PDF(Pubmed)
Abstract：
Gastric banding was one of the first operations to gain popularity within the field of bariatric surgery. This case details one patient\'s presentation and subsequent management of gastric band erosion with the hope of guiding other physicians and supporting the decreased use of gastric banding. The patient, a 61-year-old Caucasian female, presented to the bariatric clinic complaining of a multiyear history of epigastric pain and acid reflux, which was refractory to treatment with proton pump inhibitors. She had a history of laparoscopic adjustable gastric band (LAGB) placement in 2007. She was initially successful in achieving weight loss and maintained regular band adjustments but was lost to follow-up and regained a body mass index (BMI) of 41.59 kg/m2. Evaluation with upper gastrointestinal (GI) endoscopy was recommended and performed. This revealed a LAGB in its entirety with tubing within the gastric fundus. Removal with dual endoscopy and abdominal laparoscopy was recommended and scheduled. During attempts to remove the band using an endoscopic snare, significant difficulty was encountered. Ultimately, an endoscopic rat-tooth grasper was used to lyse the band and tubing into four sections for complete removal. The subcutaneous port of the band was successfully removed laparoscopically, and the patient was discharged from the operating room. She reported limited pain in the postoperative suite but was lost to follow-up regarding long-term symptom relief. This report describes the presentation and management of one patient\'s experience with a known complication of LAGB-band erosion. This complication necessitated two additional procedures with anesthesia and placed the patient at increased risk for esophageal perforation, complications related to sedation, and the development of abdominal adhesions. Her case aims to support the decreasing prevalence of LAGBs within bariatric surgery and hopes to guide other physicians challenged with the management of similar cases.
摘要：
胃束带术是减肥手术领域最早流行的手术之一。此病例详细介绍了一名患者的胃束带侵蚀的介绍和后续处理，希望指导其他医生并支持减少使用胃束带。病人,一名61岁的白人女性,提交给减肥诊所抱怨多年的上腹痛和酸反流的历史，用质子泵抑制剂治疗是难治的。她在2007年有腹腔镜可调节胃束带（LAGB）放置的病史。她最初成功实现了体重减轻，并保持了定期的波段调整，但在随访中失去了体重指数（BMI）为41.59kg/m2。推荐并进行上消化道（GI）内镜检查。这揭示了在胃底内具有管道的全部LAGB。建议并计划使用双内窥镜和腹腔镜手术切除。在尝试使用内窥镜圈套器移除带的过程中，遇到了重大困难。最终,使用内窥镜大鼠牙齿抓紧器将束带和导管溶解成四个部分，以完全去除。腹腔镜下成功移除带子的皮下端口，病人从手术室出院。她报告术后套件疼痛有限，但因长期症状缓解而失去随访。本报告描述了一名患者已知的LAGB带侵蚀并发症的表现和管理。这种并发症需要另外进行两次麻醉手术，并使患者发生食管穿孔的风险增加。与镇静有关的并发症，和腹部粘连的发展。她的案例旨在支持减肥手术中LAGB的患病率降低，并希望指导其他医生对类似病例的管理提出质疑。
