- 作者：Manish S. Parikh ; Scott Laker ; Matt Weiner ; Omid Hajiseyedjavadi and Christine J. Ren
- 刊名：Journal of the American College of Surgeons
- 出版年：2006
- 出版时间：February 2006
- 年：2006
- 卷：202
- 期：2
- 页码：252-261
- 全文大小：115 K
Background
Several surgical treatment options for morbid obesity exist. Currently, there are no studies that objectively compare complication rates after laparoscopic bariatric operations performed at a single institution. We objectively classify and compare complications resulting from laparoscopic adjustable gastric banding (LABG), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion (BPD) with duodenal switch (DS).Study design
A retrospective review of a prospective database of all patients undergoing laparoscopic bariatric operation was performed. Complications were categorized according to severity score using a well-described classification system and compared between procedures.
Results
From September 2000 to July 2003, 780 laparoscopic bariatric operations were performed: 480 LAGB, 235 RYGB, and 65 BPD±DS. There was one late death. Total complication rates were: 9 % for LAGB, 23 % for RYGB, and 25 % for BPD±DS. Complications resulting in organ resection, irreversible deficits, and death (grades III and IV) occurred at rates of 0.2 % for LAGB, 2 % for RYGB, and 5 % for BPD±DS. LAGB group had a statistically significant lower overall complication rate, both by incidence and severity, as compared with other groups (p < 0.001). After controlling for differences of admission body mass index, gender, and race, the LAGB group had an almost three and a half times lower likelihood of a complication compared with the RYGB group (odds ratio, 3.4; 95 % CI, 2.2−5.3, p < 0.001) and had an over three and a half times lower likelihood of a complication compared with the BPD with DS group (odds ratio, 3.6; 95 % CI, 1.8−7.1, p < 0.001). There was no statistically significant difference between complication rates of RYGB and BPD±DS.
Conclusions
Bariatric operation complication rates range from 9 % to 25 % ; very few complications are serious. Laparoscopic adjustable gastric banding is the safest operation in terms of complication rate and severity when compared with laparoscopic Roux-en-Y gastric bypass or laparoscopic malabsorptive operations.