A prospective randomized trial of placement of the laparoscopic adjustable gastric band: Comparison of the perigastric and pars flaccida pathways
A prospective randomized trial of placement of the laparoscopic adjustable gastric band: Comparison of the perigastric and pars flaccida pathways
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DOI：
10.1381/0960892054222858
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发表时间：
2005-06-01
期刊：
影响因子：
2.9
通讯作者：
Anderson, M
中科院分区：
文献类型：
--
作者：
O'Brien, PE;Dixon, JB;Anderson, M
背景：腹腔镜可调节胃束带术（LAGB）是治疗肥胖症安全有效的方法。LAGB后最常见的问题是胃通过带脱垂（滑动）的发生。已经提出，与传统的胃周（PG）路径（胃小弯和小网膜之间的解剖，穿过小囊顶点，到达His角）相比，松弛部（PF）路径（从右胃底，沿着左胃至His角的解剖）与脱垂相关的可能性较小。我们已经测试了这一假设，使用随机对照试验formation.Methods：我们已经进行了一项随机对照试验，比较LAGB使用PF和PG途径后的结果。202例患者（平均年龄40岁，平均体重123公斤，平均BMI 45）被随机分配到PF或PG途径，并遵循了2 years.Results：在24个月，有16个修订程序脱垂，4 PF组（所有前脱垂）和15 PG组（12后方和3前方）。差异有显著性（P < 0.001）。PF组和PG组的平均体重减轻百分比分别为53%和46%。两组代谢综合征的改善同样显著（术前59%，2年时19%）。SF-36生活质量测量的所有8个配对领域评分在两组中均显著改善（P < 0.001）。结论：PF途径在产生实质性体重减轻、改善健康和改善生活质量方面与PG途径一样有效，并且与脱垂（滑脱）相关的可能性显著降低。建议将其作为主要夹层通道。
Background: Laparoscopic adjustable gastric banding (LAGB) is a safe and effective method for the treatment of obesity. The most common problem after LAGB has been the occurrence of prolapse (slippage) of the stomach through the band. It has been proposed that the pars flaccida (PF) pathway (dissection from the base of the right crus, along the left crus to the angle of His) is less likely to be associated with prolapse than the traditional perigastric (PG) pathway (dissection between the lesser curvature of stomach and lesser omentum, across the apex of the lesser sac, to the angle of His). We have tested this hypothesis using a randomized controlled trial format.Methods: We have performed a randomized controlled trial to compare the outcomes after LAGB using PF and PG pathways. 202 patients (mean age 40 years, mean weight 123 kg, mean BMI 45) were randomly allocated to the PF or PG pathway and followed for 2 years.Results: At 24 months, there have been 16 revisional procedures for prolapse, 4 in the PF group (all anterior prolapse) and 15 in the PG group (12 posterior and 3 anterior). This difference is significant (P < 0.001). The mean % excess weight lost was 53% for the PF group and 46% for the PG group. There was equally significant improvements in the metabolic syndrome in both groups (59% preoperatively and 19% at 2 years). All 8 paired domain scores of the SF-36 measures of quality of life were improved significantly in both group (P < 0.001).Conclusions: The PF pathway is as effective as the PG pathway in generating substantial weight loss, improved health and improved quality of life and is significantly less likely to be associated with prolapse (slippage). It is recommended as the primary dissection pathway.