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首页> 外文期刊>Surgical Endoscopy >Intragastric gastric band migration: Erosion: An analysis of multicenter experience on 177 patients
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Intragastric gastric band migration: Erosion: An analysis of multicenter experience on 177 patients

机译：胃内胃带迁移：侵蚀：177例患者的多中心经验分析

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摘要

Background: Laparoscopic adjustable gastric banding (LAGB) has proven to be a safe and effective surgical treatment for morbid obesity. It can be a simple, fast, reversible, anatomy-preserving procedure. Despite these advantages, its long-term efficacy came into question by the occurrence of complications such as intragastric band migration. Consistent information regarding this complication is still lacking. Treatment for migration is still being debated as well. Most of the inconsistencies of these data stem from the very low number of patients reported in single-center experiences or case reports. Lack of multicenter experience is evident. The aim of this study was to perform a retrospective analysis of data on intragastric migration in a large multicenter cohort of patients who underwent LAGB. Methods: A retrospective multicenter study on LAGB patients was performed. Data had been entered into a prospective database of the Italian Group for LapBand? (GILB) since January 1997. Pars flaccida and perigastric positioning were considered along with different kinds of gastric bands by the same manufacturer. Time of diagnosis, mean body mass index (BMI), presentation symptoms, and conservative and surgical therapy of intragastric migration were considered. Results: From January 1997 to December 2009, a total of 6,839 patients underwent LAGB and their data were recorded [5,660 females, 1,179 males; mean age 38.5 ± 18.2 years (range 21-62 years); mean BMI = 46.7 ± 7.7 kg/m2 (range 37.3-68.3); excess weight (EW) 61.8 ± 25.4 kg (range 36-130); %EW 91.1 ± 32.4 % (range 21-112 %)]. A total of 177 of 6,839 (2.5 %) intragastric erosions were observed. According to the postoperative time of follow-up, the diagnosis of intragastric migration was made in 74 (41.8 %), 14 (7.9 %), 38 (21.4 %), 40 (22.6 %), 6 (3.4 %), and 4 (2.2 %) banded patients at 6-12, 24, 36, 48, 60, and 72 months after banding, respectively. Most of intragastric band migration during the first 2 years occurred in bands with no or a few milliliters of filling. In patients with late erosion, the bands were adjusted several times; no band was overfilled but one was filled to the maximum or submaximum with a maximum of two adjustments. Erosions diagnosed during the first 24 months were related to the experience of the surgical staff, while late erosions were not. Conclusions: Intragastric band migration or band erosion is a rare, disturbing, and usually not life-threatening complication of gastric banding. Its pathogenesis is probably linked to different mechanisms in early (technical failure in retrogastric passage) or late (band management) presentation. It is usually asymptomatic and there is no pathognomonic presentation. A wide range of therapeutic options are available, from simple endoscopic or laparoscopic removal to early or late band replacement or other bariatric procedure. More experience and more studies are needed to lower its presentation rate and definitively clarify its pathogenesis to address the right therapeutic option.
机译：背景：腹腔镜可调胃绑带（LAGB）已被证明是一种用于病态肥胖的安全有效的手术治疗方法。它可以是一个简单，快速，可逆的，保留解剖结构的过程。尽管具有这些优点，但其长期疗效因出现诸如胃内带迁移等并发症而受到质疑。仍然缺乏有关这种并发症的一致信息。移徙的待遇也仍在辩论中。这些数据的大部分不一致之处是由于单中心经验或病例报告中报告的患者人数很少。缺乏多中心经验是显而易见的。这项研究的目的是对大型多中心接受LAGB治疗的患者的胃内迁移数据进行回顾性分析。方法：对LAGB患者进行了一项回顾性多中心研究。数据已输入到意大利LapBand集团的预期数据库中？ （GILB）自1997年1月以来。同一家制造商考虑了pars flaccida和胃周定位以及不同种类的胃束带。诊断时间，平均体重指数（BMI），表现症状以及胃内迁移的保守治疗和外科治疗均应考虑。结果：从1997年1月到2009年12月，总共进行了6839例LAGB患者，并记录了他们的数据[5660例女性，1179例男性;平均年龄38.5±18.2岁（范围21-62岁）;平均BMI = 46.7±7.7 kg / m2（范围37.3-68.3）;超重（EW）61.8±25.4千克（范围36-130）; ％EW 91.1±32.4％（范围21-112％）]。共观察到177例胃内糜烂，占6,839例（占2.5％）。根据术后随访时间，诊断为胃内移行的有74例（41.8％），14例（7.9％），38例（21.4％），40例（22.6％），6例（3.4％）和4例。 （2.2％）分别在绑扎后6-12、24、36、48、60和72个月对患者进行绑扎。在最初的2年中，大多数胃内带迁移发生在没有或几毫升充盈的带中。在晚期糜烂患者中，调整带数次。没有任何频段被过度填充，但是一个频段被填充到最大或次最大值，最多进行了两次调整。在头24个月内诊断出的糜烂与手术人员的经历有关，而晚期糜烂则无关。结论：胃内束带迁移或束带侵蚀是一种罕见，令人不安且通常不危及生命的胃束带并发症。其发病机制可能与早期（胃后通道的技术衰竭）或晚期（频带管理）表现的不同机制有关。它通常是无症状的，没有病理症状表现。从简单的内窥镜或腹腔镜切除术到早期或晚期的带更换或其他减肥手术，治疗方法多种多样。需要更多的经验和更多的研究来降低其出现率，并明确其发病机理，以解决正确的治疗选择。

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