Esophageal Dysmotility Disorders After Laparoscopic Gastric Banding-An Underestimated Complication
Esophageal Dysmotility Disorders After Laparoscopic Gastric Banding-An Underestimated Complication
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DOI：
10.1097/sla.0b013e318206843e
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发表时间：
2011-02-01
影响因子：
9
通讯作者：
Wagner, Hans E.
中科院分区：
文献类型：
--
作者：
Naef, Markus;Mouton, Wolfgang G.;Wagner, Hans E.
目的：根据12年的经验，评价腹腔镜可调节胃束带术（LAGB）对食管功能障碍的长期影响。背景：LAGB后食管动力障碍和扩张已被报道。然而，只有少数研究目前长期随访data.Methods：1998年6月至2009年6月，所有患者植入的LAGB被纳入前瞻性临床试验，包括每年钡吞咽。在此期间记录食管动力障碍并进行分类。35 mm或更大的食管直径被认为是dilated.Results：腹腔镜可调胃束带术在167例（120名女性和47名男性），平均年龄为40.1 +/- 5.2岁。总体患者随访率为94%。在108例患者中发现食管动力障碍（68.8%的随访患者）。食管扩张40例（25.5%），平均食管直径为47.3 ± 6.9 mm随访73.8 ± 6.8个月（36-120）后，（35.0-94.6）与26.2 ± 2.8 mm相比无扩张（直径<35 mm）组（18.3-34.2）P < 0.01。34名患者患有III期扩张（需要进行带放气），6名患者患有IV期扩张（严重失弛缓症样扩张，必须取出带）。在29例患者中，由于胃灼热/吞咽困难进行了上消化道内镜检查。在18例患者中，内窥镜检查正常; 9例患者患有胃食管反流病，1例狭窄，1例食管裂孔hernias.Conclusions：本研究表明，食管动力障碍LAGB后是常见的，不太赞赏的并发症。尽管有足够的过度体重减轻，LAGB可能不应被视为首选手术，仅应在选定的病例中进行，直到制定出手术长期并发症风险低的患者的可靠标准。
Objective: To evaluate the effects of laparoscopic adjustable gastric banding (LAGB) on esophageal dysfunction over the long term in a prospective study, based on a 12-year experience.Background: Esophageal motility disorders and dilatation after LAGB have been reported. However, only a few studies present long-term follow-up data.Methods: Between June 1998 and June 2009, all patients with implantation of a LAGB were enrolled in a prospective clinical trial including a yearly barium swallow. Esophageal motility disorders were recorded and classified over the period. An esophageal diameter of 35 mm or greater was considered dilated.Results: Laparoscopic adjustable gastric banding was performed in 167 patients (120 females and 47 males) with a mean age of 40.1 +/- 5.2 years. Overall patient follow-up was 94%. Esophageal dysmotility disorders were found in 108 patients (68.8% of patients followed). Esophageal dilatation occurred in 40 patients (25.5%) with a mean esophageal diameter of 47.3 +/- 6.9 mm(35.0-94.6) after a follow-up of 73.8 +/- 6.8 months (36-120) compared with 26.2 +/- 2.8 mm (18.3-34.2) in patients without dilatation (diameter of < 35mm) (P < 0.01). Thirty-four patients suffered from stage III dilatation (band deflation necessary) and 6 from stage IV (major achalasia-like dilatation, band removal mandatory). In 29 patients, upper endoscopy was carried out because of heartburn/dysphagia. In 18 patients, the endoscopy was normal; 9 patients suffered from gastroesophageal reflux disease, 1 from a stenosis, and 1 from a hiatus hernia.Conclusions: This study demonstrates that esophageal motility disorders after LAGB are frequent, poorly appreciated complications. Despite adequate excess weight loss, LAGB should probably not be considered the procedure of first choice and should be performed only in selected cases until reliable criteria for patients with a low risk for the procedures long-term-complications are developed.