腹腔镜可调节胃束带减容术治疗肥胖症的护理体会

目的探讨腹腔镜可调节胃束带减容术（laparoscopic adjustable gastric banding,LAGB）治疗肥胖症的护理体会。方法回顾性分析2007年10月-2009年8月我院3例腹腔镜可调节胃束带减容术的临床护理资料。结果 3例手术均顺利进行,手术时间75 min、100 min、170min,出血量20 ml、30 ml、70 ml,术后住院3 d、4 d、8 d,1例出现套孔管感染,全组无死亡病例。术后随访,根据需要调节捆扎带、控制减重速度,1例随访7月,体重减轻36 kg,1例随访14月,体重减轻40 kg,1例随访22月,减重减轻60 kg,无体重反弹及营养不良病例。结论通过术前良好的心理护理、术前准备及术后并发症的观察与护理,对提高LAGB质量肥胖症的疗效是非常重要的。     

腹腔镜可调节捆扎带胃减容术操作要点

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

1例肥胖症患者腹腔镜下行可调节胃束带减容术的护理

对1例肥胖症患者腹腔镜下行可调节胃束带减容术，结果手术效果满意。提出术前正确评估患者病情，加强心理护理，完善术前准备，术后严密监测生命体征，预防脑梗死、肺栓塞等并发症发生，是保证手术成功的关键。     

1例肥胖症患者腹腔镜下行可调节胃束带减容术的护理

对1例肥胖症患者腹腔镜下行可调节胃束带减容术,结果手术效果满意.提出术前正确评估患者病情,加强心理护理,完善术前准备,术后严密监测生命体征,预防脑梗死、肺栓塞等并发症发生,是保证手术成功的关键.     

腹腔镜可调节捆扎带胃减容术对病态肥胖患者免疫功能的影响

目的比较病态肥胖症(MO)患者行腹腔镜可调节捆扎带胃减容术(LAGB)手术前后的免疫功能。方法MO组15例,平均体重指数(BMI)358kg/m2,于2003年6月2003年10月行LAGB,监测手术后体重变化。并于术前、术后1、3、6个月测定外周血T淋巴细胞总数(TLC)、T细胞亚群(CD+3、CD+4、CD+8、CD+4/CD+8)、自然杀伤细胞(NKC)百分比、血浆白细胞介素2(IL2)、白细胞介素6(IL6)浓度等免疫指标。对照组15例,平均BMI236kg/m2,入院时检测上述指标。应用SPSS110统计分析软件对各组数据进行统计学分析。结果MO组与对照组相比,术前CD+4、CD+4/CD+8显著降低(P<001),血浆IL2、IL6浓度显著升高(P<001)。LAGB术后6月体重、BMI、腰围及臀围均明显下降(P<001)。与术前相比,MO组术后6个月CD+4、CD+4/CD+8明显升高(P<005),但仍低于对照组(P<001);IL2、IL6浓度明显降低(P<001,P<005)。结论MO患者合并免疫功能异常,LAGB术后体重减轻后,免疫功能可部分改善。     

腹腔镜胃减容术的护理配合与体会

<正>肥胖已成为全球愈来愈严重的健康问题,它不仅增加了许多疾病的发生率,而且严重影响患者的生活品质,甚至寿命。目前,减重是治疗病态性肥胖最好的方法,不仅能大幅改善患者的健康状况,还可提高患者的生活质量。近年,由于腹腔镜技术的发展,腹腔镜胃减容术已成为减重手术的首选,每年的手术数量也在急剧增加,适于病态性或重度肥     

腹腔镜可调节捆扎带胃减容术对肥胖症患者营养状态的影响

目的　比较腹腔镜可调节捆扎带胃减容术(laparoscopicadjustablegastricbanding,LAGB)治疗病态肥胖症(morbidobesity ,MO)手术前后的营养状态,评价该手术的安全性。方法　对2 0 0 3年6月至2 0 0 3年11月收治的15例MO患者行LAGB ,监测体重变化。并于术前、术后1、3、6个月测定白蛋白、前白蛋白、转铁蛋白、视黄醇结合蛋白、血浆氨基酸比值、叶酸、VB12 、钙、铁、铜、锌及硒等营养指标,进行统计学分析。结果　术后6个月体重、体重指数、腰围及臀围均明显下降(P <0 .0 1) ,术后1、3、6个月营养指标与术前相比差异无统计学意义(P >0 . 0 5 )。结论　对MO患者行LAGB术后减肥效果良好,LAGB是治疗MO的安全、可行的手术方法,且无营养不良状态发生。     

胃减容术治疗肥胖症

肥胖是全球的高发病之一,它可引起高血压、2型糖尿病、冠心病、脂肪肝、睡眠呼吸暂停综合征等多种并发症,严重影响病人的生存时间和生活质量。饮食控制、体育锻炼、药物等保守治疗对轻度肥胖有效,但对重度肥胖效果不佳,手术是唯一长期有效的治疗方法。笔者结合在减肥手术中的临床实践,对现今流行的胃减容术作一介绍。一、减肥手术的原理及主要术式所有的减肥手术都基于两种不同的原理:减少食物吸收或/和限制食物摄入。1.减少吸收型手术:减少吸收型手术主要通过类似于短肠综合征的吸收不良效果来达到减肥的目的,包括空结肠旁路术、空回肠旁路…     

腹腔镜可调节捆扎带胃减容与袖状胃切除术治疗病态肥胖症对比分析

【摘要】目的 评价腹腔镜可调节捆扎带胃减容术及袖状胃切除术治疗病态肥胖症的效果。方法 2006年3月至2007年7月中国医科大学附属盛京医院对23例肥胖病人施行腹腔镜减肥手术,其中17例施行腹腔镜可调节捆扎带胃减容术（LAGB）,6例施行腹腔镜袖状胃切除术（LSG）,对其疗效进行随访观察。 结果 施行腹腔镜可调节捆扎带胃减容术或袖状胃切除术者均获得12个月以上的随访,术后减重效果理想,无营养不良症状。 结论 袖状胃切除术操作简单、无异物植入体内、并发症少,利于开展此项手术。但两种术式远期疗效仍需深入研究、对比观察。     

Laparoscopic adjustable silicone gastric banding in the treatment of morbid obesity

A first approach to laparoscopic placement of the adjustable silicone gastric band (ASGB) was begun in our institution in 1992. This work started on an animal model first. In the animal lab, details of laparoscopic dissection around the stomach have been defined. A new prototype of the adjustable silicone band for laparoscopic use has been devised. Four voluntary patients underwent this operation on the 1st, 2nd, and 3rd of September 1993. All the patients were female and the average weight was 116 kg (102–120 kg). The mean body mass index was 43 kg/m² (36–49 kg/m²). No major operative difficulty was encountered. Immediate postoperative outcome was uneventful.     

Anesthetic management of laparoscopic adjustable gastric banding in Japanese patients with morbid obesity

Laparoscopic adjustable gastric banding (LAGB) is a common type of bariatric surgery worldwide, though not so in Japan. Here we report the anesthetic management of LAGB in ten Japanese patients with morbid obesity. General anesthesia was induced with propofol, fentanyl, and vecuronium bromide and maintained with sevoflurane in oxygen and air (or nitrous oxide in some cases). In a limited number of patients, perioperative epidural analgesia was performed, with fentanyl injected intravenously for analgesia in the remaining patients. Although some special considerations were needed, in perioperative management, including thromboprophylaxis, there were no severe complications in any of the patients.     

Laparoscopic adjustable gastric banding for the treatment of morbid obesity

BACKGROUND: This prospective study evaluated the effectiveness and safety of laparoscopic adjustable gastric banding (LAGB) for morbid obesity. METHODS: Ninety-five consecutive patients (89 female; median age 38 years, range 19 to 69) underwent LAGB for morbid obesity. Median weight and body mass index were 123.2 (88.9 to 228.6) kg and 45 (32.7-76.4) kg/m(2) respectively. Significant coexistent disease was present in 52 (55%) patients. RESULTS: Median excess weight loss was 53% (range 96.9% to 12.1%) and 62% (range 107.5% to 32.3%) at 1 and 2 years respectively (P <0.001). Median operative time was 90 (range 35 to 285) minutes and inpatient stay 2 (range 1 to 10) days. Early complications were seen in 17 (18%) patients most commonly nausea/vomiting or dysphagia. Late complications were seen in 25 (26.3%) patients, most frequently vomiting or reflux due to band slippage or pouch dilatation. There was 1 (1%) operative death. CONCLUSIONS: LAGB is an effective operation for morbid obesity that results in equivalent weight loss to open surgical procedures.     

Laparoscopic gastric banding for morbid obesity

Background: Morbid obesity occurs in 2–5% of the population of Europe, Australia, and the United States and is becoming more common. Open surgical techniques, such as vertical banded gastroplasty and other divisional procedures in the stomach, have led to long-term weight reduction as well as an amelioration of the attendant medical problems in approximately two-thirds of patients. Materials and methods: A total of 335 patients with a median age of 41 years underwent gastric banding. We emphasized the need for long-term maintenance and follow-up. The indications for surgery comprised a body mass index >35, a stated desire to undergo the procedure, and a full understanding of all possible complications. Results: All patients have needed band adjustments of 1–4 ml over the course of their follow-up. No patient had increased his or her weight during the follow-up, and only three patients have not enjoyed sustained weight loss. Conclusions: Laparoscopic gastric banding has much to recommend it. Certainly in the short term, its results in terms of effectiveness of weight loss are at least as good as those of any open procedure. Longer follow-up will show whether this weight loss is maintainable. The procedure is technically demanding, and the major prerequisite of satisfactory performance of this surgery is laparoscopic experience. Received: 12 May 1998/Accepted: 12 February 1999     

Laparoscopic gastric banding for morbid obesity: outpatient procedure versus overnight stay

Background In western countries, laparoscopic gastric banding is increasingly used in the surgical treatment of morbid obesity. This study aimed to investigate the feasibility, safety, morbidity, and costs of an outpatient procedure (OP) compared with an overnight stay (OS). Methods In a 2-year period, 50 consecutive patients were randomized to an OP group or an OS group. Results In the OP group, 76% of the patients were successfully discharged the same day, without readmissions. Four procedures were converted, and one complication occurred. The patients in the OP group seemed to experience more pain (p = 0.009). Satisfaction scores were 8.1 (OP) and 8.8 (OS) (p = 0.06). Half of the OP patients and most of the OS patients preferred a clinical admission. The OP treatment cost 600 euros less than OS. Conclusion With proper patient selection, laparoscopic gastric banding can be performed safely and at lower cost as an outpatient procedure.     

Laparoscopic adjustable gastric banding for the treatment of adolescent morbid obesity in the United States: a safe alternative to gastric bypass

Background

Morbid obesity (MO) has reached epidemic proportions and is a major health problem in developed nations. In the adolescent with MO, early intervention can minimize obesity-related comorbidities, avoid premature mortality, improve quality of life, and prevent obesity-related diseases as these patients mature into adulthood. The primary surgical treatment of adolescent patients meeting National Institutes of Health criteria for bariatric surgery has been the gastric bypass (GB). Although GB has led to weight loss and improvement of comorbid conditions, concerns remain over the high incidence of postoperative complications and life-style-altering long-term sequelae of gastrointestinal tract reconstruction. Based on the excellent results from international adult series as well as the authors' own experience of more than 300 adult patients, laparoscopic adjustable gastric banding (LAGB) as an alternative to GB to eligible adolescents was offered.

Methods

After medical, psychologic, and nutritional screening, 4 patients (ages 17-19 years) with a body mass index of 40 or more (range, 40-61) who failed medical attempts at weight loss were selected for LAGB.

Results

The operative time was 40 to 90 minutes. All patients were discharged on the day of surgery. There were no early complications. One patient had cholecystitis 6 months after surgery requiring laparoscopic cholecystectomy. For the 4 patients, the amount of excess weight loss was 57% at 30 months, 34% at 12 months, 87% at 7 months, and 15% at 4 months, respectively.

Conclusions

In this preliminary series of the US experience in the use of LAGB for the management of adolescents with MO, the lack of operative morbidity, short operative time/hospital stay, and encouraging initial weight loss mirror the adult experience and illustrate that the LAGB is a safe and effective alternative to GB. These encouraging results support further evaluation of LAGB as a surgical option in a comprehensive adolescent weight loss program.     

Safety and feasibility of revisional laparoscopic surgery for morbid obesity: conversion of open silastic vertical banded gastroplasty to laparoscopic adjustable gastric banding

Background: Since the 1980s, bypass operations have been largely replaced by gastric restrictive operations. One of the most commonly performed operations for gastric restriction is vertical banded gastroplasty (VBG). However, the results are often disappointing. Adjustable gastric banding (AGB) is a viable alternative to VBG, and the ability to perform this surgery laparoscopically makes it an attractive option for patients in need of revisional surgery. It allows for refashioning of the gastric pouch in patients with a dilation of the pouch or disruption of the staple line. Methods: A total of 48 patients were referred to our center due to post-VBG weight gain. All patients underwent preoperative evaluation to determine the cause for failure of the operation. All patients found suitable for revisional surgery underwent laparoscopic placement of an adjustable band. Results: All but one of the operations were completed laparoscopically; one patient required conversion to open surgery prior to band placement via laparoscopy. This patient needed a blood transfusion. Postoperative band erosion occurred in one patient; laparoscopy surgery was used successfully for removal of the band and suturing of the stomach. Conclusions: Our short-term results indicate that revisional operation for morbid obesity using laparoscopic AGB is a safe procedure when performed cautiously. It enables early patient mobilization and discharge with good functional results and fewer perioperative complications.     

Treating morbid obesity with laparoscopic adjustable gastric banding

BACKGROUND: Morbid obesity results in multiple comorbidities and an increased mortality rate. The National Institutes of Health has stated that surgery is the most effective long-term therapy; therefore, we evaluated a laparoscopically implantable adjustable gastric band. METHODS: We reviewed 2 multicenter prospective, open-label, single-arm surgical trials--trial A (3 years) and trial B (1 year)--with ongoing safety follow-up. These trials were conducted in United States community and university hospitals (trial A = 8 sites and trial B = 12 sites). Trial A comprised 292 subjects (mean +/- SD preoperative weight: 133 kg +/- 24.4), and trial B comprised 193 subjects (129 kg +/- 20.8). Intervention included placement of a constrictive, adjustable band around the upper stomach to limit food intake and induce weight loss. Main outcome measures were the primary efficacy end point of weight loss. Secondary end-points were change in quality-of-life, safety parameters, and complications, including band slippage, reoperation, and device explantation. RESULTS: In the 2 trials, 485 devices were implanted (92% laparoscopically), and no deaths occurred. Of the patients in trial A, 206 (70.5%) completed the 3-year follow-up, and 142 (73.6%) of patients in trial B completed the 1-year follow-up. Weight-loss results, using the last value carried forward, for all 292 patients in trial A and all 193 patients in trial B demonstrated a change in mean body mass index (kg/m2) +/- SD from 47.4 +/- 7.0 to 39.0 +/- 7.3 in trial A and from 46.7 +/- 7.8 to 38.4 +/- 7.6 in trial B subjects at 1 year (P < .001 for both trials A and B), with minimal further change at 3 years (39.0 +/- 8.5) in trial A subjects. The percentage of initial body weight lost at 1 year was 17.7% +/- 9.4% for trial A subjects and 18.2% +/- 8.9% for trial B subjects, whereas the 3-year total for trial A subjects was 18.3% +/- 13.1%. At 1 year, 76% of patients in trial A and 66% of patients in trial B had complications, mostly related to upper gastrointestinal symptoms. By 9 years after surgery, 33% (96 of 292) of trial A subjects had their devices explanted because of complications or inadequate weight loss. CONCLUSIONS: These first-generation implantable adjustable gastric band results suggest that this is a viable bariatric surgery therapeutic option for the treatment of obesity.     

Esophageal dilation after laparoscopic adjustable gastric banding

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

Laparoscopic sleeve gastrectomy versus laparoscopic adjustable gastric banding for the treatment severe obesity in high risk patients

Background:

Laparoscopic sleeve gastrectomy (LSG) has emerged as an alternative restrictive bariatric procedure to the most popular laparoscopic adjustable gastric banding (LAGB). We analyze and compare the clinical and weight loss outcomes of LSG versus LAGB for the treatment of severe obesity in high-risk patients.

Methods:

Forty severely obese veterans (20/group) received either LSG or LAGB and were followed prospectively for 2 years. Outcome measures included operating room (OR) time, estimated blood loss (EBL), length of hospital stay (LOS), morbidity, mortality, reoperations, readmission rates, and weight loss over time.

Results:

The cohort primarily comprised high-risk and older male veterans. Patient''s baseline demographics were similar between groups. LSG was associated with prolonged OR time (116±31 vs. 94±28min), higher EBL (34±28 vs. 17±19mL), and LOS (2±.9 vs. 1±.4days) when compared with LAGB. Minor morbidity and readmissions were similar between groups, while no major morbidity, reoperations, or mortality occurred. Total weight and BMI decreased significantly after surgery in both groups (LSG: 302±52 to 237lbs and 45±5 to 36±5kg/m² vs. LAGB: 280±36 to 231±29lbs and 43±5 to 36±5kg/m², respectively). Total weight loss was superior in the LSG vs. LAGB group at 2 years (TWL=65±24 vs. 49±28 lbs (P=.03); %EWL=51±20 vs. 46±23%; %EBMI loss=48±22 vs. 45±23%, and %BWL = 21±8 vs. 17±9%, respectively).

Conclusion:

In severely obese and high-risk patients, laparoscopic sleeve gastrectomy provides superior total weight loss at 2 years.