Assessment of patients with failed gastric operations for morbid obesity

The success of gastric restriction procedures for morbid obesity depends on a persistently small gastric pouch and stoma, an intact staple line, and, of equal importance, dietary compliance. Evaluation of patients with either excessive or inadequate weight loss should be directed at determining both the technical adequacy of the operation and the depth of understanding the patient has of his or her role in the success of the procedure. Because of the poor prognosis for weight loss, patients who are not likely to be complaint or who demonstrate a lack of understanding of the behavioral modification required to ensure the success of the procedure should not have reoperation, even if a large pouch or stoma or a disrupted staple line is seen on an upper gastrointestinal series.