Gastric partitioning for morbid obesity: postoperative weight loss, technical complications, and protein status

The study of 325 patients who underwent gastric partitioning (stapling) was undertaken to assess the complications and weight-loss records over a 5-year period. A subgroup of 15 patients was studied to determine protein status preoperatively and 2, 4, and 6 months after surgery. Laboratory tests, anthropometric measures, and food records were used to assess patient health and nutritional status. Four operative techniques have been used by a surgeon in Reno, NV, since 1979. The main postoperative complication in the first two procedures, a nonreinforced horizontal staple line (Groups 1 and 2), was staple line disruption and, therefore, poor weight-loss results. The staple line was reinforced in the next 193 patients (Group 3), and the patients followed a blenderized diet for 8 weeks postoperatively. Persistent vomiting was the most common problem in that group; 24% required dilatation of the stoma via gastroscopy. The vertical staple procedure was adopted for the next 48 patients (Group 4) to further minimize disruption and severe vomiting. Other operative complications were relatively few. At 48 and 18 months, respectively, Groups 3 and 4 showed an average weight loss of 27% of the preoperative weight. Eating patterns and food tolerances changed dramatically postoperatively, and protein intake dropped significantly. Mean protein intakes below standard recommended dietary allowance (RDA) were observed in a subgroup of Groups 3 and 4. However, the mean total lymphocyte count and albumin values demonstrated that patients were not compromising visceral proteins. The mean creatinine height indexes and arm muscle areas showed no significant difference in somatic protein status.(ABSTRACT TRUNCATED AT 250 WORDS)