|Title:||Laparoscopic Vertical Banded Gastroplasty and Laparoscopic Gastric Bypass ：a Comparison||Authors:||LEE, WEI-JEI
|Keywords:||Laparoscopy;vertical banded gastroplasty;gastric bypass;randomized trial;bariatric surgery;morbid obesity||Issue Date:||2004||Journal Volume:||v.14||Journal Issue:||n.5||Start page/Pages:||626-634||Source:||Obesity Surgry||Abstract:||
Background: Vertical banded gastroplasty (VBG) and gastric bypass (GBP) are the two bariatric procedures recommended by NIH consensus conference. Recent advancement in laparoscopic (L) techniques has made LVBG and LGBP alternatives for the conventional open approach. Methods: From December 2000 to February 2002, 80 patients ( 24 men and 56 women; mean age 32 years, range 18-57) with morbid obesity (mean BMI 43.2 kg/m2, range 36-59. 8) were enrolled in a prospective trial and randomly assigned to LVBG or LGBP. Changed in quality of life were assessed using the Gastro-intestinal quality of life index (GIQLI). Results: The conversion rate was zero for LVBG and 2.5﹪(1/ 40) for LGBP. There has been no mortality. Surgical time was significantly longer for LGBP (209 min vs 126 min for LVBG, P<0.001). Mean hospital stay was 3.5 days for the LVBG vs 5 .7 days for LGBP (P<0. 001). Postoperative analgesic usage was also less for LVBG patients (mean dose 1.4 vs 2.4, P<0. 05). Early complication rate was higher in the LGBP group ( 17.8﹪vs 2.5﹪, P<0.001). All 3 major complications were in the LGBP group, of which 2 were related to anastomotic leakage (5﹪). Late complications consisted of upper GI bleeding, stenosis and others observed in 4 LGBP patients ( 10﹪) and 2 LVBG patients (5﹪). Mean follow-up was 20 months (range 18 to 30). BMI fell significantly in both group, with significant improvement of obesity-related co- morbidities. LGBP had significantly better excess weight loss then LVBG (62.9﹪vs 55.4﹪at 1 year and 71.4﹪vs 53.1﹪at 2 years), as well as lower BMI than LVBG (29.6 vs 31.1 at 1 year and 28.5 vs 31.9 at 2 years). There was no difference in the reduction of obesity-related laboratory abnormalities at 1 year except a lower hemoglobin in LGBP ( 11.8 vs 13.8, P<0.05). Preoperative GIQLI scores were similar between the groups; however, at 1 year, LGBP patents had better GIQLI scores than LVBG patients (121vs 106, P<0. 01). LVBG had improvement in physical condition, social function and emotional conditional but deterioration in GI symptoms which resulted in no increase in total GIQLI score. morbidities. LGBP had significantly better excess weight loss then LVBG (62.9﹪vs 55.4﹪at 1 year and 71.4﹪vs 53.1﹪
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