| Background:laparoscopic adjustable gastric banded plication is a new operation.The first case was performed by Huang,Taiwan,in 2009.It consists of laparoscopic adjustable gastric banding surgery and laparoscopic greater curvature plication.LAGBP meets the principle of limiting intake,reducing stomach volume and the "gastric center hypothesis".It has the advantages of simple operation,no gastrointestinal excision,reversibility,and fewer complications.As a standard metabolic procedure,laparoscopic sleeve gastrectomy has a definite reduction in weight loss and diabetes.A short-term study of LAGBP is found to be effective and safe in weight loss,but there is a lack of a comparative study with LSG.In the later period,LAGBP was modified.The efficacy and safety of the modified LAGBP was further explored.Objective:1:To explore the efficacy and safety of laparoscopic gastric banded plication(LAGBP)for obesity and type 2 diabetes mellitus(T2DM)by comparing the 3-year results between LAGBP and laparoscopic sleeve gastrectomy(LSG).2:The feasibility and safety of the two-folding-formula were discussed by comparing the weight reduction effect and safety of the modified LAGBP group and the traditional LAGBP group for 1 year after operation.Methods:1:From April 2012 to April 2014,there were 32 cases and 34 cases of obese patients who underwent LAGBP procedure and LSG procedure in PLA General Hospital.Among them,there were 9 cases and 11 cases of obesity with type 2 diabetes in LAGBP group and LSG group,respectively.Anthropometric indicators,diabetes-related indicators and postoperative complications were compared.2:24 patients were underwent the modified LAGBP procedure from July 2015 to December 2016 in PLA General Hospital.From September 2011 to July 2015,24 patients who underwent traditional LAGBP procedure were selected for preoperative indexes matching with modified LAGBP procedure.The matching indexes were gender,age,preoperative BMI.The operative time,intraoperative bleeding,hospital stay,postoperative complications and the percentage of excess weight loss(%EWL)at 1 year after operation were compared between the two groups.Results:1:There was no significant difference between the two groups in preoperative basic indicators(P>0.05)except age difference.The excess weight loss rates(%EWL)of LAGBP group was lower than that in LSG at 12 months after operation[(57.52±13.53)%vs(73.43±10.78)%,P=0.000],but were 72.55±10.14%and 71.23± 13.32%respectively at 24 months after operation(P=0.817),71.23±13.35%and 67.43± 15.32%respectively at 36 months after operation(P=0.299),which two group%EWL had no significantdifference.The remission rates of diabetes in the LAGBP group and the LSG group were 100%(9/9)and 90.91%(10/11),respectively.The difference was not statistically significant(P=1.00).The operation time[(90.0±12.2)min vs(97± 15.7)min,P=0.0482],the amount of bleeding[(14.7±4.5)ml vs(20.3±10.8)ml,P=0.0084]and the length of hospitalization[(4.3±0.8)d vs(6.21±1.5)d,P=0.000]in group LAGBP were lower than that in group LSG.The postoperative complications of LAGBP group and LSG group were 6.25%(2/32)and 8.82%(3/34)respectively,without significant difference(P=0.944).2:Preoperative indicators of both groups were comparable except for age.The operation time of the modified group and the traditional group were(98± 20)min and(87± 17)min,respectively,with significant difference between the two groups(P<0.05).The bleeding volume in the modified group and the traditional group were(18.3 ± 7.5)mL and(23.5 ± 11.7)mL,respectively,with no significant difference between the two groups(P>0.05).The hospitalization time was(4.5± 0.7)days and(4.3 ± 0.9)days in the modified group and the traditional group,respectively,with no significant difference between the two groups(P>0.05).The%EWL of the modified group and the traditional group at 12 months after operation were(63.77 ± 11.26)%and(57.36 ± 9.72)%,respectively,the difference was statistically significant(P<0.05).The two groups of%EWL had an upward trend in 1 years,and the increase of%E WL in the modified group was higher than that of the traditional group at 1-6 months after the operation.The postoperative complications of the modified group and the traditional group were 8.33%(2/24)and 12.5%(3/24),respectively,with no significant difference between the two groups(P>0.05).Conclusions:1:Compared with LSG,LAGBP has shorter operation time,less intraoperative blood loss,shorter hospital stay and similar weight loss effect in the second to third year after operation,which is considered as an effective,safe and reversible metabolic procedure.2:LAGBP improved by the folding formula,the effect of weight loss was significantly increased,but there was no significant difference in postoperative complications.The folding formula "(1.5 + x)/2"based on 36 Fr bougie helps to standardize the LAGBP,provides a reference for the LAGBP multicenter study,and provides an idea for surgeries that require bougies. |
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