Schlauchmagenbildung als Revisionseingriff nach Magenbandversagen

Zusammenfassung

Die Adipositaschirurgie erfährt international und auch in Deutschland einen enormen Aufschwung. Nach Angaben der deutschlandweiten Qualitätssicherungsstudie stellte in den Jahren 2004–2006 die Magenbandimplantation mit insgesamt 678 Fällen die häufigste Operation dar. Im Verlauf zeigt sich für die Magenbandimplantation jedoch eine hohe Rate an Therapieversagern, sodass eine hohe Rate an Umwandlungsoperationen erforderlich wurde. Dabei ist die Frage weiterhin offen, welches adipositaschirurgische Verfahren dann zu empfehlen ist. Die vorliegende Arbeit soll die Durchführung der Schlauchmagenbildung als Revisionseingriff nach Versagen der Magenbandimplantation darstellen. Im Zeitraum 8/2008–4/2012 wurde bei 39 Patienten (31♀/8♂) mit einem Durchschnittsalter von 43,7 ± 7,8 (26–61) Jahren und einem BMI von 47,1 ± 9,1 (30,4–67,4) kg/m² eine Schlauchmagenoperation nach zuvor fehlgeschlagener Magenbandtherapie durchgeführt. Die Indikation zur Umwandlung wurde aufgrund von Dysphagie (38,5 %), fehlender Gewichtsreduktion (33,3 %), Magenbandslippage (17,9 %), Magenbandmigration (5,1 %), Magenbanddefekt (2,6 %) sowie einer Magenbandinfektion (2,6 %) gestellt. Die Operation wurde 19-mal einzeitig und 20-mal zweizeitig durchgeführt. Die durchschnittliche Operationszeit betrug 129 ± 49 (50–312) min. Es wurde eine Komplikationsrate von 7,7 % beobachtet. Es traten eine proximale Leckage, eine therapiebedürftige Stenose des Schlauchmagens und eine ausgeprägte Wundinfektion auf. Der prozentuale Übergewichtsverlust betrug nach 1, 3, 6, 12, 24 und 36 Monaten 23 %, 39 %, 51 %, 52 %, 60 % und 46 %. Die Umwandlungsoperation von einer Magenbandimplantation zu einem Schlauchmagen ist mit einem vergleichsweise geringen Risiko, bei guten mittelfristigen Ergebnissen, zweizeitig, aber auch einzeitig möglich.

Abstract

The number of bariatric surgical procedures is still increasing in Germany and also worldwide. According to the German quality assurance study of surgical treatment of obesity, the laparoscopic adjustable gastric banding (LAGB) was the most common bariatric operation with a total of 678 cases between 2004 and 2006 in Germany. In the meantime a high rate of LAGB treatment failures has been reported, so that a high rate of revisional bariatric operations is required. But still the question is open which bariatric procedure can be recommended. The aim of this study is to report the results and follow-up of conversion of failed LAGB to laparoscopic sleeve gastrectomy (LSG). Between 8/2008 and 4/2012 39 patients (31♀/8♂) with a mean age of 43.7 ± 7.8 (26–61) years and a BMI of 47.1 ± 9.1 (30.4 to 67.4) kg/m² had revisional surgery for converting a failed LAGB to LSG. The indications for conversion were dysphagia (38.5 %), weight regain (33.3 %), band slippage (17.9 %), band erosion (5.1 %), band defect (2.6 %) as well as band sepsis (2.6 %). 19 procedures were performed as a one-stage operation and 20 procedures as a two-stage operation. The average operating time was 129 ± 49 (50–312) min. The complication rate was 7.7 %. There were one proximal leak, one gastric sleeve stenosis and one pronounced wound infection. The percent excess weight loss was 23 %, 39 %, 51 %, 52 %, 60 % and 46 % after 1, 3, 6, 12, 24 and 36 months follow- up, respectively. Converting a failed LAGB into a LSG is a revision procedure with low complication rate and promising results, which can be performed as a two-stage as well as a one-stage procedure.

Schlüsselwörter

Adipositaschirurgie - Schlauchmagenbildung - Magenband - Revisionsoperation

Key words

bariatric surgery - sleeve gastrectomy - gastric banding - revision operation

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