The digitus quintus, rigid stoma, 4-5 position gastroplasty

In 55 patients a rigid stoma gastroplasty was performed. The operative technique is described. It includes the construction of a rigid stoma and a double line of staples across the stomach to give a pouch volume of 40 to 60 ml. The diameter of the stoma is established by a nasogastric tube and the digitus quintus of the assistant's hand at the level of the cuticle. A 1- to 2-year follow-up indicates that these stomas do not dilate but tend to decrease in diameter. Stomal stenosis occurred in 2 of the 55 patients studied. Weight loss was satisfactory, although incomplete in most patients. It is likely that the weight loss will not be as great as with intestinal bypass. There were no serious late postoperative complications. However, an appreciable number of patients had emesis early in the postoperative period, intolerance of red meat and constipation. It is apparent that a rigid stoma of constant diameter is at least as important as a small gastric pouch in achieving adequate and lasting weight loss. A longer follow-up is necessary to assess this procedure completely.