Long-term Outcomes of Laparoscopic Adjustable Gastric Banding
Long-term Outcomes of Laparoscopic Adjustable Gastric Banding
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DOI：
10.1001/archsurg.2011.45
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发表时间：
2011-07-01
影响因子：
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通讯作者：
Dapri, Giovanni
中科院分区：
文献类型：
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作者：
Himpens, Jacques;Cadiere, Guy-Bernard;Dapri, Giovanni
目的：确定腹腔镜可调节胃束带术 (LAGB) 治疗病态肥胖的长期疗效和安全性。设计：2009 年在外科医生办公室进行临床评估（LAGB 后 12 年以上）。地点：比利时布鲁塞尔大学肥胖中心。患者：1994 年 1 月 1 日至 12 月 31 日期间，共有 151 名连续受益于 LAGB 的患者， 1997 年，联系进行评估。干预：腹腔镜可调节胃束带术。主要结果指标：死亡率、主要和次要并发症的数量、矫正手术的数量、体重减轻的患者数量、合并症的进展、患者满意度和生活质量。结果：患者的中位年龄为 50 岁（范围：28-73 岁）。手术死亡率为零。总体而言，随访率为 54.3%（151 名患者中的 82 名）。无关原因导致的长期死亡率为3.7%。 22% 的患者出现轻微并发症，39% 出现严重并发症（28% 出现带状糜烂）。 17% 的患者将手术改为腹腔镜 Roux-en-Y 胃绕道手术。总体而言，（意向治疗）平均（SD）超额体重减轻为 42.8% (33.92%)（范围为 24%-143%）。 36 名患者 (51.4%) 仍然佩戴着束带，平均超重减轻率为 48%（范围为 38%-58%）。总体而言，60.3%的患者满意度指数良好。生活质量评分（使用减肥分析和报告结果系统）为中性。结论：根据对 54.3% 患者的随访，LAGB 似乎在 12 年或更长时间后导致平均超重减轻 42.8%。 78 名患者中，47 名（60.3%）感到满意，生活质量指数为中性。然而，由于近三分之一的患者经历了带子侵蚀，并且近 50% 的患者需要去除带子（导致再手术率达到 60%），因此 LAGB 似乎会导致相对较差的长期结果。
Objective: To determine the long-term efficacy and safety of laparoscopic adjustable gastric banding (LAGB) for morbid obesity.Design: Clinical assessment in the surgeon's office in 2009 (>= 12 years after LAGB).Setting: University obesity center in Brussels, Belgium.Patients: A total of 151 consecutive patients who had benefited from LAGB between January 1, 1994, and December 31, 1997, were contacted for evaluation.Intervention: Laparoscopic adjustable gastric banding.Main Outcome Measures: Mortality rate, number of major and minor complications, number of corrective operations, number of patients who experienced weight loss, evolution of comorbidities, patient satisfaction, and quality of life were evaluated.Results: The median age of patients was 50 years (range, 28-73 years). The operative mortality rate was zero. Overall, the rate of follow-up was 54.3% (82 of 151 patients). The long-term mortality rate from unrelated causes was 3.7%. Twenty-two percent of patients experienced minor complications, and 39% experienced major complications (28% experienced band erosion). Seventeen percent of patients had their procedure switched to laparoscopic Roux-en-Y gastric bypass. Overall, the (intention-to-treat) mean (SD) excess weight loss was 42.8% (33.92%) (range, 24%-143%). Thirty-six patients (51.4%) still had their band, and their mean excess weight loss was 48% (range, 38%-58%). Overall, the satisfaction index was good for 60.3% of patients. The quality-of-life score (using the Bariatric Analysis and Reporting Outcome System) was neutral.Conclusion: Based on a follow-up of 54.3% of patients, LAGB appears to result in a mean excess weight loss of 42.8% after 12 years or longer. Of 78 patients, 47 (60.3%) were satisfied, and the quality-of-life index was neutral. However, because nearly 1 out of 3 patients experienced band erosion, and nearly 50% of the patients required removal of their bands (contributing to a reoperation rate of 60%), LAGB appears to result in relatively poor long-term outcomes.