Vertical banded gastroplasty: results in 233 patients

The authors describe their experience with vertical banded gastroplasty in 233 patients for whom the follow-up ranged from 12 to 30 months. There were no deaths. Intraoperatively, two gastric perforations and one esophageal perforation occurred; these were closed and drained. A postoperative leak was treated promptly by removal of the collar, drainage and gastrostomy. There were three instances of late obstruction, due in one to mesh adhering to liver and in two to stenoses; gastrogastrostomy was followed by regained weight. Removal of the collar was also associated with failure to lose adequate weight. Rare complications were intraluminal erosion of mesh and staple-line breakdown. The gallbladder was still present in 175 patients; of these, 25 had gallstones and underwent a cholecystectomy at the time of gastroplasty. Of the other 150, symptomatic gallstones subsequently developed in 13. At 12 months after gastroplasty 80% of patients had lost at least 50% of excess weight and at 24 months 83% had lost 50% or more of excess weight (15 patients lost to follow-up). To avoid failures, the collar circumference should not be more than 5.0 cm. A small experience suggests that revision of a failed horizontal gastroplasty to vertical banded gastroplasty is hazardous.