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Obesity surgery: discouraging long term results with Mason's vertical banded gastroplasty
P C Versélewel de Witt Hamer1, M A Hunfeld, W E Tuinebreijer
1Department of General Surgery, Red Cross Hospital, Beverwijk, The Netherlands.
Objective:
To evaluate the long term results of Mason's vertical banded gastroplasty (VBG) using accepted criteria, and to find out which factors predicted success.
Design:
Retrospective survey of a cohort of 40 severely obese patients (mean initial body mass index (BMI in kg/m2): 43, range 34-62).
Setting:
General teaching hospital, The Netherlands.
Main Outcome Measures:
Success according to three definitions: weight loss of more than 25%; percentage of excess weight 50% or less; and BMI < 30.
Results:
Mean follow-up was 7.4 years (range 0.5-10) or 85%. The distribution over MacLean and Reinhold criteria shows a shift towards unfavourable categories. The consecutive percentages of success at five years were 35%, 62%, and 35%. Logistic regression analysis of success at 5 years shows that the following factors significantly predicted success: Definition I: age odds ratio (95% confidence interval): 0.88 (0.78 to 0.99). Definition II: age: 0.84 (0.69-1.01), outlet > or = 5 cm: 176 (2.4 to 12774), percentage of ideal weight > or = 100%: 0.03 (0.002 to 0.48). Definition III: age: 0.86 (0.75 to 0.99), pouch size > or = 15 ml: 10.64 (1.48 to 76.6).
Conclusion:
The long term results of VBG are disappointing when assessed by the standard criteria.