Vertical isolated gastroplasty with gastro-enteral bypass: preliminary results

The authors present a new restrictive and malabsorptive operation for treatment of morbid obesity, called vertical isolated gastroplasty (VIG).

From Feb 2004 to May 2005, 30 patients with BMI > or = 40 kg/m2 or >35 kg/m2 with co-morbidities underwent VIG via laparoscopy or laparotomy. The technique consisted in creation of a gastric tube preserving pylorus, and a Roux-limb of 300 cm to the bypassed stomach with the division 30 cm distal to the ligament of Treitz. Excess weight loss (EWL), BMI, complications and co-morbidities were assessed.

BMI and average preoperative weight were 41.2 kg/m2 and 110.7 kg, respectively. At 12 months postoperatively, BMI and average weight were 23.4 kg/m2 and 65.1 kg, respectively, with EWL 90.2%. None of the patients presented dumping. Improvement in co-morbidities was >90%. Complications consisted of: 1 dehiscence of gastric sutureline, 1 hemoperitoneum, 1 gastroenterostomy ulcer, 1 anemia of undetermined cause, and 3 cholelithiasis. There was no mortality.

VIG has thus far been safe and effective, with the same results as other bariatric operations. VIG has certain advantages, such as lack of dumping and lack of clinically significant stenosis of the gastroenterostomy, which can occur with other techniques. Because a duodenal bypass is not performed, it allows physiologic absorption of iron and diagnostic and/or therapeutic access to the ampulla of Vater.