共查询到20条相似文献,搜索用时 31 毫秒
1.
Background Bariatric operations significantly improve glucose metabolism, decrease insulin resistance, and lead to clinical resolution
of type II diabetes mellitus in many patients. The mechanisms that achieve these clinical outcomes, however, remain ill defined.
Moreover, the relative impact of various operations on insulin resistance remains vigorously contested. Consequently, the
purpose of this study was to compare directly the impact of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic
adjustable gastric banding (LAGB) on hemoglobin A1c (HbA1c) levels and insulin resistance in comparable groups of morbidly
obese patients.
Methods Data were entered prospectively into our bariatric surgery database and reviewed retrospectively. Patients selected operations.
Principle outcome variables were percent excess weight loss (%EWL), HbA1c, and homeostatic model assessment for insulin resistance
(HOMA IR).
Results The number of follow-up visits for 111 LAGB patients was 263 with a median of 162 days (17–1,016) and 291 follow-up visits
for 104 LRYGB patients for a median of 150 days (8–1,191). Preoperative height, weight, body mass index, age, sex, race, comorbidities,
fasting glucose, insulin, HbA1c, and HOMA IR were similar for both groups. In particular, the number of patients who were
diabetics and those receiving insulin and other hypoglycemic agents were similar among the two groups. The LAGB patients lost
significantly less weight than the LRYGB patients (24.6% compared to 44.0% EWL). LAGB reduced HbA1c from 5.8% (2–13.8) to
5.6% (0.3–12.3). LRYGB reduced HbA1c from 5.9% (2.0–12.3) to 5.4% (0.1–9.8). LAGB reduced HOMA IR from 3.6 (0.8–39.2) to 2.3
(0–55) and LRYGB reduced HOMA IR from 4.4 (0.6–56.5) to 1.4 (0.3–15.2). Postoperative HOMA IR correlated best with %EWL. Indeed,
regression equations were essentially identical for LAGB and LRYGB for drop in %EWL versus postoperative HOMA IR.
Conclusion Percent excess weight loss significantly predicts postoperative insulin resistance (HOMA IR) during the first year following
both LRYGB and LAGB. 相似文献
2.
Numan Hamza M.D. Muhammad Hasan Abbas M.Phil. Ammar Darwish Zainab Shafeek John New Basil J. Ammori M.B.Ch.B. M.D. 《Surgery for obesity and related diseases》2011,7(6):691
Background
Type 2 diabetes mellitus (T2DM) is associated with obesity and results in considerable morbidity and mortality. Our objectives were to evaluate the effect of laparoscopic bariatric surgery on the control of T2DM in morbidly obese patients in a U.K. population and to determine the predictors of T2DM remission after bariatric surgery. The study was performed at teaching university hospitals and affiliated private hospitals.Methods
Of 487 patients who underwent laparoscopic bariatric procedures from 2002 to 2007, 74 patients (15.2%) had established T2DM. The results are presented as the mean values. Multivariate analysis was used to identify the factors predictive of remission of T2DM after bariatric surgery.Results
The body mass index before laparoscopic gastric bypass (LGB; n = 48) and laparoscopic adjustable gastric banding (LAGB; n = 26) were comparable (52 versus 51 kg/m2, P = .508). At a mean follow-up of 16.9 months, 41% had remission and 59% had experienced improvement in T2DM. Although the duration of follow-up was significantly longer for the patients who had undergone LAGB than for those who had undergone LGB (23 versus 13.4 months, P = .001), the percentage of excess weight loss (%EWL) was significantly greater after LGB than after LAGB (59.4% versus 48.8%, P = .031), with an associated greater remission rate of T2DM (50% versus 24%, P = .034). Multivariate analysis revealed a greater %EWL and younger age to be independent predictors of postoperative remission of T2DM, and LGB, longer follow-up, and female gender were independent predictors of a greater %EWL.Conclusion
The %EWL was the only predictor of remission of T2DM that was influenced by the choice of bariatric procedure. In our study, LGB offered greater weight loss and a chance of remission of T2DM compared with LAGB and within 2 years of surgery. 相似文献3.
Ma Y Pagoto SL Olendzki BC Hafner AR Perugini RA Mason R Kelly JJ 《Obesity surgery》2006,16(9):1227-1231
Background: Weight loss after bariatric surgery varies and depends on many factors, such as time elapsed since surgery, baseline
weight, and co-morbidities. Methods: We analyzed weight data from 494 patients who underwent laparoscopic Roux-en-Y gastric
bypass (RYGBP) by one surgeon at an academic institution between June 1999 and December 2004. Linear regression was used to
identify factors in predicting % excess weight loss (%EWL) at 1 year. Results: Mean patient age at time of surgery was 44
± 9.6 (SD), and the majority were female (83.8%). The baseline prevalence of co-morbidities included 24% for diabetes, 42%
for hypertension, and 15% for hypercholesterolemia. Baseline BMI was 51.5 ± 8.5 kg/m2. Mean length of hospital stay was 3.8 ± 4.6 days. Mortality rate was 0.6%. Follow-up weight data were available for 90% of
patients at 6 months after RYGBP, 90% at 1 year, and 51% at 2 years. Mean %EWL at 1 year was 65 ± 15.2%. The success rate
(≥50 %EWL) at 1 year was 85%. Younger age and lower baseline weight predicted greater weight loss. Males lost more weight
than females. Diabetes was associated with a lower %EWL. Depression did not significantly predict %EWL. Conclusion: The study
demonstrated a 65 %EWL and 85% success rate at 1 year in our bariatric surgery program. Our finding that most pre-surgery
co-morbidities and depression did not predict weight loss may have implications for pre-surgery screening. 相似文献
4.
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
5.
Background Gastric banding is a safe and efficient bariatric procedure. We report here the results of 591 consecutive gastric bandings
in terms of excess weight loss with up to 10 years follow-up and the complications.
Methods Between June 1996 and September 2006, 591 patients underwent laparoscopic adjustable gastric banding (LAGB) by the same surgeon
(JB). Of these patients, 69.2% were women. Mean age was 33.6 years ± 10.7 and mean BMI was 41.95 kg/m2 ± 8.7. Patients were reviewed monthly for the first 6 months, every 2 months for the next 6 months, and yearly thereafter.
Excess weight loss was calculated at 6 months and 1, 2, 4, 6, 8, and 10 years.
Results Six hundred eleven bands were implanted in 591 patients. Fifty-one patients (8.6%) had band removal due to a complication.
Mean follow-up was 35 ± 2 months. Percentage of excess weight loss was 45.8% ± 27.4 at 6 months, 66.7% ± 30.3 at 1 year, 72.6% ± 28.8
at 2 years, 75.9% ± 27.4 at 4 years, 82.8% ± 32.6 at 6 years, 82.3% ± 25.1 at 8 years, and 82.7% ± 4.2 at 10 years. Complications
encountered were band failure (9.3%), slippage (5.3%), erosion (4.6%), infection (2.4%), high band position (1.9%), and others
(2.8%). Complication rate was 23.3% overall but dropped to 2.5% when calculated on the second half of the patients.
Conclusion LAGB is a safe and efficient bariatric procedure. With experience, the complication rate drops to a very low level. Close
follow-up can further increase its efficacy.
Presented at 12th Annual Meeting of IFSO, Porto, Portugal, September 2, 2007. 相似文献
6.
Background
Obesity becomes a global epidemic disease, and bariatric surgery is increasing in Korea as well as in western countries. The first laparoscopic Roux-en-Y gastric bypass (LRYGBP) was performed in 2003, and the Lap Band® was approved for use in Korea in 2004. There are no data regarding gastric bypass and adjustable gastric banding regarding weight loss as well as changing of pre-existing comorbidities up to date.Methods
St. Mary’s Hospital Center, main leader of bariatric surgery in Korea, performed 76 weight loss operations [LRYGBP?=?25, laparoscopic adjustable gastric banding (LAGB) ?=?51] for morbid obesity. We retrospectively reviewed a series of bariatric cases and examined changes of weight loss, postoperative complications, and pre-existing comorbidities between two procedures.Results
There were no significant differences in age, BMI, sex distribution, pre-existing comorbidities in two procedures. Patients undergoing LRYGBP had longer operative times, more blood loss, and longer hospital stays. There is significant difference regarding postoperative complication (p?0.05) but neither for mortality nor pulmonary embolism with both procedures. Percentage of excess weight loss (%EWL) of LRYGBP at 12, 24, and 36 months were 76.9%, 79.7%, and 85.8%, and %EWL of LAGB were 46.8%, 55.1%, 63.3%, respectively. The patients in the LRYGBP who has dyslipidemia, sleep apnea, degenerative joint disease, and diabetes mellitus were more likely to improve than the patients after LAGB at early postoperative period.Conclusions
The results of our initial study indicate that LRYGBP and LAGB are technically feasible and safe. It is a low rate of major postoperative complications without mortality. LRYGBP and LAGB are quite satisfactory and promising bariatric procedures with significant weight loss and improvement of obesity-related metabolic comorbidities in Korean.7.
Jose Luis Leyba Salvador Navarrete Aulestia Salvador Navarrete Llopis 《Obesity surgery》2011,21(2):212-216
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most widely used bariatric procedures today, and laparoscopic
sleeve gastrectomy (LSG) as a single-stage procedure for the treatment of morbid obesity is becoming increasingly popular.
In this study, we prospectively compared both techniques in order to establish whether there is any superiority of one over
the other based on morbidity and effectiveness. From January 2008 to December 2008, 117 obese patients with indication for
bariatric surgery were assigned by patient choice after informed consent to either a LRYGB procedure (n = 75) or a LSG procedure (n = 42). We determined operative time, length of stay, morbidity, co-morbidity outcomes, and excess weight loss at 1 year postoperative.
Both groups were comparable in age, sex, body mass index, and co-morbidities. Mean operative time of LSG was 82 min while
LRYGB was 98 min (p < 0.05). Differences in length of stay, major complications, improvement in co-morbidities, and excess weight loss were not
significant (p > 0.05). One year after surgery, average excess weight loss was 86% in LRYGB and 78.8% in LSG (p > 0.05). In the short term, both techniques are comparable regarding safety and effectiveness, so not one procedure is clearly
superior to the other. 相似文献
8.
Revision of Failed Laparoscopic Adjustable Gastric Banding to Roux-en-Y Gastric Bypass 总被引:3,自引:3,他引:0
Background: The most common bariatric surgical operation in Europe, laparoscopic adjustable gastric banding (LAGB), is reported
to have a high incidence of long-term complications. Also, insufficient weight loss is reported. We investigated whether revision
to Roux-en-Y gastric bypass (RYGBP) is a safe and effective therapy for failed LAGB and for further weight loss. Methods:
From Jan 1999 to May 2004, 613 patients underwent LAGB. Of these, 47 underwent later revisional Roux-en-Y gastric bypass (RYGBP).
Using a prospectively collected database, we analyzed these revisions. All procedures were done by two surgeons with extensive
experience in bariatric surgery. Results: All patients were treated with laparoscopic (n=26) or open (n=21) RYGBP after failed
LAGB. Total follow-up after LAGB was 5.5±2.0 years. For the RYGBP, mean operating time was 161±53 minutes, estimated blood
loss was 219±329 ml, and hospital stay was 6.7±4.5 days. There has been no mortality. Early complications occurred in 17%.
There was only one late complication (2%) – a ventral hernia. The mean BMI prior to any form of bariatric surgery was 49.2±9.3
kg/m2, and decreased to 45.8±8.9 kg/m2 after LAGB and was again reduced to 37.7±8.7 kg/m2 after RYGBP within our follow-up period. Conclusion: Conversion of LAGB to RYGBP is effective to treat complications of LAGB
and to further reduce the weight to healthier levels in morbidly obese patients. 相似文献
9.
Franco Favretti David Ashton Luca Busetto Gianni Segato Maurizio De Luca 《World journal of surgery》2009,33(10):2039-2048
The advent of laparoscopic adjustable gastric banding (LAGB) during the latter part of the 20th century represents a watershed
in the management of chronic obesity. In this paper we provide an overview of LAGB with respect to its development, clinical
outcomes, and future role. We also address current controversies, including a comparison of LAGB with Roux-en-Y gastric bypass
(RYGBP). At present LAGB seems to be increasing in popularity in the United States, whereas in Europe there seems to be a
trend away from gastric banding toward RYGBP. Optimal outcomes after LAGB are a function of correct laparoscopic technique,
an experienced surgical team, a well-engineered device, and intensive long-term follow-up. The majority of studies show that
LAGB is an extremely safe and effective procedure, with an operative mortality of 0–0.1% and excess weight loss (%EWL) of
50–60%. Commensurate with this degree of weight loss, almost all studies show substantial improvements in obesity-related
co-morbidities, such as hypertension, type II diabetes, and dyslipidemia. In addition, LAGB has been shown to be both safe
and effective in the super-obese, in adolescents, and in older patients and can be delivered as an ambulatory procedure. Operative
mortality and early complication rates are significantly higher for RYGBP and, whilst gastric bypass results in greater weight
loss than LAGB in the first 2 years, at 3 years and beyond the difference appears to be less marked. Overall, LAGB provides
a safe, effective intervention for obese patients and remains our first-choice procedure for bariatric surgery. 相似文献
10.
Laparoscopic Adjustable Gastric Banding: Early Experience in 400 Consecutive Patients in the USA 总被引:3,自引:3,他引:0
Background: Early experience with 400 consecutive patients who underwent laparoscopic adjustable gastric banding (LAGB) is
reported. Methods: From Nov 2002 to Aug 2004, prospective data were collected on 400 consecutive LAGB patients and evaluated
retrospectively. Results: There were 354 (88.5%) females and 46 males (11.5%), with mean age 43.6 years and mean BMI 46.2
kg/m 2 . For outpatients (freestanding ambulatory surgery center), mean OR time was 55.4 min in 208 patients (52%), compared to mean inpatient OR time of 70.5 min in 192 patients. Inpatients had a higher BMI (48.2 ± 9.3 SD) than outpatients (43.9 ± 5.7 SD) (P<0.0001). Complications occurred in 35 patients (8.8%). These consisted of 9 slipped bands (2.3%) that were surgically repositioned,
6 port problems (1.5%) that were successfully repaired, 17 patients with temporary stoma occlusion (4.3%) that spontaneously
resolved, and 2 bowel perforations (0.5%) that required surgical repair and band removal. One patient died of pneumonia 2
weeks after an uneventful procedure. Average 1-year percent excess weight loss (%EWL) in 138 patients was 48.2%. Patients
who had ≤50 kg initial excess weight (n=37, 27%) had a significantly higher %EWL (55.2%) at 1 year than patients who had >50
kg initial excess weight (P=0.0011). Conclusions: LAGB has been safe and effective thus far for the surgical treatment of morbid obesity, and can be
performed as an outpatient in select patients. 相似文献
11.
12.
Background
Several studies have been investigated to find the long-term effect of bariatric surgery on weight loss; nevertheless, a meta-analysis can detailedly demonstrate the effect of bariatric surgery on weight in morbidly obese patients. This study aimed to assess the long- and very long-term effects of laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic sleeve gastrectomy (LSG) on weight loss in adults.Methods
An electronic search using PubMed, Scopus, and Google scholar databases was performed for all English-language articles up to May 15, 2016 with no publication date restriction. Outcome was long-term (≥5–10 years) and very long-term (≥10 years) weight reduction that reported as the mean %EWL and changes in BMI from baseline.Results
Eighty articles with 87 arms were included in this meta-analysis. The excess weight loss percentage (%EWL) was 47.94% and 47.43% after LAGB at ≥5 and ≥10 years, respectively. After LRYGB the %EWL was 62.58% at ≥5 years and 63.52% at ≥10 years. It was 53.25% at ≥5 years after LSG. Results of subgroup analyses have indicated that LRYGB leads to higher %EWL in America and Asia compared with Europe. Meta-regression analyses have shown that there is no significant association between %EWL and baseline age, BMI and length of follow-up after three procedures. However, there is a positive association between gender and %EWL after LRYGB (β?=?1.24). No publication bias was found.Conclusions
These findings suggest that LRYGB is an effective procedure in morbidly obese patients that leads to sustainable weight loss over the long- and very long-term periods in compared with LAGB and LSG.13.
Dineros H Sinamban R Siozon M Llido LO Yumang E Gregorio AE Cacas R 《Obesity surgery》2007,17(1):82-87
Background Information on experience in bariatric surgery in the Asia-Pacific region is minimal: hence the need for more reports from
this area.
Methods The procedures of bariatric surgery and outcome as part of a weight management program in a tertiary care private hospital
in the Philippines is reported from years 2002 to 2004. 50 patients were included, of which 60% underwent laparoscopic adjustable
gastric banding (LAGB) and 40% Roux-en- Y gastric bypass (RYGBP).
Results There were more females than males (64% vs 36%) with the mean age 38 ± 13.1 years. Initial mean BMI was 46.2 kg/m2, which
decreased to 27.0 kg/m2 in 1 year. Initial mean weight was 126.7 ± 25.4 kg, of which the 1 year weight loss was 32.3 kg for the morbidly obese and
58.0 kg for the super obese. %EWL at 1 year was 30.2%. There was greater weight loss with RYGBP compared to LAGB at 1 year
(43.5 kg vs 30.2 kg). There was no mortality, and early complications were: wound infection (2/50 or 4%), and 1/50 or 2% each
for pneumonia, dehydration, gastritis, and leakage. Late complications were: band slippage (2/20 or 10%), stomal stenosis
(1/20 or 5%), and ventral hernia (1/5 or 20%).
Conclusion Bariatric surgery is safe with a low complication rate and the outcome was similar to the reported data from Asia and the
western world. 相似文献
14.
Langer FB Bohdjalian A Shakeri-Manesch S Felberbauer FX Ludvik B Zacherl J Prager G 《Obesity surgery》2008,18(11):1381-1386
Background Beside complications like band migration, pouch-enlargement, esophageal dilation, or port-site infections, laparoscopic adjustable
gastric banding (LAGB) has shown poor long-term outcome in a growing number of patients, due to primary inadequate weight
loss or secondary weight regain. The aim of this study was to assess the safety and efficacy of laparoscopic conversion to
Roux-en-Y gastric bypass (RYGBP) in these two indications.
Methods A total of 25 patients, who underwent laparoscopic conversion to RYGBP due to inadequate weight loss (n = 10) or uncontrollable weight regain (n = 15) following LAGB, were included to this prospective study analyzing weight loss and postoperative complications.
Results All procedures were completed laparoscopically within a mean duration of 219 ± 52 (135–375) min. Mean body weight was reduced
from 131 ± 22 kg (range 95–194) at time of the RYGBP to 113 ± 25, 107 ± 22, and 100 ± 21 kg at 3, 6, and 12 months, respectively,
which results in excess weight losses (EWL) of 28.3 ± 9.9%, 40.5 ± 12.3%, and 50.8 ± 15.2%. No statistically significant differences
were found comparing weight loss within these two groups.
Conclusion RYGBP was able to achieve EWLs of 37.6 ± 16.1%, 48.5 ± 15.1%, and 56.9 ± 15.0% at 3, 6, and 12 months following conversion,
respectively, based on the body weight at LAGB. 相似文献
15.
Antonio Iannelli Anne Sophie Schneck Emila Ragot Arnaud Liagre Yves Anduze Simon Msika Jean Gugenheim 《Obesity surgery》2009,19(9):1216-1220
Background The problem of revision of failed gastric banding (GB) and vertical banded gastroplasty (VBG) procedures has become a common
situation in bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) has been recently used to revise failed restrictive
procedures. The objective of this study is to evaluate the results of LSG as revisional procedure for failed GB and VBG.
Methods A prospective held database was questioned regarding patients' demographic, indication for revision, conversion to open surgery,
morbidity, percentage of excess weight loss (%EWL), evolution of comorbidities, and need for a second procedure after LSG.
Results Forty-one patients, 34 women and seven men with a mean age of 42 years (range 19 to 63 years) and a mean body mass index at
49.9 kg/m2 (range 35.9–63 kg/m2), underwent laparoscopic conversion of GB (36 patients) and VBG (five patients) into LSG. Indication for revisional surgery
was insufficient weight loss in all the cases. All procedures were completed laparoscopically. There was no mortality and
five patients (12.2%) developed complications (high leak, one patient; intra-abdominal abscess, three patients; and complicated
incisional hernia, one patient). At a mean follow-up of 13.4 months, %EWL is on average 42.7% (range 4–76.1%). Six patients
had a second procedure (four had laparoscopic duodenal switch, one had laparoscopic Roux-en-Y gastric bypass, and one had
laparoscopic biliopancreatic diversion).
Conclusion Conversion of GB and VBG into LSG is feasible and safe. LSG is effective in the short term with a mean %EWL of 42.7% at 13.4 months.
Long-term results of LSG as revisional procedure are awaited to establish its efficacy in the long term. 相似文献
16.
Background Hiatal hernia, present radiologically in about 50% of patients desiring bariatric surgery, has been thought a contraindication
to laparoscopic adjustable gastric banding (LAGB). Posited was the notion that adding crural repair to LAGB would enable this
procedure to be offered to patients desiring bariatric surgery who had hiatal hernias.
Methods After obtaining IRB approval, charts of all patients who underwent simultaneous crural repair and LAGB from June 2003 to January
2006 were reviewed. All patients were evaluated with the DeMeester score and the GERD-HQRL score pre- and postoperatively.
Statistical analyses included the Mann–Whitney U test and the Chi-squared test.
Results Twenty-one patients underwent laparoscopic procedure with crural repair; none required conversion to an open procedure. There
were no mortalities. Two complications, a wound infection at the level of the port, and a case postoperative dysphagia resolved
with therapy. Eighty-six percent of the patients ceased regular intake of heartburn medicines, P < .01. Median percent excess weight loss was 45% at 1 year and 55% at 2 years. The modified DeMeester score fell to 0–2 postoperatively
(P < .01). Two years after the procedure, symptoms were less, as assessed by GERD-HQRL scores (P < .01).
Conclusion Crural repair permits LAGB to be safely and effectively performed in patients with hiatal hernia. 相似文献
17.
Erosion of the laparoscopic adjustable gastric band (LAGB) into the lumen of the stomach is a recognised complication of this
procedure. We undertook a systematic literature review of the incidence, clinical features and management of erosions occurring
after LAGB. A systematic search of relevant medical databases for full-text original articles looking for LAGB patients and
reported erosions was conducted. We focussed on incidence, aetiology, clinical presentation, treatment, complications and
weight loss. Twenty-five studies of LAGB reported 231 erosions in 15,775 patients (overall incidence of 1.46%). The mean number
of patients per study was 631 (±486), and the mean follow-up was 3.73 (±2.4) years. In four reports involving less than 100
patients, there were 27 erosions in a total of 270 patients (10%) compared with 180 erosions in 12,978 patients (1.386%) in
the remaining 21 reports. Multiple regression analysis showed that erosion rate was significantly predicted by number of patients
and number of years of surgeon experience (r
2 = 0.186). Treatment was most commonly by removal of the band, repair of the stomach and later, band replacement. Other options
were removal alone or conversion to another procedure. Weight loss was retained after treatment of the erosion with a mean
weight loss at final follow-up of 50.34 ± 3.9 percent excess weight loss. Incidence of erosion after gastric banding is relatively
low and can be related to surgeon experience. The most common treatment described in the literature is removal of the eroded
band with delayed replacement. Replacement of the band is associated with maintenance of weight loss. 相似文献
18.
Bariatric revision surgery is associated with several complications that can be attributed to decreased quality of tissue
and complexity of the surgery. A laparoscopic sleeve gastrectomy is a simple technique with potential advantages. Therefore,
the results of this procedure were evaluated as a revisional option. Fifty-one patients underwent laparoscopic sleeve gastrectomy
(LSG). Indications for the LSG were insufficient weight loss (34 patients, group 1) or vomiting (17 patients, group 2) following
a laparoscopic adjustable gastric banding (LAGB) or vertical banded gastroplasty (VBG). Patient and procedure characteristics
as well as outcome were collected prospectively. From October 2006 to June 2010, 51 patients with a failed prior bariatic
procedure (VBG or LAGB) were converted to (L)SG. The conversion rate was zero. The median procedure time was 99 min (range
54–221) and hospital stay was 3 days (range 2–38). There was no mortality after 30 days. Complications included bleeding (six)
and leakage of the staple line (seven). Mean follow-up was 13.8 (2–46) months. LSG as revision surgery for insufficient weight
loss resulted in extra weight loss of 52.7%, and the overall extra weight loss was 49.3%. When LSG was performed because of
vomiting, 82% was able to eat solid food at follow-up. Of the 65 pre-existent co-morbidities, 21 were resolved and 18 improved.
LSG as a revision procedure is feasible. An additional weight loss and further resolution of co-morbidity seem achievable,
however, at the cost of a high number of complications. Therefore, revision bariatric surgery should be limited to expert
tertiary bariatric centers. 相似文献
19.
Background
Obesity is a worldwide epidemic and surgery is the only proven long-term treatment. The two most commonly performed bariatric procedures are laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB). There are advocates of both procedures but LAGB is associated with potentially high failure rates and may require conversion to an alternative procedure.Methods
This study reports our unit results for failed LAGB converted to LRYGB and compares them to primary LRYGB patients. All patients undergoing revisional LRYGB from July 2006 to December 2011 were included in the study. Comparisons were made to patients undergoing primary LRYGB over the same time period for post-operative weight loss, complications and length of stay.Results
Of the patients, 722 were analysed of which 55 underwent revisional surgery. There was no statistical difference in percentage of excess weight loss at 6 months, 1 year or 2 years following surgery between the primary and revisional surgery cohorts (54.5, 63.7, 65.2 vs 51.6, 59.5, 59.4, p?=?NS). There was no difference in morbidity, mortality or length of stay between the two groups. Revisional LRYGB was carried out as a single surgery in 43 (78 %) patients.Conclusions
Revisional LRYGB surgery can be carried out safely and efficiently in experienced bariatric units. Good short- and medium-term weight loss can be achieved with no increase in morbidity, mortality or length of hospital stay. This study adds weight to the argument that LRYGB is the revisional procedure of choice following failed LAGB. 相似文献20.
Background Roux-en-Y gastric bypass (RYGBP) is presently one of the most popular surgical procedures for obesity. One of the possible
long-term problems is weight regain, usually after a period of successful weight loss. Weight regain after RYGBP can be due
to new eating habits, like sweet-eating or grazing, or volume eating because of impaired restriction. This paper reports our
experience in patients who presented weight regain after laparoscopic RYGBP, because of new appearance of volume eating or
hyperphagia, treated by the laparoscopic placement of a non-adjustable silicone ring around the gastric pouch.
Methods From July 2004 to November 2007, six patients affected by weight regain due to hyperphagic behavior, benefited from revision
of RYGBP consisting of the placement of a non-adjustable silicone ring loosely encircling the stomach part. Mean weight and
body mass index (BMI) at the time of RYGBP were 105.0 kg ± 12.3 and 36.3 ± 3.0 kg/m2, respectively, and all patients suffered from obesity-related co-morbidities. After a mean time from RYGBP of 26.0 ± 14.2 months,
patients presented a weight regain of 4.7 ± 3.4 kg compared with their minimal weight, with a final mean weight, BMI, and
percentage of excess weight loss (%EWL) at the time of the silicone ring of 86.0 ± 13.1 kg, 29.5 ± 3.9 kg/m2, and 47.0 ± 24.7%, respectively. Preoperative evaluation for each patient included history and physical examination, nutritional
and psychiatric evaluation, laboratory tests, and barium swallow check. Outcome measures included evaluation of the Roux-en-Y
construction, operative time, postoperative morbidity and mortality, and weight loss in terms of absolute weight loss, BMI,
and %EWL.
Results Any modification of the digestive circuit was evidenced. Mean operative time was 82.5 ± 18.3 min. No operative mortality and
no conversion to open surgery were achieved. No postoperative complications were achieved. Mean hospital stay was 2.6 ± 1.5 days.
After a mean follow-up of 14.0 ± 9.2 months, the six patients presented a mean weight loss of 9.1 ± 2.4 kg, with a final mean
weight, BMI, and %EWL of 76.8 ± 13.7 kg, 26.4 ± 4.2 kg/m2, and 70.4 ± 30.4%, respectively. Difference in term of %EWL before and after revision (23.4 ± 5.7) is statistically significant
(p < 0.05). There have been no erosions or slippage of the ring during this follow-up.
Conclusion One of the possible causes of weight regain after RYGBP is the new eating behavior of the patient, one of which is hyperphagia.
Treatment of this condition can be the placement of a non-adjustable silicone ring loosely fitted around the gastric pouch
which contributes to improved weight loss.
This paper was presented at the XIII World Congress of International Federation for the Surgery of Obesity and metabolic disorders,
Buenos Aires, Argentina, September 24–27, 2008. 相似文献