An update on 73 US obese pediatric patients treated with laparoscopic adjustable gastric banding: comorbidity resolution and compliance data
An update on 73 US obese pediatric patients treated with laparoscopic adjustable gastric banding: comorbidity resolution and compliance data
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DOI：
10.1016/j.jpedsurg.2007.09.035
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发表时间：
2008-01-01
影响因子：
2.4
通讯作者：
Fielding, George A.
中科院分区：
文献类型：
--
作者：
Nadler, Evan P.;Youn, Heekoung A.;Fielding, George A.
背景：青少年肥胖仍然是儿科和成人医学界面临的最困难和最重要的挑战之一。越来越多的证据表明，减肥手术是实质性和可持续减肥的唯一可靠方法；然而，关于青少年和成年人的最佳手术程序的争论仍在继续。虽然大多数美国成人减肥外科医生更喜欢胃旁路手术，但我们的机构已经证明，在成人和青少年中使用腹腔镜可调胃束带(LAGB)可以获得同等的体重减轻和显著较低的发病率。这项分析是对我们最初73名患者结果的更新，包括合并症和依从性数据的解决。方法：自2001年9月以来，所有在我所接受LAGB治疗的13至17岁青少年都被录入我们前瞻性收集的数据库，并进行了回顾。术前收集的数据包括年龄、性别、种族、体重指数(BMI)和是否存在合并症。术后记录的数据包括住院时间、手术并发症、需要再次手术、超重减重百分比(%EWL)、每隔3个月体重指数(BMI)、合并症状况、术后就诊次数和腰带调整次数。结果：自2001年9月以来，73名13~17岁(平均15.8+/-1.2岁)的青少年接受了LAGB。其中54人为女性，19人为男性。术前平均体重298磅，体重指数48 kg/m(2)。术后6个月、1年和2年的EWL分别为35%+/-16%、57%+/-23%和61%+/-27%。1例因滑脱再次手术后发生胃穿孔。另有一名患者因滑脱后的限制不耐受而要求摘除带子。共有6例患者出现带状滑脱，3例患者出现症状性裂孔疝气。营养并发症包括13例无症状铁缺乏，4例无症状维生素D缺乏，14例轻度主观脱发。在进入我们的食品和药物管理局批准的研究并获得一年随访的21名患者中，有51名患者被确认为合并疾病。其中完全缓解35例(68.5%)，好转9例(17.5%)，不变5例(10%)，1年后加重2例(4%)。在一年多前接受手术的50名初始患者中，有2名患者居住在离我们机构很远的地方，在那里正在进行带状结构的维护，因此，这些患者被排除在分析之外。两名患者在第一年失访，3名患者在第二年失访，总体依从率至少为89.5%。第一年的平均就诊次数为10+/-3次，平均调整次数为6+/-2次。结论：对于病态肥胖的儿童患者，腹腔镜可调胃束带术仍然是一种有吸引力的治疗策略，术后1年和2年的EWL均大于55%，与胃旁路手术相比，并发症较少。此外，与LAGB相关的体重减轻提供了极好的分辨率或改善了共病条件。尽管患者有必要的承诺，包括频繁的办公室探视和波段调整，但青少年完全有能力做出这一承诺，不遵守规定不应成为劝阻青少年进行LAGB的理由。在我们看来，它仍然是患有病态肥胖症的儿童患者的最佳手术选择。(C)2008 Elsevier Inc.保留所有权利。
Background: Adolescent obesity continues to present one of the most difficult and important challenges for both the pediatric and adult medical communities. Evidence is mounting that bariatric surgery is the only reliable method for substantial and sustainable weight loss; however, the debate continues with regard to the optimal surgical procedure for both adolescents and adults. Although most US adult bariatric surgeons prefer the gastric bypass, our institution has demonstrated equivalent weight loss with significantly less morbidity using laparoscopic adjustable gastric banding (LAGB) in both adults and adolescents. This analysis is an update of our results in our first 73 patients, including resolution of comorbid conditions and compliance data.Methods: All adolescents aged 13 to 17 years who have undergone LAGB at our institution have been entered into our prospectively collected database since September 2001 and were reviewed. Data collected preoperatively included age, sex, race, body mass index (BMI), and presence of comorbid conditions. Postoperatively recorded data included length of stay, operative morbidity, need for reoperation, percentage of excess weight loss (%EWL), and BMI at 3-month intervals; status of any comorbid conditions, and number of postoperative visits and band adjustments.Results: Seventy-three adolescents aged 13 to 17 years (mean, 15.8 +/- 1.2 years) have undergone LAGB at our institution since September, 2001. Of these, 54 were female and 19 were male. The mean preoperative weight was 298 lb, with a BMI of 48 kg/m(2). The %EWL at 6 months, 1 year, and 2 years postoperatively was 35% +/- 16%, 57% +/- 23%, and 61% +/- 27%, respectively. One patient experienced a gastric perforation after a reoperation for band replacement because of a slip. One additional patient requested band removal because of restriction intolerance after a slip. A total of 6 patients developed band slippage, and 3 patients developed symptomatic hiatal hernias. Nutritional complications included asymptomatic iron deficiency in 13 patients, asymptomatic vitamin D deficiency in 4 patients, and mild subjective hair loss in 14 patients. In 21 patients who entered our Food and Drug Administration-approved study and had reached 1-year follow-up, there were 51 identified comorbid conditions. Of these, 35 (68.5%) were completely resolved, 9 (17.5%) were improved, 5 (10%) were unchanged, and 2 (4%) were aggravated after 1 year. Of 50 initial patients who underwent surgery more than 1 year ago, 2 patients lived a large distance from our institution, where band maintenance is being performed locally, and thus, the patients were excluded from the analysis. Two patients were lost to follow-up in the first year, and 3 patients were lost to follow-up in the second year, for an overall compliance rate of at least 89.5%. The mean number of office visits was 10 +/- 3 in the first year, and the mean number of adjustments was 6 +/- 2.Conclusions: Laparoscopic adjustable gastric banding continues to represent an attractive treatment strategy for morbidly obese pediatric patients with a %EWL of more than 55% at both 1- and 2-year follow-up, with minimal morbidity compared with the gastric bypass. Furthermore, the weight loss associated with LAGB provides excellent resolution or improvement of comorbid conditions. Although there is a necessary commitment by the patient that involves frequent office visits and band adjustments, adolescents are entirely capable of this commitment, and noncompliance should not be a reason to dissuade adolescents from having LAGB. It remains, in our opinion, the optimal surgical option for pediatric patients with morbid obesity. (C) 2008 Elsevier Inc. All rights reserved.