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首页> 外文期刊>Surgical Endoscopy >Video. When sleeve gastrectomy fails: adding a laparoscopic adjustable gastric band to increase restriction.
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Video. When sleeve gastrectomy fails: adding a laparoscopic adjustable gastric band to increase restriction.

机译：视频。当套管胃切除术失败时：增加腹腔镜可调节胃带以增加限制。

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The use of laparoscopic sleeve gastrectomy (LSG) as a procedure for morbid obesity has recently increased. The LSG procedure is used most often as a part of a biliopancreatic diversion with duodenal switch (BPDDS) or as a first stage that can be converted to a BPDDS or Roux-en-Y gastric bypass (RYGB). However, the surgical indications for LSG have rapidly expanded, and some centers use the sleeve as the primary operation for morbid obesity.The utility of LSG as a primary procedure is controversial, with consensus lacking in the literature. Whether the etiology of failed sufficient weight loss is the result of an inadequate sleeve or attributable to dilation or hypertrophy of the sleeve, the incidence of failed sleeve gastrectomies may be significant.In the treatment of a patient with a failed LSG, the options typically include creation of a tighter sleeve or conversion to biliopancreatic diversion or RYGB. These procedures, however, are complex and can carry significant morbidity.The authors report a case of a morbidly obese 42-year-old man who failed to lose sufficient weight after an LSG. Because the patient was dependent on several oral antipsychotic medications, he refused any malabsorptive procedure, and a decision was made to proceed with laparoscopic adjustable gastric banding (LAGB). The case proceeded successfully, and at this writing, 9 months after surgery, the patient has achieved a 57% excess weight loss from an original weight of 390 lb.The insertion of an LAGB into its normal anatomic position is feasible after a sleeve gastrectomy, and its use can induce sufficient restriction and weight loss results equivalent to those of a sleeve or band alone and possibly better.
机译：近年来，腹腔镜袖胃切除术（LSG）作为病态肥胖的治疗方法已得到增加。 LSG手术最常用作伴十二指肠开关的胆胰转移术的一部分（BPDDS）或可转换为BPDDS或Roux-en-Y胃旁路手术（RYGB）的第一阶段。然而，LSG的手术适应症迅速扩大，一些中心将袖套作为病态肥胖的主要手术方法。LSG作为主要手术方法的实用性尚有争议，文献上缺乏共识。体重减轻失败的病因是由于套管不足或由套管扩张或肥大引起的，套管胃切除术失败的发生率可能很大。在治疗LSG失败的患者时，通常选择包括建立更紧的袖子或转化为胆胰转移或RYGB。然而，这些程序很复杂，可能会带来很高的发病率。作者报告了一例病态肥胖的42岁男性，该患者在LSG后未能减轻体重。由于该患者依赖于几种口服抗精神病药物，因此他拒绝了任何吸收不良的程序，并决定继续进行腹腔镜可调胃绑扎术（LAGB）。该病例成功进行，在撰写本文时，手术后9个月，患者的体重减轻了390磅，原始体重390磅增加了57％。在进行袖胃切除术后，将LAGB插入其正常解剖位置是可行的，并且它的使用可以引起足够的限制，并且减肥效果等同于单独使用袖子或绑带的效果，并且可能更好。

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