| Obesity refers to the excessive accumulation and (or) abnormal distribution of bodyfat caused by multifactor including genetics, high-calorie, high-fat diet and physicalinactivity. It leads to a variety of serious diseases, such as metabolic syndrome,cardiovascular diseases and psychological disorders, and it also associates with breastcancer, colorectal cancer, prostate cancer and other malignancies.Obesity has become aglobal health problem, especially in developed countries. In2007, there had been morethan1/3of U.S. adults with a BMI>30kg/m2. However, this problem is also notoptimistic in the developing countries. In China, with the development of economic andsocial and deterioration of the environment, the number of obese population rapidlyincrease. Obesity and its co-morbidities seriously impact on people’s quality of life andlife expectancy, and also increase the government’s health expenditure. Compared withthe non-surgical approach, the surgical treatment of obesity has been proven to be aclinically effective and cost-effective method. Currently, there are3types of bariatricsurgery which are performed widely: laparoscopic adjustable gastric banding (LAGB),laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy (LSG).Compared with the others, Laparoscopic adjustable gastric banding （LAGB） is moresimple, safe, reversible and shorter in hospital stay, especially for moderately obesepatients. LAGB was major surgical procedure between2003and2011in China.Although FDA lowered the BMI threshold for application of the LAGB in2011[4], ourcenter have reduced its application since2011because of some of its late complications(band slippage or erosion).Arapis, et al.[5] through a long-term follow-up found that LAGB did not apply tosuper-obese patients with BMI≥50kg/m2. Thirty-four moderately obese patients (withBMI30-35kg/m2) who underwent LAGB were followed up for7years in another study,the results suggested that LAGB is a safe and effective surgical method in moderatelyobese patients [6]. Are these conclusions applicable to Chinese people whose body sizeand fat distribution are different from Westerner? What kind of obese patients is moreappropriate to use LAGB? Should LAGB be replaced by other bariatric procedures? Inorder to answer these questions, we conducted an analysis of medical records andlong-term follow-up data of patients who underwent LAGB in our center. Part One: Long-Term Outcomes and Experience of Laparoscopic AdjustableGastric BandingA retrospective study was performed to review the follow-up data of obese patientswho underwent LAGB from November2003to May2013at Shanghai ChanghaiHospital. The main outcome included weight loss, percentage excess weightloss(%EWL), reoperation rate, and reasons for reoperation. A total of254LAGBprocedures were performed in our hospital. End by May2013, one hundred andforty-five Chinese patients (57.8%) were followed up,99patients with BMI≥35kg/m2(BMI≥35kg/m2group) and46patients with BMI<35kg/m2(BMI <35kg/m2group). Themean age was27.2±7.6years, mean weight was108.8±26.3kg, mean BMI was37.8±6.6kg/m2. In the10years of follow-up, the mean%EWL are greater than30%. In the BMI≥35kg/m2group, the mean%EWL are more than25%within5years postoperative, but itdropped to less than25%after5years. However, in the BMI<35kg/m2group, the mean%EWL at each time point are over50%. The reoperation rate was33.1%, it is17.4%inthe BMI<35kg/m2group and34.3%in the BMI≥35kg/m2group. In Conclusion，LAGB is safe and effective for the treatment of obesity, especially for obese patientswith BMI <35kg/m2. Coupled with the application of new technologies and materials,appropriate patient selection, and multidisciplinary follow-up and management, LAGB isstill one of the alternative to treat obesity.Part Two: Influential factors analysis of the removal of gastric banding afterlaparoscopic adjustable gastric bandingA retrospective study was performed to review the clinical data of40patients whorequired reoperation to remove the gastric banding after LAGB from November2003toMarch2013at the Department of Minimally Invasive Surgery, ChanghaiHospital．Selected56patients whose follow-up period is5years and did not receivere-operation as control group. We conducted a case-control study to analyze. Chi-squaretest and multivariate and non—conditional1ogistie regression analysis were used toidentify the risk factors of removing of gastric banding. Age and gender were notstatistically significant different（P＞0.05）. Multiple factors of Logistic regressionshowed that BMI≥35kg/m2, postoperative clinic visits per year＜2and on the basis of gastrointestinal disease were risk factors for the removal of gastric banding(Wald=3.214、6.255、4.712, P＜0.05). In Conclusion, the risk factors for the removal of gastric bandinginclude BMI, postoperative clinic visits and the basis of gastrointestinal disease. In thetreatment of obesity with LAGB should take full account of the above factors.In Conclusion, this study and other long-term follow-up study showed that LAGB issafe and effective for the treatment of obesity, especially for type I obesity. With theapplication of new technologies and materials, the prevalence of adverse events andreoperation is decreasing. However, in order to get the good outcome, multidisciplinarypostoperative management is more essential. In addition, the risk factors for the removalof gastric banding include BMI, postoperative clinic visits and the basis ofgastrointestinal disease. In the treatment of obesity with LAGB should take full accountof the above factors. |
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