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1.
Amber L. Shada Peter T. Hallowell Bruce D. Schirmer Philip W. Smith 《Obesity surgery》2013,23(5):608-612
Background
Laparoscopic adjustable gastric banding (LAGB) is a common surgical treatment for obesity. Evidence for and against the association of aerobic exercise (AE) and weight loss after LAGB exists. We hypothesize that aerobic exercise is associated with improved weight loss and resolution of comorbidities after LAGB.Methods
A review of a prospectively collected database identified patients who underwent LAGB over a 3-year period at a single institution. Body mass index (BMI), comorbidities, frequency, and duration of exercise were collected preoperatively and at 6, 12, 24, and 36 months postoperatively. Excess weight loss (EWL) was calculated. Groups were analyzed using Fisher’s exact test and ANOVA.Results
Of the 145 LAGB patients, 120 had adequate data for analysis. AE had no association with weight loss at 6 months. At 12, 24, and 36 months following LAGB, patients who reported 150 min or more per week of exercise had an EWL of 35.5, 47.3, and 54.1 %, respectively, while those reporting 0–59 min per week of AE had an EWL of 25.3, 32.1, and 33.0 % (p?=?0.03, 0.03, and 0.02, respectively). BMI and age was not statistically different among groups. Diabetes and obstructive sleep apnea were significantly improved in patients exercising at least 60 min per week as compared to those exercising 0–59 min.Conclusions
AE is significantly associated with weight loss and comorbidity resolution after LAGB. We propose that patients who perform more AE will have higher levels of EWL. 相似文献2.
Karl J. Neff Ling Ling Chuah Erlend T. Aasheim Sabrina Jackson Sukhpreet S. Dubb Shiva T. Radhakrishnan Arvinder S. Sood Torsten Olbers Ian F. Godsland Alexander D. Miras Carel W. le Roux 《Obesity surgery》2014,24(5):684-691
Background
Despite the evidence for benefits beyond weight loss following bariatric surgery, assessments of surgical outcomes are often limited to changes in weight and remission of type 2 diabetes mellitus. To address this shortfall in assessment, the King’s Obesity Staging System was developed. This system evaluates the individual in severity stages of physical, psychological, socio-economic and functional disease. These are categorised into disease domains arranged so as to allow an alphabetic mnemonic as Airways, Body Mass Index (BMI), Cardiovascular, Diabetes, Economic, Functional, Gonadal, Health Status (perceived) and (body) Image.Methods
In this cohort study, patients were assessed before and 12 months after surgery using the modified King’s Obesity Staging Score. We studied 217 consecutive patients undergoing Roux-en-Y gastric bypass (RYGB; N?=?148) and laparoscopic adjustable gastric band (LAGB; N?=?69) using the modified King’s Obesity Staging System to determine health benefits after bariatric surgery.Results
Preoperatively, the groups had similar BMI, but the RYGB group had worse Airways, Cardiovascular, and Diabetes scores (p?<?0.05). After surgery, RYGB and LAGB produced improvements in all scores. In a subgroup paired analysis matched for preoperative Airways, BMI, Cardiovascular, and Diabetes scores, both procedures showed similar improvements in all scores, except for BMI where RYGB had a greater reduction than LAGB (p?<?0.05).Conclusions
Both RYGB and LAGB deliver multiple benefits to patients as evaluated by the modified King’s Obesity Staging System beyond BMI and glycaemic markers. A validated staging score such as the modified King’s Obesity Staging System can be used to quantify these benefits. 相似文献3.
Vilma Dzenkeviciūte Zaneta Petrulioniene Virginijus Sapoka Sigita Aidietiene Lina Abaraviciute 《Obesity surgery》2014,24(11):1961-1968
Background
Herein, we investigate the anthropometric, biochemical and left ventricle (LV) geometry changes following the laparoscopic adjustable gastric banding (LAGB) operation in morbidly obese individuals.Methods
Eighty-three morbidly obese participants (mean age, 46.1?±?11.5 years; 30.1 % men), scheduled for elective LAGB were examined before and 12 months after the surgery. LV geometry and diastolic function were investigated by 2-dimensional echocardiography, whereas laboratory tests assessed the glycaemic, serum lipid and inflammatory marker profiles.Results
Twelve months after the operation, body mass index (BMI) decreased from 46.9?±?7.2 kg/m2 to 40.1?±?8.2 kg/m2 (p?0.05), which was associated with the significant improvements in glycaemic control, inflammatory state, LV end-diastolic diameter (53.6?±?4.6 mm vs. 52.9?±?4.1 mm, p?0.05), LV mass (223.6?±?61.3 vs. 215.4?±?52.7 g, p?0.05) and LV mass index (53.9?±?14.1 g/m2.7 vs. 52.0?±?12.3 g/m2.7, p?0.05). However, no overall improvements in LV geometry or the prevalence of LV hypertrophy subtypes were recorded 12 months after the LAGB. The reduction in LV end-diastolic diameter (ß?=?0.56, p?=?0.0001) and BMI (ß?=?0.26, p?=?0.015) were both associated with diminished LV mass. Additionally, a statistically significant correlation between LV mass and changes in BMI (R?=?0.29, p?=?0.007), waist circumference (R?=?0.32, p?=?0.004), LV end-diastolic diameter (R?=?0.63, p?=?0.0001) and E-wave deceleration time (R?=??0.24, p?=?0.03) were observed within our study population.Conclusions
LV mass decreases 12 months after LAGB surgery, but no improvements in LV geometry and function occur. The regression of LV mass is better predicted by weight loss than by reduction in blood pressure or changes in metabolic parameters. 相似文献4.
Background
Although some patients attain good outcomes after adjustable gastric band (LAGB), a certain quantity have experienced complications and insufficient weight loss. The objective of this study is to assess the safety and outcome of laparoscopic sleeve gastrectomy (LSG) as a conversion surgery after a failed LAGB.Methods
This is a retrospective analysis of 40 patients who received LSG as conversional surgery from 2009 to 2012 in Al Amiri Hospital, Kuwait. Data analyzed included percentage of excessive weight loss (EWL%), body mass index (BMI), and postoperative complications. Paired t test was utilized to evaluate total weight loss after both procedures.Results
Among the 40 patients that underwent conversion surgery, the mean age was 36 years old, 34 (85 %) of which were females. Follow-up for LAGB was 1 to 11 years (median, 4.5 years) and 6 months to 3 years (median, 1 year) for LSG. Mean BMI before LAGB was 44 kg/m2 (SD?=?7.2) and mean weight was 117.2 kg (SD?=?25.1). A percentage of 20 % achieved good outcomes and 7.5 % experienced complications and 60 % insufficient weight loss. Median EWL% achieved with LAGB was 11.5 %, and after LSG, a median EWL% of 56.9 % was recorded. After conversional surgery, a significant drop in BMI was noted with p value?0.002.Conclusions
Laparoscopic conversion from LAGB to LSG may be considered as an alternative for patients with a failed LAGB procedure. However, a longer follow-up study is required to validate the results. 相似文献5.
Background
Predicting weight loss after laparoscopic adjustable gastric banding (LAGB) from preoperative factors has been challenging. This study aimed to determine the relationship between weight loss from a preoperative low-calorie meal replacement diet (LCMRD) and weight loss after LAGB in a cohort of morbidly obese adolescents.Methods
Fifty-one subjects (86 % female, 61 % Caucasian, mean age 16 years, mean weight 140.1 kg) received 2 weeks of LCMRD prior to LAGB. We utilized Pearson’s correlation coefficients to test the relationship between weight loss on a LCMRD and weight loss at 3, 6, and 12 months after LAGB.Results
Mean weight loss was 5.7 kg (standard deviation (SD) 2.5) during the LCMRD period and 17.4 kg (SD 12.4) at 1 year postoperatively. Having a higher baseline weight (p?<?0.01) and losing less weight prior to LCMRD (p?<?0.05) was associated with more weight loss during LCMRD. Weight loss during LCMRD was not significantly associated with postoperative weight loss at any time point.Conclusions
Weight loss during LCMRD was not significantly associated with postoperative weight loss in our study. Less variability in adherence, less influence of genetic and biological potential, and more diuresis during a short course of LCMRD compared to in the postoperative period may explain this lack of association. 相似文献6.
Matthew G. Browning Nancy G. Baugh Luke G. Wolfe John K. Kellum James W. Maher Ronald K. Evans 《Obesity surgery》2014,24(11):1981-1986
Background
Weight loss outcomes following laparoscopic adjustable gastric banding (LAGB) are widely variable, and physical activity (PA) participation improves these results. The purpose of this study was to retrospectively describe PA behaviors before and after LAGB and to evaluate the impact of PA on weight loss outcomes.Methods
Participants were 172 individuals (145 females, mean age 43.3?±?12.0 years, mean body mass index [BMI] 43.8?±?5.1 kg/m2) who underwent LAGB at a university medical center. Height, weight, presence of comorbidities, and PA participation were assessed prior to and 3, 6, and 12 months after surgery. Those who reported engaging in ≥150 min of weekly moderate-to-vigorous PA (MVPA) were considered active.Results
Less than 40 % of participants were active prior to surgery, while 31 % of those who were inactive before surgery became active at 6 months of follow-up. Unlike previous reports on gastric bypass patients, there was no statistically significant (p?>?0.05) relationship between postoperative PA status and weight loss outcomes at 3, 6, or 12 months in LAGB patients. Interestingly, participants who reported ≥150 min of MVPA prior to surgery achieved approximately 10 % greater excess weight loss (p?0.05) and a 2.4-kg/m2 greater decrease in BMI (p?0.05) at 1 year post-LAGB compared to those who were inactive preoperatively.Conclusions
In our sample, higher levels of preoperative PA participation were associated with improved weight loss outcomes following LAGB. We posit that higher preoperative volumes are indicative of habitual exercise and that those who report being active prior to surgery are likely to maintain these behaviors throughout follow-up. 相似文献7.
Wendy A. Brown Julia Moszkowicz Leah Brennan Paul R. Burton Margaret Anderson Paul E. O’Brien 《Obesity surgery》2013,23(10):1611-1615
Background
This study aimed to test the hypothesis that the amount of weight lost on a mandatory 2-week pre-operative very-low-calorie diet (VLCD) would predict the longer-term outcomes of laparoscopic adjustable gastric banding (LAGB).Methods
All patients treated with a primary LAGB from 21 October 2008 until 30 June 2010, who were prescribed a 2-week pre-operative VLCD, have been included in the study. Patient age, weight, BMI and excess weight (defined as weight above a BMI of 25) were extracted on the day of first visit, day of surgery and at the post-operative visits at 3, 12 and 24 months. From these data, percent excess weight loss (EWL) was calculated and compared at all time points.Results
The weight loss achieved on a mandatory 2-week pre-operative diet did not predict weight outcomes at 2 years (r?=??0.008; p?=?0.931). Using multivariate analysis, the best predictor of 24-month percent EWL was percent EWL at 3 months post operation (sr2?=?0.34; p?=?0.003).Conclusions
Results from a pre-operative diet should not be used to predict the ultimate outcome of bariatric surgery. The weight loss at 3 months following LAGB was a strong predictor of longer-term outcomes. There may be potential for improving longer-term results with LAGB by better supporting patients who are not achieving good weight loss at this early time point. 相似文献8.
Background
Proven short-term effectiveness of obesity therapy should be re-evaluated in the long-term. The objective of this paper is to determine the long-term (10 years) outcome for patients from a randomised controlled trial (RCT).Methods
A RCT in 2002 compared laparoscopic adjustable gastric band (LAGB) for obesity with non-surgical therapy. Follow-up has been conducted at 10 years. Eighty patients (BMI 30–35) were randomised to a non-surgical or a surgical program. Outcome data are available on 37 (92.5 %) of the surgical patients and 27 (62.5 %) of the non-surgical patients at 10 years.Results
Weight change, the metabolic syndrome, quality of life, adverse events and direct costs of the surgical cohort were the main results of the study. A durable weight loss is present in the surgical group with a mean (SD) 10-year weight loss of 14.1 (7.7)?kg (63.4 % EWL), better than the non-surgical group (mean (SD)?=?0.4 (10.5)?kg; p?<?0.001). The metabolic syndrome was reduced from 14 to 4 of the 37 patients who completed 10 years within the LAGB groups. Proximal gastric enlargements occurred in 17 (30 %) of the 57 who had LAGB and removal of the band occurred in 7 (12 %). The annual maintenance costs including additional surgery was AUD $765 per patient per year.Conclusions
Bariatric surgery with the LAGB can achieve long-term weight reduction which is better than a program of non-surgical therapy. There is also a sustained reduction of the metabolic syndrome. There is a significant maintenance requirement after LAGB. 相似文献9.
Paul Del Prado Pavlos K. Papasavas Darren S. Tishler Andrea M. Stone Janet S. Ng Sean B. Orenstein 《Obesity surgery》2014,24(4):584-587
Background
Past medical or family history of autoimmune diseases and patient chronic steroid use are label contraindications for laparoscopic placement of adjustable gastric band (LAGB). We reviewed our experience with placement of LAGB in patients with autoimmune disease or chronic steroid use.Methods
This was a retrospective review of our prospective bariatric database. All patients who underwent LAGB and had a diagnosis of autoimmune disease or chronic steroid use with at least 1-year follow-up data were included in the study. Data on demographics, weight loss, and complications were collected.Results
Sixteen patients with autoimmune diseases or chronic steroid use underwent LAGB. Diseases included were lupus (n?=?6), sarcoidosis (n?=?4), renal transplant (n?=?2), rheumatoid arthritis (n?=?1), ulcerative colitis (n?=?1), Grave's disease (n?=?1), and celiac disease (n?=?1). No patients developed infectious complications. One patient required port replacement due to malfunction, and one patient underwent a conversion to gastric bypass due to failure of weight loss. The average preoperative body mass index was 46.8 kg/m2 with an average weight of 292.0 lbs. Average excess weight loss was 39.8 % (range, 7.4 to 95.5 %) at a median follow-up of 54 months.Conclusions
Our review indicates that LAGB in patients with autoimmune diseases or chronic steroid use is safe, with no infectious complications and only one explant. Some of these autoimmune conditions may improve following significant weight loss, but larger studies are required to further substantiate these findings. 相似文献10.
İbrahim Sakçak Mehmet Fatih Avşar Enver Okan Hamamcı Settar Bostanoğlu Muhittin Sonışık Akın Bostanoğlu Nihal Zekiye Erdem Erdal Coşgun 《Obesity surgery》2010,20(5):610-615
Background
There are differences in the levels of inflammation mediators, lipids, and formed elements of the blood in morbidly obese patients compared with individuals of normal weight. In the current study, the change in these parameters was determined in patients who achieved weight loss by undergoing laparoscopic adjustable gastric banding (LAGB) by comparing preoperative, and early (3 months) and late (12 months) postoperative values.Methods
The body mass index (BMI), weight, blood pressure, and waist circumference of 72 patients treated by LAGB procedures between September 2006 and February 2009 were measured and recorded. Pre- and postoperative 3- and 12-month C-reactive protein (CRP), immunoglobulin (Ig) G, IgA, IgM, fibrinogen (Fbg), complement components C3 and C4, total cholesterol, triglycerides, low-density lipoprotein-C and high-density lipoprotein-C levels, and leukocyte, neutrophil, lymphocyte, and platelet counts were also measured. Results were presented as mean?±?SD. The preoperative values were compared with the 3- and 12-month values. A p value?<?0.05 was considered statistically significant.Results
BMI, weight, blood pressure, and waist circumference measurements were reduced at 3 and 12 months postoperatively compared with preoperative values (p?<?0.05). Among the inflammatory mediators, IgG, IgM, and Fbg were reduced to near-normal values, beginning in the early postoperative period (p?<?0.05). There was no significant reduction parallel to weight loss with respect to CRP, C3, C4, and IgA values at 3 months postoperatively (p?>?0.05). However, the 12-month values of these parameters were significantly reduced (p?<?0.05).Conclusions
Morbid obesity leads to significant changes in the levels of inflammation mediators. While there is a significant reduction in some of these mediators accompanying slight weight loss in the early period following an LAGB procedure, significant changes occur in other mediators in the late period when there is a larger amount of weight loss. 相似文献11.
Jonathan Afoke Sanjay Agrawal Janet Edmond David Mahon Richard Welbourn 《Surgical endoscopy》2013,27(4):1219-1224
Background
Laparoscopic adjustable gastric banding (LAGB) is a popular choice for patients seeking weight loss surgery. Since behavioural change appears to play a role in weight loss outcomes we postulated that publicly funded patients might not do as well as self-payers. This series examines the effect of public funding versus self-pay on patients undergoing LAGB over 1, 2 and 3 years.Methods
Consecutive non-randomised cohort series of patient undergoing LAGB over 5 years (September 2003 to December 2008) in a single unit. Age, sex, funding route, body mass index (BMI) and complications were recorded. Per cent excess weight loss (EWL) and the Reinhold criterion for success (proportion achieving 50 % EWL) were assessed.Results
Ninety-nine patients were publicly funded, and 250 patients were self-payers. Initial BMI was significantly higher in publicly funded patients (46.6 vs. 42.3 kg/m2, p < 0.001) with a higher proportion of males (22.2 vs. 6.0 %, p < 0.001). Mean % EWL was significantly less for publicly funded patients at 1 year (38.1 vs. 53.5 %, p < 0.001) and 2 years (49.6 vs. 64.1 %, p < 0.001), but not at 3 years (59.7 vs. 61.8 %, p = 0.784). Fewer publicly funded patients achieved 50 % EWL at 1 year (24.5 vs. 50.2 %, p < 0.001), but with no significant difference at 2 years (54.8 vs. 67.0 %, p = 0.140) or 3 years (55.2 vs. 66.0 %, p = 0.349).Conclusions
Self-pay patients initially achieved more % EWL and greater success in reaching 50 % EWL after LAGB, but this difference was not maintained. The results suggest that patient motivation, using self-pay as a surrogate marker, may affect early results, but the operation itself is the main determinant of weight loss at 3 years. 相似文献12.
Jie Fan Jian Hui Xu Jia Wang Gui Zhen Wang You Qin Zhang Xing Zhen Liu 《Obesity surgery》2014,24(6):891-896
Background
Despite some reports about the long-term metabolic outcomes after laparoscopic adjustable gastric banding (LAGB) in the Western populations, there are few reports on the Asian population whose body size and fat distribution are different. Therefore, this study was conducted to evaluate the medium-term effects of LAGB on weight loss and metabolic outcomes of obese patients with different body mass index (BMI) in China.Methods
A retrospective study was performed to review the 5-year follow-up data of 56 patients (18 males, 38 females) who received LAGB from November 2003 to May 2013 at the Shanghai Changhai Hospital. The patients were evaluated at years 1, 3, and 5 after operation in the outpatient clinic, and the weight loss, metabolic parameters, and remission of comorbidities were measured.Results
The 56 patients preoperatively had BMI of 37.4?±?6.0 kg/m2, with BMI?<?35 kg/m2 in 19 patients (BMI <35 kg/m2 group), and BMI?≥?35 kg/m2 in 37 patients (BMI?≥?35 kg/m2 group). The percentages of excess weight loss (%EWL) of the BMI?<?35 kg/m2 group at years 1, 3, and 5 were 65.2, 65.6, and 65.7 %, respectively, indicating the majority of metabolic parameters were significantly improved (P?<?0.05). However, in the BMI?≥?35 kg/m2 group, the %EWL were 37.9, 34.8, and 26.5 %, respectively, except at year 1 when the metabolic parameters improved significantly (P?<?0.05), those at year 3 and year 5 did not significantly improve compared with the preoperative levels. Similar results were observed in the improvement of comorbidities.Conclusions
Relatively low medium-term weight loss, metabolic improvement, and resolution or remission of obesity-related comorbidities and high reoperation rate were observed in our population of patients with BMI?≥?35 kg/m2 who underwent LAGB. 相似文献13.
Sergio Carandina Malek Tabbara Manuela Bossi Nada Helmy Claude Polliand Christophe Barrat 《Journal of gastrointestinal surgery》2014,18(10):1730-1736
Introduction
Conversion to laparoscopic gastric bypass (LRYGB) appears to be the treatment of choice after failed LAGB. To reduce the risk of postoperative complications, some surgeons routinely adopt a two-stage strategy. The purpose of this study was to analyze our institution’s experience with the two-stage procedure for LAGB conversion to LRYGBMaterials and Methods
The bariatric database of our institution was reviewed to identify patients who had undergone conversion of LAGB to LRYGB from November 2007 to June 2012.Results
One hundred patients were included. Of these, 62 (62 %) required conversion to LRYGB for inadequate weight loss or weight regain and 38 for band-related complications. All the procedures were performed in two stages and laparoscopically. The average time between band removal and LRYGB was 17.3 months. The mean follow-up after LRYGB was 31?±?18.7 months. The mean BMI prior to LRYGB conversion was 45.3?±?5.2. Early complications occurred in 15 patients (15 %), while late complications occurred in only 3 patients (3 %). The average %EWL at 24 months and 48 months after conversion was 70.1 and 69.4 %, respectively.Conclusion
Although a two-stage conversion strategy increases the number of operations and hospital stay without decreasing the rate of early complications compared to one-stage conversion; it has shown to be associated with low rates of GJA stenosis and excellent %EWL. 相似文献14.
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
Background
Laparoscopic adjustable gastric banding (LAGB) is a commonly performed bariatric procedure. LAGB is frequently complicated by slippage. Possible treatment for slippage is rebanding, but long-term effects are unknown. The aim of this study was to investigate whether rebanding after gastric band slippage is associated with weight loss failure.Methods
This was a post hoc analysis of a prospectively collected database of 627 consecutive LAGB patients. Rebanding for slippage was performed in 81 patients. The effect of rebanding on weight loss was evaluated by three analyses: (1) in 81 rebanded patients, weight loss was compared before and after rebanding, separately for patients in whom primary LAGB was successful or unsuccessful; (2) 81 rebanded patients were matched to 81 patients without slippage for prognostic variables and compared for weight loss after rebanding; (3) multivariate logistic regression was performed whether rebanding was independently associated with weight loss failure.Results
The chance of a fair result of rebanding for patients following primary successful (n?=?34) and unsuccessful LAGB (n?=?22) was 62 and 27 % after median follow-up of 113 and 97 months, respectively. There was no difference in weight loss failure between 81 rebanded patients and 81 matched patients: 54 vs 59 % (P?=?0.43). In multivariate analysis, rebanding was not significantly associated with weight loss failure: adjusted odds ratio 1.42; 95 % confidence interval 0.85–2.38; P?=?0.18.Conclusion
In general, rebanding after LAGB has no negative effect on weight loss. However, patients in whom LAGB was unsuccessful prior to rebanding have poor long-term weight loss results. 相似文献15.
S. A. Saboor Aftab L. Halder M. K. Piya N. Reddy I. Fraser V. Menon S. Bridgwater D. Kendrick S. Kumar T. M. Barber 《Obesity surgery》2014,24(6):885-890
Background
There is uncertainty regarding preoperative predictors of a successful outcome for bariatric surgery (BarSurg), on which to determine appropriateness for such a procedure. Our aims were to identify preoperative clinical and psychosocial predictors of success following BarSurg and to explore the influence of body mass index (BMI) on these parameters.Methods
Preoperative data, including Impact of Weight on Quality of Life—Lite (IWQOL-Lite) scores transformed to Health-Related Quality of Life (HRQOL) scores, were accrued from 76 morbidly obese adults awaiting BarSurg. Pre- and postoperative data were also accrued for 26 patients who had completed 1-year follow-up post-bariatric surgery (laparoscopic adjustable gastric banding—LAGB). Statistical analysis was performed to assess the relationships between preoperative HRQOL scores, preoperative BMI and excess weight loss 1 year following BarSurg (EWL-1 year).Results
Preoperative BMI showed a significant independent, negative linear correlation with the public distress domain of preoperative quality of life (QOL) (r?=??0.368, p?=?0.001; β?=??0.245, p?=?0.009). Preoperative BMI had a significant, positive and independent association with EWL-1 year (r?=?0.499, p?=?0.009; β?=?0.679, p?=?0.015). Preoperative QOL scores had no association with EWL-1 year.Conclusions
Preoperative BMI appears to predict EWL-1 year following restrictive bariatric surgery (LAGB). Preoperatively, patients with higher BMI appear to manifest greater public distress. Preoperative QOL scores, however, do not appear to have any predictive value for EWL-1 year post-LAGB. Preoperative BMI should therefore be employed as a predictor of EWL-1 year post-LAGB. Other measures of successful outcomes of bariatric surgeries (such as effects on QOL scores at 1 year) should be explored in future, larger and longer term studies. 相似文献16.
Allison M. Barrett Kim T. Vu Kulmeet K. Sandhu Edward H. Phillips Scott A. Cunneen Miguel A. Burch 《Journal of gastrointestinal surgery》2014,18(10):1737-1743
Introduction
The laparoscopic adjustable gastric band (LAGB) can be revised to sleeve gastrectomy (LSG) for various reasons. Data are limited on the safety and efficacy of single-stage removal of LAGB and creation of LSG.Methods
A retrospective review of cases was performed from 2010 to 2013. From the primary LSG group, a control group was matched in a 2:1 ratio.Results
Thirty-two patients underwent single-stage revision from LAGB to LSG, with a control group of 64. The most common indication for revision was insufficient weight loss (62.5 %). Operative time for revision and control groups was 134 and 92 min, respectively (p?0.0001). Hospital stay was 3.22 and 2.59 days, respectively (p?=?0.02). Overall, the 30-day complication rate for revision and control patients was 14.71 and 6.25 %, respectively (p?=?0.20). There were no leaks, one stricture (3.13 %) in the revision group, and one reoperation for bleeding in the control group (1.56 %). For patients with BMI >30 at surgery, change in BMI at 12 months for revision and control was 8.77 and 11.58, respectively (p?=?0.02).Conclusion
Single-stage revision can be performed safely, with minimal increases in hospital stay and 30-day complications. Weight loss is greater in those who undergo primary LSG compared to those who undergo LSG as revision. 相似文献17.
Tung T. Tran Eric Pauli Jerome R. Lyn-Sue Randy Haluck Ann M. Rogers 《Surgical endoscopy》2013,27(11):4087-4093
Background
Increasing experience with laparoscopic adjustable gastric banding (LAGB) has demonstrated a high rate of complications and inadequate weight loss. Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) have been reported to be safe and effective in selected patients. The purpose of our study was to evaluate the incidence and outcomes of revisional weight loss surgery (RWLS) after laparoscopic gastric banding at our institution.Methods
From June 2006 to February 2013, all patients who underwent LAGB and those who required revision were retrospectively analyzed. All procedures were performed by two surgeons with extensive experience in bariatric surgery. Parametric data are presented as mean ± SD; nonparametric data are presented as median and interquartile range (IQR).Results
During the study period, 256 patients underwent LAGB. A total of 111 patients (43 %) required reoperation. Sixty-one patients (56 women, age = 43.7 ± 12 years) with a BMI of 45.4 ± 6 kg/m2 successfully underwent RWLS (53 RYGB, 8 LSG). Indications for RWLS included dysphagia (40 patients, 63 %), inadequate weight loss (17 patients, 27 %), GERD (2 patients, 3 %), gastric prolapse (2 patients, 3 %), and needle phobia (1 patient, 2 %). Two required conversion to an open RYGB due to extensive adhesions. RWLS was undertaken approximately 36.3 [25–45] months after LAGB. Removal of the gastric band and the RWLS were performed in 15 patients with an interval of 3 [1.5–7] months between procedures. Median operative time was 165 [142–184] min. Median hospital length of stay was 2 [2–3] days. Early complications occurred in 11 patients (18 %), including 4 anastomotic leaks. Twelve patients (20 %) presented with late complications requiring intervention. There was one death. At a median follow-up of 12.4 months, excess weight loss was 47.5 ± 27 %, and 48 % of patients achieved a BMI < 33.Conclusion
LAGB is associated with a high incidence of reoperation. Reoperative weight loss surgery can be performed in selected patients with a higher rate of complications than primary surgery. Good short-term weight loss outcomes can be achieved. 相似文献18.
Aayed R. Alqahtani Mohamed Elahmedi Hussam Alamri Rafiuddin Mohammed Fatima Darwish Ali M. Ahmed 《Obesity surgery》2013,23(6):782-787
Background
Laparoscopic adjustable gastric banding (LAGB) has a significant incidence of long-term failure, which may require an alternative revisional bariatric procedure to remediate. Unfortunately, there is few data pinpointing which specific revisional procedure most effectively addresses failed gastric banding. Recently, it has been observed that laparoscopic sleeve gastrectomy (LSG) is a promising primary bariatric procedure; however, its use as a revisional procedure has been limited. This study aims to evaluate the safety and efficacy of LSG performed concomitantly with removal of a poor-outcome LAGB.Methods
A retrospective review was performed on patients who underwent LAGB removal with concomitant LSG at King Saud University in Saudi Arabia between September 2007 and April 2012. Patient body mass index (BMI), percentage of excess weight loss (%EWL), duration of operation, length of hospital stay, complications after LSG, and indications for revisional surgery were all reviewed and compared to those of patients who underwent LSG as a primary procedure.Results
Fifty-six patients (70 % female) underwent conversion of LAGB to LSG concomitantly, and 128 (66 % female) patients underwent primary LSG surgery. The revisional and primary LSG patients had similar preoperative ages (mean age 33.5?±?10.7 vs. 33.6?±?9.0 years, respectively; p?=?0.43). However, revisional patients had a significantly lower BMI at the time of surgery (44.4?±?7.0 kg/m2 vs. 47.9?±?8.2; p?<?0.01). Absolute BMI postoperative reduction at 24 months was 14.33 points in the revision group and 18.98 points in the primary LSG group; similar %EWL was achieved by both groups at 24 months postoperatively (80.1 vs. 84.6 %). Complications appeared in two (5.5 %) revisional patients and in nine (7.0 %) primary LSG patients. No mortalities occurred in either group.Conclusions
Conversion of LAGB by means of concomitant LSG is a safe and efficient procedure and achieves similar outcomes as primary LSG surgery alone. 相似文献19.
Mousa Khoursheed Ibtisam Al-Bader Ali Mouzannar Abdulla Al-Haddad Ali Sayed Ali Mohammad Abe Fingerhut 《Surgical endoscopy》2013,27(11):4277-4283
Background
A considerable number of patients require revisional surgery after laparoscopic adjustable gastric banding (LAGB). Studies that compared the outcomes of revisional sleeve gastrectomy (r-SG) and revisional Roux-en-Y gastric bypass (r-RYGB) after failed LAGB are scarce in the literature. Our objective was to determine whether significant differences exist in outcomes between r-SG and r-RYGB after failed LAGB.Methods
From 2005 to 2012, patients who underwent laparoscopic r-SG and r-RYGB after failed LAGB were retrospectively compared and analyzed. Data included demographics, indication for revision, operative time, hospital stay, conversion rate, percentage excess weight loss (%EWL), and morbidity and mortality.Results
Out of 693 bariatric procedures, 42 r-SG and 53 r-RYGB were performed. The median preoperative weight (107.7 and 117.7 kg, respectively, p = 0.02) and body mass index (BMI) (38.5 vs. 43.2 kg/m2, respectively, p = 0.01) were statistically significantly lower in r-SG than in r-RYGB. The mean operative time and median hospital stay were significantly shorter in r-SG than in r-RYGB (108.4 vs. 161.2 min, p < 0.01) (2 vs. 3 days, p = 0.02), respectively. One patient underwent conversion to open surgery after r-RYGB (p = 0.5). The reoperation rate was lower in r-SG than in r-RYGB (0.0 vs. 3.8 %, p = 0.5). There was one postoperative leak in the r-RYGB, and the overall complication rate was significantly lower in r-SG patients than in r-RYGB patients (7.1 vs. 20.8 %, p = 0.05). The mean follow-up was significantly shorter in the r-SG group (9.8 vs. 29.3 months, p < 0.01). However, the mean postoperative BMI was not different at 1 year (32.3 vs. 34.7, p = 0.29) as well as mean %EWL was (47.4 vs. 45.6 %, p = 0.77).Conclusions
Both r-SG and r-RYGB are safe procedures with similar outcomes in terms of %EWL. As a result of the long-term potential nutritional complication of r-RYGB, r-SG may be a better option in this group of patients. Longer follow-up is needed. 相似文献20.
S. Thomas R. Bhattacharya J. B. Saltikov D. J. Kramer 《Archives of orthopaedic and trauma surgery》2013,133(2):215-218