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1.
Mini-Gastric Bypass by Mini-Laparotomy: A Cost-Effective Alternative in the Laparoscopic Era 总被引:1,自引:1,他引:0
BACKGROUND: Laparoscopic mini-gastric bypass (MGB) is being increasingly performed worldwide. Results of MGB by mini-laparotomy (minilap MGB) are hereby reported. METHODS: 126 patients undergoing minilap MGB from October 2004 to October 2006, were reviewed at an academic institution. RESULTS: Mean age was 35 +/- 11.4 years (range 15-72), preoperative BMI was 44 +/- 6.9 kg/m2 (range 35-61.8) and 80 (63.4%) were women. Co-morbidities were present in 42 (33.3%). Operative time was 144 +/- 15.8 minutes (range 120-160) and length of hospital stay was 3.32 +/- 0.62 days (range 2-18). There was no hospital mortality, and the in-hospital complication rate was 4.7%. No anastomotic leakage occurred, and the incidence of wound sepsis was 2.3%. The mean total cost of the procedure was 3408 +/- 547 USD (range 2967-6876). Five patients (3.9%) developed incisional hernias and 3 (2.3%) marginal ulcers. BMI at 6 months was 33.0 +/- 3.1 kg/m2 (range 26.8-43.5, P < 0.001) compared with preoperative value. At 1 year, mean excess weight loss was 68.4% and comorbidities resolved in 85%. CONCLUSION: Minilap MGB is a simple, safe, effective and low-cost gastric bypass. It represents an attractive cost-effective alternative to laparoscopic MGB. 相似文献
2.
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
3.
Chakhtoura G Zinzindohoué F Ghanem Y Ruseykin I Dutranoy JC Chevallier JM 《Obesity surgery》2008,18(9):1130-1133
BACKGROUND: Since 2002, we have performed 350 laparoscopic Roux-en-Y gastric bypasses (LRYGB). We decided to evaluate the laparoscopic mini-gastric bypass (LMGB), an operation reported as effective, yet simpler than LRYGB. It consisted of a long lesser curvature tube with a terminolateral gastroenterostomy, 200 cm distal to the Treitz ligament. METHODS: From October 2006 to November 2007, 100 patients (23 men and 77 women) underwent LMGB. The mean age was 40.9 +/- 11.5 years (17.5-62.4), the preoperative mean body weight was 131 +/- 23.1 kg (82-203) and the mean BMI was 46.9 +/- 7.4 kg/m(2) (32.8-72.4). Twenty-four patients had prior restrictive procedure: 20 LAGB of which nine were already removed and four VBG (two laparoscopic and two by open surgery). In preoperative gastric endoscopy Helicobacter pylorii was present in 26 patients and eradicated. RESULTS: All procedures were completed laparoscopically by six different surgeons. Mean operative time was 129 +/- 37 min. There was no death. Seven patients (7%) presented major early complications: three reoperations for incarcerated herniation of small bowel in the trocar wound, one peritonitis due to a traumatic injury of the biliary limb, one perianastomotic abscess, one intraabdominal bleeding requiring splenectomy, and one endoscopic haemostasis for anastomotic bleeding. One patient presented anastomotic stenosis that required endoscopic dilatation 2 months postoperatively. Mean BMI at 3 months was 38.7 kg/m(2) (31.2-60.9) and at 6 months 35.1 (23.6-53.0). Nine patients complained of diarrhea that resolved 3 months postoperatively and, significantly, only two patients complained of biliary reflux. CONCLUSION: Pending long-term evaluation, LMBG seems a good alternative to LRYGB, giving the same results with a more simple and reproductible technique. 相似文献
4.
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
5.
Laparoscopic Sleeve Gastrectomy as Treatment for Morbid Obesity: Technique and Short-Term Outcome 总被引:5,自引:1,他引:4
Roa PE Kaidar-Person O Pinto D Cho M Szomstein S Rosenthal RJ 《Obesity surgery》2006,16(10):1323-1326
Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) and laparoscopic adjustable gastric banding (LAGB) are the most
commonly performed surgical procedures for weight reduction in the United States. Currently, laparoscopic sleeve gastrectomy
(LSG) is being explored. The aim of this study was to assess the safety and short-term efficacy of LSG as a treatment option
for weight reduction. Methods: Data of all patients who underwent LSG for treatment of morbid obesity between November 2004
and March 2006 and completed the 3- and 6-month follow-up visits at the time of the study, were retrospectively reviewed.
Data collected included demographics, operative time, length of stay, postoperative complications, and degree of weight reduction.
Results: Of the 62 patients who underwent LSG performed by two surgeons, the data of 30 patients (7 males and 23 females)
were further analyzed. Mean preoperative BMI was 41.4 (33-59) kg/m2. Mean operative time was 80 min (range 65-130). Mean hospital stay was 3.2 days (range 2 to 25). Mean weight loss at 3 and
6 months following the procedure was 22.7 kg and 30.5 kg respectively, and mean % excess weight loss (EWL) was 40.7 and 52.8,
respectively. Three patients were considered to have mild complications, and one patient had a major complication that necessitated
surgical intervention. There was no mortality. Conclusions: In the short-term, LSG is a safe and effective treatment option. 相似文献
6.
Stoopen-Margain E Fajardo R España N Gamino R González-Barranco J Herrera MF 《Obesity surgery》2004,14(2):201-205
Background: Morbid obesity requires life-long treatment, and bariatric surgery provides the best results. Among the bariatric
procedures, laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been considered to be superior. However, it requires advanced
laparoscopic skills and a learning curve. We analyzed our results in an initial series of 100 patients. Methods: Data of 100
consecutive patients who underwent LRYGBP for morbid obesity in a 2.5-year period were prospectively collected and analyzed
with emphasis on results and complications. Results: Mean age was 31±5 years. There were 63 woman and 37 men. Preoperative
BMI was 50±9 kg/m2. 33 patients were considered super-obese (BMI>50). Mean operative time was 3.8 ± 0.7 hours. Two patients required conversion
to open surgery. Mean hospital stay was 6 days. Complications occurred in 10 patients. Mortality rate was 2%. Excess body
weight loss was as follows: 33 ± 8% at 3 months (n=92), 47 ± 2% at 6 months (n=82), 62 ± 4% at 1 year (n= 70), 66 ± 5% at
18 months (n= 63) and 67 ± 8% at 2 years (n= 35). There was significant improvement in several co-morbid conditions, such
as diabetes and hypertension. Conclusion: LRYGBP is a reproducible technique. It requires the combination of bariatric and
laparoscopic expertise. 相似文献
7.
Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been shown to be safe and effective. There is little data on
the outcomes in massively super-obese patients, with a body mass index (BMI) &ge60 kg/m2(super-super-obese). The goal of this study was to determine the safety and effectiveness of LRYGBP in these patients, and
compare these results to patients with a BMI <60. Methods: 213 consecutive patients undergoing LRYGBP by a single surgeon
at a university hospital were included in the study. The patients were divided into 2 groups: BMI <60 kg/m2(n=167) and BMI ≥60 kg/m2 (n=46). The 2 groups were compared with regard to perioperative complications, and postoperative weight loss. Results: Both
groups had statistically similar complication rates. There were major complications in 8 patients (5%) in the lower BMI group
and in 3 patients (7%) in the higher BMI group. There were minor complications in 9 patients (5%) in the lower BMI group and
in 4 patients (9%) in the higher BMI group. Mean percent excess weight loss (%EWL) was 64% at 1 year in the BMI <60 group
and 53% in the BMI ≥60 group. Conclusion: LRYGBP can be performed safely and effectively in super-super-obese patients (BMI
≥60). Although these patients have less %EWL than lighter patients, they still end up with a good result. Therefore, LRYGBP
should be considered a good surgical option even for patients with a BMI ≥60. 相似文献
8.
Laparoscopic Roux-en-Y gastric bypass: minimally invasive bariatric surgery for the superobese in the community hospital setting 总被引:2,自引:0,他引:2
Moose D Lourie D Powell W Pehrsson B Martin D LaMar T Alexander J 《The American surgeon》2003,69(11):930-932
Roux-en-Y gastric bypass (RYGB) operation has become a popular choice for weight-reduction surgery. We report an outcome analysis of our early results with laparoscopic Roux-en-Y gastric bypass for superobese (BMI >50) patients. Between January 2000 and October 2001, we operated on 71 superobese patients. The mean body mass index (BMI) of patients at time of surgery was 57 kg/m2. The prospectively collected data included patient demographics, comorbidities, operative times, postoperative weight loss, and complications. Conversion to open gastric bypass was required in one patient. The overall complication rate was 10 per cent. Preoperative comorbidities were resolved or improved in 93 per cent of patients at 1-year postoperative. Average operative time and length of hospital stay were 196 minutes and 2.3 days, respectively. Mean percentage excess weight loss at 3, 6, 9, and 12 months was 27 per cent, 39 per cent, 49 per cent, and 55 per cent, respectively. Mean BMI decreased to 36 kg/m2 over a 12-month period. Laparoscopic Roux-en-Y gastric bypass surgery for superobese patients as performed in the community hospital setting can be both safe and effective with respect to overall postoperative course, early weight loss, and reduction of comorbidity. 相似文献
9.
Background: Bariatric surgery in patients >50 years has been controversial. We investigated the safety and efficacy of laparoscopic
Roux-en-Y gastric bypass (LRYGBP) in patients >55 years of age. Methods: Prospective data on 71 patients (54 females and 17
males) undergoing LRYGBP were reviewed. The patients were followed for a mean of 17 months (range 2-35 months). Results: The
mean age was 59 years (range 55-67 years), and the mean preoperative BMI was 50.2 kg/m2 (range 37-65 kg/m2). There were no conversions to open technique. Mean percent of excess weight loss (%EWL) was 20%, 48%, 64% and 67% at 1,
6, 12 and 24 months respectively. 89% of patients had at least a 50% EWL at 1 year postoperatively. There was a significant
decrease in the number of patients requiring medical treatment for co-morbidities associated with morbid obesity: diabetes
mellitus 87%, hypertension 70% and sleep apnea 86%. There was no inpatient mortality. 1 patient died suddenly 2 weeks postoperatively
of possible myocardial infarction or pulmonary embolism. 16 patients developed 22 complications. The median length of hospital
stay was 3 days. Conclusion: LRYGBP is a safe and well-tolerated surgical option for the treatment of morbid obesity in patients
>55 years old. These patients demonstrate a satisfactory weight loss and resolution of co-morbidities. 相似文献
10.
Laparoscopic Gastric Bypass beyond Age 60 总被引:4,自引:0,他引:4
Background: Previous reports have questioned the safety and efficacy of gastric bypass in older patients. We examine our results
in the older group of patients to shed some light on the appropriateness of offering gastric bypass to senior patients. Methods:
A retrospective review of a prospectively collected database on all laparoscopic Roux-en-Y gastric bypass (LRYGBP) cases performed
from March 2001 to October 2003 was conducted. Patients >60 years of age were compared to the overall group. Results: A total of 550 patients underwent LRYGBP: all were completed laparoscopically. In the 527 patients <60 years of age, there were no
deaths and there were 15 complications (2.8% perioperative morbidity). In the group of patients >60 years old, there were
23 patients; mean age was 64.4 years (60-75 years). There was 1 death in this group (4.3% mortality rate) and 1 postoperative
complication (4.3% morbidity rate). In the >60 year group at an average of 12 months follow-up, weight loss was 43.2 kg (28.6-73.2
kg), change in BMI was 16.5 (11-23), and excess weight loss was 65% (40-110%). Also, diabetes resolved in 3 out of 4 patients
(75%), obstructive sleep apnea in 2 of 3 (67%), hypercholesterolemia in 3 of 5 (60%) and hypertension resolved or improved
in 10 of 11 patients (91%). Conclusion: While patients >60 years of age had a higher morbidity and mortality, their risk/benefit
ratio was acceptable. Older patients achieve significant weight loss and resolution of obesity-associated comorbidities. 相似文献
11.
Bowel Obstruction after Laparoscopic Roux-en-Y Gastric Bypass 总被引:5,自引:5,他引:0
Background: Bowel obstruction has been frequently reported after laparoscopic Roux-en-Y gastric bypass (LRYGBP). The aim of
this study was to review our experience with bowel obstruction following LRYGBP, specifically examining its etiology and management
and to strategize maneuvers to minimize this complication. Methods: We retrospectively reviewed the charts of 9 patients who
developed postoperative bowel obstruction after LRYGBP. Each chart was reviewed for demographics, timing of bowel obstruction
from the primary operation, etiology of obstruction, and management. Results: 9 of our initial 225 patients (4%) who underwent
LRYGBP developed postoperative bowel obstruction. The mean age was 46 ± 12 years, with mean BMI 47 ± 9 kg/m2. 6 patients developed early bowel obstruction, and 3 patients developed late bowel obstruction. The mean time interval for
development of early bowel obstruction was 16 ±16 days. The causes for early bowel obstruction included narrowing of the jejunojenunostomy
anastomosis (n=3), angulation of the Roux limb (n=2), and obstruction of the Roux limb at the level of the transverse mesocolon
(n=1). The mean time interval for development of late bowel obstruction was 7.4 ± 0.5 months. The causes for late bowel obstruction
included internal herniation (n=2) and adhesions (n=1). 6 of 9 bowel obstructions (66%) were considered technically related
to the learning curve of the laparoscopic approach. Eight of the 9 patients required operative intervention, and 6 of the
8 reoperations were managed laparoscopically. Management included laparoscopic bypass of the jejunojejunostomy obstruction
site (n=5), open reduction of internal hernia (n=2), and laparoscopic lysis of adhesion (n=1). Conclusions: Bowel obstruction
is a frequent complication after LRYGBP, particularly during the learn ing curve of the laparoscopic approach. Specific measures
should be instituted to minimize bowel obstruction after LRYGBP as most of these complications are considered technically
preventable. 相似文献
12.
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
13.
Higa-Sansone G Szomstein S Soto F Brasecsco O Cohen C Rosenthal RJ 《Obesity surgery》2004,14(8):1132-1134
Background: Psoriasis is a chronic skin disease characterized by epithelial hyperplasia and an accelerated rate of epithelial
turnover affecting approximately 1-3% of the population. Exogenous and endogenous factors including morbid obesity can increase
the morbidity of psoriasis. Case Report: A 55-year-old male, who weighed 131 kg with BMI 41 kg/m2, underwent laparoscopic Roux-en-Y gastric bypass (LRYGBP). He had a 15-year duration of severe psoriasis and was being medically
treated. At 12 months after LRYGBP, he had lost 39 kg (68% EWL), and had complete resolution of the psoriasis and had discontinued
all preoperative medications related to the disease. At 2 years after LRYGBP, psoriasis has not recurred. Conclusion: Weight
loss after LRYGBP should be considered as a strategy in the treatment of severe psoriasis in morbidly obese patients. 相似文献
14.
目的探讨腹腔镜下胃肠外科手术治疗单纯性肥胖症及其合并2型糖尿病(T2DM)患者的效果及安全性。方法上海第二军医大学附属长海医院微创外科2003年6月至2010年6月间对219例肥胖症患者进行了腹腔镜下胃肠外科手术,其中201例行腹腔镜下可调节胃绑带术(LAGB组),13例行腹腔镜下改良简易型胃肠短路术(LMGB组),5例行腹腔镜下管状胃胃切除术(LSG组)。总结分析该组患者的临床和随访资料。结果LAGB组患者体质量指数(BMI)平均37.9kg/m2,术后6个月及12个月BMI分别为平均32.4kg/mz和29.7kg/m2;43例术前合并T2DM者.11例(25.6%)术后临床部分缓解,16例(37.2%)完全缓解;有26例(12.9%)术后出现并发症。LMGB组患者BMI平均34.7kg/m2,术后6个月及12个月BMl分别为平均31.6kg/m2和26.9kg/m2:10例术前合并T2DM者,2例(20.0%)术后临床部分缓解,7例(70.0%)完全缓解;有2例(15.4%)术后出现并发症。LSG组患者BMI平均43.8kg/m2.术后6个月及12个月BMl分别为平均38.1kg/m2和34.3kg/m2;3例术前合并T2DM者,术后1例达到临床部分缓解,1例完全缓解:有1例术后出现并发症。所有术式组均无围手术期死亡。结论腹腔镜下胃肠外科手术对单纯性肥胖症有效.并能使合并的T2DM得到缓解.同时手术并发症较少。 相似文献
15.
BACKGROUND: Variability in weight loss has been observed from morbidly obese patients receiving bariatric operations. Genetic effects may play a crucial role in this variability. METHODS: 304 morbidly obese patients (BMI > or =39) were recruited, 77 receiving laparoscopic adjustable gastric banding (LAGB) and 227 laparoscopic mini-gastric bypass (LMGB), and 304 matched non-obese controls (BMI < or =24). Initially, all subjects were genotyped for 4 SNPs (single nucleotide polymorphisms) on UCP2 gene in a case-control study. The SNPs significantly associated with morbid obesity (P < 0.05) were considered as candidate markers affecting weight change. Subsequently, effects on predicting weight loss of those candidate markers were explored in LAGB and LMGB, respectively. The peri-operative parameters were also compared between LAGB and LMGB. RESULTS: The rs660339 (Ala55Val), on exon 4, was associated with morbid obesity (P = 0.049). Morbidly obese patients with either TT or CT genotypes on rs660339 experienced greater weight loss compared to patients with CC after LAGB at 12 months (BMI loss 12.2 units vs 8.1 units) and 24 months (BMI loss 13.1 units vs 9.3 units). However, this phenomenon was not observed in patients after LMGB. Although greater weight loss was observed in patients receiving LMGB, this procedure had a higher operative complication rate than LAGB (7.5% vs. 2.8%; P < 0.05). CONCLUSION: Ala55Val may play a crucial role in obesity development and weight loss after LAGB. It may be considered as clinicians incorporate genetic susceptibility testing into weight loss prediction prior to bariatric operations. 相似文献
16.
Wei-Jei Lee Kong-Han Ser Yi-Chih Lee Jun-Juin Tsou Shu-Chun Chen Jung-Chien Chen 《Obesity surgery》2012,22(12):1827-1834
Background
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the gold standard for the treatment of morbid obesity but is technically challenging and results in significant perioperative complications. While laparoscopic mini-gastric bypass (LMGB) has been reported to be a simple and effective treatment for morbid obesity, controversy exists. Long-term follow-up data from a large number of patients comparing LMGB to LRYGB are lacking.Methods
Between October 2001 and September 2010, 1,657 patients who received gastric bypass surgery (1,163 for LMGB and 494 for LRYGB) for their morbid obesity were recruited from our comprehensive obesity surgery center. Patients who received revision surgeries were excluded. Minimum follow-up was 1?year (mean 5.6?years, from 1 to 10?years). The operative time, estimated blood loss, length of hospital stay, and operative complications were assessed. Late complication, changes in body weight loss, BMI, quality of life, and comorbidities were determined at follow-up. Changes in quality of life were assessed using the Gastrointestinal Quality of Life Index.Results
There was no difference in preoperative clinical parameters between the two groups. Surgical time was significantly longer for LRYGB (159.2 vs. 115.3?min for LMGB, p?<?0.001). The major complication rate was borderline higher for LRYGB (3.2 vs. 1.8?%, p?=?0.07). At 5?years after surgery, the mean BMI was lower in LMGB than LRYGB (27.7 vs. 29.2, p?<?0.05) and LMGB also had a higher excess weight loss than LRYGB (72.9 vs. 60.1?%, p?<?0.05). Postoperative gastrointestinal quality of life increased significantly after operation in both groups without any significant difference at 5?years. Obesity-related clinical parameters improved in both groups without significant difference, but LMGB had a lower hemoglobin level than LRYGB. Late revision rate was similar between LRYGB and LMGB (3.6 vs. 2.8?%, p?=?0.385).Conclusions
This study demonstrates that LMGBP can be regarded as a simpler and safer alternative to LRYGB with similar efficacy at a 10-year experience. 相似文献17.
Background: Bariatric surgery is the only method for sustained weight loss in morbid obesity. However, 10-25% of patients
will require re-operation for unsatisfactory weight loss or weight regain after restrictive surgery. Re-operation is associated
with higher morbidity and mortality. This study is to evaluate the s a fety and efficacy of laparoscopic mini-gastric bypass
(LMGB) for failed vertical banded gastroplasty (VBG). Methods: From May 2001 to March 2003, 29 consecutive patients underwent
LMGB for failed VBG. Average age was 39.7 years (range 22 to 56), and average BMI before re-operation was 41.7 kg/m2 (range 35.0-70.8). 8 patients had previous open VBG, and 21 had laparoscopic VBG. The re-operation was for regain of weight
in 16 patients, inadequate weight loss in 10 patients, and severe reflux esophagitis in 3 patients. Re-operation was performed
after an average of 58.5 months (range 14 to 180). Results: All the re-operations were completed laparoscopically. Average
operative time was 171.4 minutes (range 130 to 290). There was 1 mortality, due to leakage (3.4%). 1 re-operation was necessary,
for incarceration of small bowel in a trocar wound 10 days after the LMGB (3.4%). 1 anastomotic site bleeding and 1 wound
infection occurred. Average BMI 12 months after the LMGB was 32.1 kg/m2 (range 26.4 to 42.7). The quality of life study was significantly improved. The revision operation had much more technical
difficulty for those with previous open VBG than laparoscopic VBG. Conclusion: LMGB is an effective and safe revision operation
for patients with failed VBG. A large series and long-term follow up is needed for confirmation. 相似文献
18.
Alfalah H Philippe B Ghazal F Jany T Arnalsteen L Romon M Pattou F 《Obesity surgery》2006,16(2):147-150
Background: Laparoscopic bariatric operations can be technically challenging in massively obese patients. The potential of
the intragastric balloon for preoperative weight reduction was evaluated in candidates for laparoscopic Roux-en-Y gastric
bypass (LRYGBP) with super obesity. Methods: From January 2004 to March 2005, 10 patients with super obesity who were potential
candidates for LRYGBP were included in a prospective observational study. An intragastric balloon was placed endoscopically
under general anesthesia. Patients were then followed by a multidisciplinary team until removal of the balloon after 6 months.
Weight, BMI, and percent excess weight lost (%EWL) were monitored after 1, 3 and 6 months. Results: The 10 patients were all
female with mean ± SD age of 33±11 years (range 17-51). Initial weight was 175±25 kg (range 135-223) and initial BMI was 64±7
kg/m2 (range 59-78). After completion of 1, 3 and 6 months, weight, BMI, and %EWL reached respectively: 166±27 kg*, 165±27 kg*,
and 169±26 kg*; 61.1±7.6 kg/m2*, 60.8±8.4 kg/m2*, and 61±8.2 kg/m2*; 9±5%, 10±7%, 7±6%. (*=P<0.01 vs preop). Conclusion: In potential candidates for LRYGBP with super obesity, preoperative placement of an intragastric
balloon can reduce the excess weight by 10% within 3 months. Extending this period failed to improve these results further. 相似文献
19.
Background:The authors assessed whether laparoscopic rebanding or laparoscopic Roux-en-Y gastric bypass (LRYGBP) is the best
approach for failed gastric banding after pouch dilatation. Methods: Between January 2000 and June 2005, 489 patients underwent
laparoscopic gastric banding, and of these, 33 (6.7%) required rescue procedures for pouch dilatation. Each reoperated patient
was contacted to obtain information about their postoperative course. Additionally, preoperative weight and BMI, weight loss
at 1 year postoperatively, weight at time of pouch dilatation and the time-period between the primary operation and pouch
dilatation were analyzed. Results: The most common operation for pouch dilatation was band repositioning or rebanding (16
patients). Band removal without replacement was performed in 7 patients. 8 patients underwent conversion to a LRYGBP. 1 patient
underwent laparoscopic gastric sleeve resection and 1 patient received an intragastric balloon. Patients who underwent conversion
to LRYGBP are very content and, although weight loss has been nearly the same as after gastric banding, they would prefer
the gastric bypass operation to the gastric banding. Conclusion: Conversion to LRYGBP appears to offer significant advantages,
and appears to be the rescue therapy of choice after failed laparoscopic gastric banding. 相似文献
20.
Giuseppe Nanni Pietro Familiari Alessandro Mor Amerigo Iaconelli Vincenzo Perri Francesco Rubino Giuseppe Boldrini Maria Paola Salerno Laura Leccesi Samuele Iesari Liliana Sollazzi Valter Perilli Marco Castagneto Gertrude Mingrone Guido Costamagna 《Obesity surgery》2012,22(12):1897-1902