The Clinical Analysis Of Laparoscopic Adjustable Gastric Banding For Morbid Obesity

Objectives(1)To introduce the surgical technique of laparoscoopic adjustable gastric banding(LAGB). (2)To study the efficacy of LAGB for morbid obesity. (3)To compare the nutritional status and immunity of morbid obesity(MO) before and after laparoscopic adjustable gastric banding (LAGB). And the safety of LAGB are discussed.MethodsThe 15 patients included 6 males and 9 females. The mean age was 27.7 years (range,14 39). The mean height was 165.9cm (range, 150 174.5). The mean weight was 98.7kg (range, 88 122.5). The mean body mass index (BMI) was 35.8kg/m²(range, 28.68 42.67). The patients had been suffered from obesity for 4 12 years, 14 cases of which combined with complications such as hypertention, diabetes mellitus, arthritis and so on. All the patients were treated by LAGB from Jun. 2003 to Oct. 2003 in our department. 1 month after the surgery, we began to adjust the band through injecting water into the port to keep the weight stable losing. Meanwhile, the patients' nutritional (serum Alb, PreAlb, TFN, RBP, SAAR, folacin, VB₁₂, calcium, iron, cuprum, zinc and selenium) and immune(TCL, CD₃⁺, CD₄⁺, CD₈⁺, CD₄⁺/CD₈⁺, NKC and serum IL-2, IL-6 level) parameters were determined before and 1, 3 and 6 months postoperatively. 15 cases with a normal BMI (23.6kg/m²) were set as controls. And the results were statistically analyzed using SPSS v11.0 for windows.ResultsAll operations were successful for one time. There were no conversions and deaths. The mean operative time was 99.8 minutes (range,65 185). The mean bleeding was 28.7ml (range,10 60). The mean postoperative stay was 3.13 days (range, 2 5).There were no preoperative complications.1, 3, 6 months after surgery , the mean injection volume were 3.6ml, 5ml and 6.5ml. The weight loss were 3.47 ± 1.72kg, 9.70 ± 3.69kg, 18.17 ± 5.29kg. The EWL% were (9.53 ± 4.6)%, (27.77 ± 12.9)%, (51.48 ± 18.87)%. 6 months postoperatively, the complications of MO were cured or alleviated. The effect are satisfying.There was no significant changes of nutritional parameters pre and postoperatively (P>0.05). Before surgery, the MO had a significant lower level of CD4+ . CD4+/CD8+ and a higher level of serum IL-2 . IL-6 than the controls(P<0.01). There was a significant reduction of weight and BMI 6 months postoperatively (P<0.01). At the same time, CD4+ increased and serum IL-2 decreased significantly. But CD4+/CDg+ and serum IL-2 m IL-6 were still abnormal compare to the controls.Conclusions(1)LAGB is a minimal invasive, safe and effective procede for morbid obesity. But the long-term effect is to be investigated. (2)No major nutritional deficiencies was found following LAGB. (3)MO may combined with an abnormal immunity. But after enough weight loss induced by LAGB, it can be partly reversed.