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Role of a minimally invasive approach in the management of laparoscopic adjustable gastric banding postoperative complications

机译：微创治疗在腹腔镜可调式胃绑带术后并发症处理中的作用

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Hypothesis: Complications after laparoscopic adjustable gastric banding as treatment for morbid obesity may require a major reintervention. A minimally invasive approach represents an attractive management alternative for such complications. Design: Prospective case series. Setting: Major academic medical and surgical center Patients: From January 1996 to July 2003, 47 patients who had undergone laparoscopic adjustable gastric banding were operated on again. Considering the causes for reoperation, the patients were divided into 4 groups: group A had major complications (n = 26); group B, minor complications (n = 11); group C, psychological problems (n = 6); and group D, insufficient weight loss (n = 4). Interventions: Forty-three procedures, 38 using general anesthesia (groups A, C, and D) and 5 using local anesthesia (group B), were performed. Main Outcome Measures: Feasibility, safety, and effectiveness of a minimally invasive approach in the treatment of laparoscopic adjustable gastric banding complications. Results: In group A, 9 of 10 patients with irreversible gastric pouch dilatation and 15 of 16 with intragastric band migrations were treated laparoscopically. In group B, 5 ports were substituted and 2 reconnections of the catheter-port system were performed. In group C, 6 laparoscopic band removals were carried out. In group D, 4 laparoscopic revision procedures for insufficient weight loss were performed. The operative mortality was nil. The most frequent cause of reoperation was intragastric migration (37.2%). A minimally invasive approach was adopted in 94.7% of cases. Conclusion: Laparoscopy is safe and effective, even as a second operative procedure.
机译：假设：腹腔镜可调节胃束带作为病态肥胖的治疗后的并发症可能需要再次介入。微创方法代表了这种并发症的一种有吸引力的治疗选择。设计：预期案例系列。地点：主要的​​学术医学和外科中心患者：从1996年1月至2003年7月，再次对47例接受了腹腔镜可调式胃绑带的患者进行了手术。考虑到再次手术的原因，将患者分为4组：A组有严重并发症（n = 26）； A组有严重并发症。 B组，轻度并发症（n = 11）； C组，心理问题（n = 6）； D组，体重减轻不足（n = 4）。干预：进行四十三次手术，其中38例使用全身麻醉（A，C和D组），而5例使用局部麻醉（B组）。主要结果指标：微创方法在腹腔镜可调式胃绑带并发症治疗中的可行性，安全性和有效性。结果：在A组中，对10例不可逆性胃囊扩张患者中的9例和16例胃内带迁移的患者中的15例进行了腹腔镜治疗。在B组中，替换了5个端口，并进行了导管端口系统的2次重新连接。在C组中，进行了6次腹腔镜带切除术。在D组中，进行了4次减肥不足的腹腔镜翻修手术。手术死亡率为零。再次手术的最常见原因是胃内迁移（37.2％）。 94.7％的病例采用了微创方法。结论：腹腔镜检查是安全有效的，即使是第二次手术。

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