flaccida, 171 cases. There were 414 women and 86 men. The mean age was 39.2 ± 11.0 years (17–68). The mean weight was 126 kg, and mean BMI was 43.4 kg/m² prior to operation. Results: There were 32 cases of slippage (17%) in group A and five cases (7%) in Group B (P < 0.05). In group C there were 15 cases (21%) of slippage and in group D six cases (3%) (P < 0.05). There were no significant differences between Groups A and C or Groups B and D. Except for one case of band erosion in Group C, erosion, tube disconnection and aneurysmatic balloon dilatation occurred only in groups A and B. Band erosion occurred in 2% each in groups A and B, tube disconnection in 3% and 4%, respectively, and balloon dilatation in 2% in each of groups A and B. Conclusions: Slippage was primarily route dependent. Erosion, tube disconnection and aneurysmatic dilatation of the balloon were encountered almost exclusively in the high‐pressure system. We conclude that the pars flaccida route with the low‐pressure system is more effective in reducing the rate of complications necessitating reoperation.     

腹腔镜可调控性胃捆扎带减肥术治疗病态肥胖术后并发症的诊治

目的探讨腹腔镜可调控性胃捆扎带减肥术（LAGB）术后并发症的发生及其诊治。方法回顾分析2003年6月至2004年11月23例在我院行LAGB减肥术的病态肥胖患者的临床资料。结果术后出现恶心、呕吐3例,腹部穿刺口感染1例,进食不耐受5例,以上均经保守处理治愈。捆扎带移位1例,行腹腔镜胃捆扎带取出术。注水泵移位1例,行注水泵异位包埋治愈。未出现死亡和血栓栓塞病例。结论LAGB治疗病态肥胖症的术后并发症的诊断和治疗有其特殊性,只要方法得当,可获得良好效果。     

腹腔镜可调节胃束带术后并发症及治疗

目的探讨腹腔镜可调节胃束带术（LAGB）后并发症及治疗方法。方法回顾性分析2005年9月至2011年6月天津市南开医院行LAGB随访2年以上的83例肥胖症患者的临床资料。腹腔镜下放置胃束带,使束带上方形成1个容量约20～30ml胃小囊,将注水泵埋于剑突下腹直肌前鞘浅面。在术后4周根据患者体质量变化、餐后症状及上消化道造影情况,对胃束带进行注水调节。采用门诊和电话方式进行随访,随访时间截至2013年7月。结果83例患者并发症发生率为44．6％（37／83）,其中早期并发症（1个月内）6例、远期并发症31例。早期并发症主要表现为进食后呕吐,5例患者通过减慢进食速度、减少进食量后缓解;1例患者症状严重,予禁食水并营养支持,5d后症状缓解。远期并发症中,25例患者发生束带腐蚀胃壁并向胃腔内移位（其中6例合并注水泵处感染）,通过腹腔镜手术（早期1例行开腹手术）将胃束带取出,并缝合胃壁穿孔处获得治愈;10例患者发生注水泵相关并发症（6例为上述注水泵感染者,4例为注水泵移位）,通过手术将注水泵取出;2例发生束带滑动移位,通过抽净注水泵内生理盐水,改为流质饮食,减少进食量后,1例患者束带位置恢复正常,另1例患者无变化,行腹腔镜手术取出胃束带。结论LAGB术后并发症发生率较高,并随着术后时间的延长而增高,远期并发症多数需要再次手术治疗。     

Early and late complications following laparoscopic adjustable gastric banding

There is limited U.S. data on short- and long-term complications of laparoscopic adjustable gastric banding (LAGB) as a treatment option for morbid obesity. Hereafter, we present our experience with the first 154 consecutive LAGBs performed at Loyola University Medical Center. Inpatient and outpatient charts were reviewed retrospectively for all patients undergoing LAGB between November 2001 and February 2003 for perioperative morbidity and mortality and repeat operations. Thirty-seven men (24%) and 117 women (76%) underwent LAGB in a 16-month period. There was one (0.6%) death from postoperative myocardial infarction (MI) and one (0.6%) pulmonary embolism. Six (3.9%) patients required readmission to the hospital for dehydration. During a mean follow-up of 33 weeks (range, 4-69 weeks), 14 (9%) patients required repeat operations. There were five (3.2%) band slippages and one (0.6%) gastric erosion. Three bands were removed laparoscopically. Three slippages were revised laparoscopically. One patient underwent laparoscopic cholecystectomy. Seven patients (4.5%) required port revisions for catheter disconnection (4), leak at port site (2), or flipped port (1). LAGB is a safe operative approach for the management of morbid obesity. The incidence of postoperative complications can be minimal with application of a standardized technique. LAGB should be strongly considered for morbidly obese patients who have failed nonoperative management.     

Conversions and complications in 185 laparoscopic adjustable silicone gastric banding cases

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     

Evolution of laparoscopic adjustable gastric banding

This article reviews the use of laparoscopic adjustable gastric banding in the United States today. It comments on the history of the procedure as well as technical aspects of the operation. Short-term and long-term outcomes of the procedure are examined, and the advantages and disadvantages of this procedure in comparison with the laparoscopic gastric bypass are discussed.     

腹腔镜可调胃束带手术的现状

肥胖是由多种因素作用于机体,从而导致体内脂肪（主要是三酰甘油）蓄积所形成的病理状态。世界范围内（包括发达国家和发展中国家）,肥胖的发生率不仅在成人中以惊人的速度上升,儿童和青少年中肥胖的发生率也让人担忧[1]。近年来我国肥胖人口上升速度也不容忽视,     

腹腔镜可调节捆扎带胃减容术操作要点

目的探讨腹腔镜下可调节捆扎带胃减容术的安全性、可行性、有效性。方法对122例单纯性肥胖患者施行腹腔镜可调节捆扎带胃减容术（LAGB），年龄16～62岁，体重指数（BMI）32～52不等的资料进行分析。结果全组无死亡病例，并发症3例，胃排空障碍1例，经保守治疗后好转；皮下注水泵移位2例，经再次手术固定后未再移位。术后随访2～54月，减重10～70kg，平均25kg，无体重反弹及营养不良病例。结论LAGB术操作简便、手术风险小、不对胃进行任何破坏，生理改变较小，且可在体外经胃捆扎带通过水囊进行按需调节调节减重、减重效果持久而明显的优点。     

Long-term outcomes of laparoscopic adjustable gastric banding

Background

Laparoscopic adjustable gastric banding (LAGB) is an option for the treatment of severe obesity. Few US studies have reported long-term outcomes. We aimed to present long-term outcomes with LAGB.

Presentation and management of port disconnection after laparoscopic adjustable gastric banding

Aim  Laparoscopic adjustable gastric banding (LAGB) is a common and effective minimally invasive procedure in the treatment of morbid obesity. Port and connection tube complications are rarely reported. The aim of this study was to find presenting signs and predictors of tube disconnection from the access port that allow prompt diagnosis and appropriate treatment. Patients and methods  A retrospective chart review was performed on the 29 patients who underwent 31 laparoscopic reconnections of the connecting tube following LAGB during a 10-year period. Results  Presenting signs were sudden lower-abdominal pain and free food passage following by weight gain and inability for band adjustment. Additional imaging was used to confirm diagnosis in the first three patients. Diagnostic laparoscopy for suspected acute appendicitis found tube disconnection from the port in one patient. Laparoscopic reconnection was successful in all patients. Access port exchange was done in 23 cases. Two patients had recurrent port disconnection. Band exchange was performed after second port reconnection. Conclusion  Sudden onset of flank or abdominal pain, free eating, weight gain, and inability to adjust the band are signs of port disconnection after LAGB. Education and information for medical staff and patients can help in early recognition of this complication and avoid unnecessary investigations.     

腹腔镜可调节胃束带术在临床中的应用进展

<正>现代微创外科通过将外科微创意识与先进科技发展的最新成果相结合,达到以最小的侵袭或损伤达到最佳的外科治疗效果,从而满足患者生物-心理-社会医学模式的需要。腹腔镜可调节胃束带术(laparoscopic adjustable gastric banding,LAGB)正是在这种外科微创化环境中     

Device-related reoperations after laparoscopic adjustable gastric banding

Laparoscopic adjustable gastric banding (LAGB) is considered a relatively safe weight loss procedure with low morbidity. When complications occur, obstruction, erosion, and port malfunction require reoperation. We retrospectively reviewed our experience with 270 consecutive patients who underwent LAGB. Device-related reoperations were performed in 26 (10%) patients. Reoperations were related to the band in 13, to port/tubing in 11, and related to both in 2 patients. Of the 15 band-related problems, it was removed in 5 (2%): slippage (3), intra-abdominal abscess (1), and during emergent operation for bleeding duodenal ulcer (1). Revision or immediate replacement was performed in 10 (4%): slippage (5), obstruction (4), and leak from the reservoir (1). Port/tubing problems were the reason for reoperations in 13 (5%): infection (5), crack at tubing-port connection (6), and port rotation (2). Port removal for infection was followed later by port replacement (average 9 months). Overall, slippage occurred in 8 (3%), obstruction in 4 (1.5%), leak from reservoir in 7 (3%), and infection in 5 (2%) patients. Fifteen device-related problems occurred during our first 100 cases and 12 subsequently (P = 0.057). Permanent LapBand loss was only 5 per cent, leading to overall rate of 95 per cent of LapBand preservation as a restrictive device.     

Esophageal dilation after laparoscopic adjustable gastric banding

BACKGROUND: Esophageal dilation can occur after laparoscopic adjustable gastric banding (LAGB). There are few studies in the literature that describe the outcomes of patients with esophageal dilation. The aim of this article is to evaluate weight loss and symptomatic outcome in patients with esophageal dilation after LAGB. METHODS: We performed a retrospective chart review of all LAGBs performed at Columbia University Medical Center from March 2001 to December 2006. Patients with barium swallow (BaSw) at 1 year after surgery were evaluated for esophageal diameter. A diameter of 35 mm or greater was considered to be dilated. Data collected before surgery and at 6 months and 1, 2 and 3 years after surgery were weight, body mass index (BMI), status of co-morbidities, eating parameters, and esophageal dilation as evaluated by BaSw. RESULTS: Of 440 patients, 121 had follow-up with a clinic visit and BaSw performed at 1 year. Seventeen patients (10 women and 7 men) (14%) were found to have esophageal dilation with an average diameter of 40.9 +/- 4.6 mm. There were no significant differences in percent of excess weight lost at any time point; however, GERD symptoms and emesis were more frequent in patients with dilated esophagus than in those without dilation. Intolerance of bread, rice, meat, and pasta was not different at any time during the study. CONCLUSIONS: In our experience the incidence of esophageal dilation at 1 year after LAGB was 14%. The presence of dilation did not affect percent excess weight loss (%EWL). GERD symptoms and emesis are more frequent in patients who develop esophageal dilation.     

Laparoscopic adjustable silicone gastric banding: complications

Laparoscopic adjustable gastric banding is a procedure that is now approved by the Federal Drug Administration for use in the United States to treat morbid obesity. Numerous complications can occur as a result of the device. These include both early technical complications as well as long-term problems such as esophageal dilatation and failed weight loss. While improvements in surgical technique may decrease early technical complications such as gastric prolapse, long-term follow-up studies will be required to determine the ultimate success of this device in controlling severe obesity.