The Efficacy And Safety Of Laparoscopic Adjustable Gastric Banding For Morbid Obesity

Objectives ①To introduce the surgical technique of laparoscoopic adjustable gastricbanding(LAGB)。②To study the efficacy of LAGB for morbid obesity. ③Tocompare the nutritional status and immunity of morbid obesity(MO) before andafter laparoscopic adjustable gastric banding (LAGB). And the safety of LAGBare discussed. Methods The 15 patients included 6 males and 9 females. The mean age was 27.7years (range,14～39). The mean height was 165.9cm (range, 150～174.5). Themean 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 obesityfor 4～12 years, 14 cases of which combined with complications such ashypertention, diabetes mellitus, arthritis and so on. All the patients were treatedby LAGB from Jun. 2003 to Oct. 2003 in our department. 1 month after thesurgery, we began to adjust the band through injecting water into the port tokeep the weight stable losing. Meanwhile, the patients' nutritional(serum Alb,PreAlb, TFN, RBP, SAAR, folacin, VB12, calcium, iron, cuprum, zinc andselenium)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 monthspostoperatively. 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. Results All operations were successful for one time. There were no conversions and 5第二军医大学硕士学位论文deaths. The mean operative time was 99.8 minutes (range,65～185). Themean bleeding was 28.7ml (range,10～60). The mean postoperative stay was 3.13days (range, 2～5).There were no preoperative complications. 1, 3, 6 months after surgery , the mean injection volume were 3.6ml, 5mland 6.5ml. The weight loss were 3.47±1.72kg, 9.70±3.69kg, 18.17±5.29kg. TheEWL% were (9.53 ± 4.6)%, (27.77 ± 12.9)%, (51.48 ± 18.87)%. 6 monthspostoperatively, the complications of MO were cured or alleviated. The effect aresatisfying. There was no significant changes of nutritional parameters pre andpostoperatively (P>0.05). Before surgery, the MO had a significant lower level ofCD4 , CD4 /CD8 + + + and a higher level of serum IL-2 , IL-6 than thecontrols(P<0.01). There was a significant reduction of weight and BMI 6 monthspostoperatively (P<0.01). At the same time, CD4 increased and serum IL-2 +decreased significantly. But CD4 /CD8 and serum IL-2,IL-6 were still abnormal + +compare to the controls. Conclusions ①LAGB is a minimal invasive, safe and effective procede for morbidobesity. But the long-term effect is to be investigated. ②No major nutritionaldeficiencies was found following LAGB. ③MO may combined with an abnormalimmunity. But after enough weight loss induced by LAGB, it can be partlyreversed.