Divided gastric bypass: a fifteen-year experience

In suitable candidates, a reduction in gastric capacity to achieve significant weight loss is life-saving. The number and variety of procedures proposed in the last 15 years suggest that the ideal operation is still in evolution. We present a 15-year experience with a single operation designed to avoid the hazards of staple line dehiscence, achieve maximum weight loss, and maintain physiologic homeostasis. From 1979 through 1994, 212 patients, whose age, weight, and number of medical complications were consistent with the criteria for morbid obesity, underwent divided gastric bypass. All patients lost at least 70 lbs, and 95 per cent of the patients lost greater than 100 lbs in 2 years, with an average loss higher than in most comparable series. There were four post operative deaths and three late deaths. Thirteen anastomotic leaks (6%) were successfully managed. Eight patients received nutritional support and antibiotics, and five patients had operative drainage. Eighteen per cent had one or more minor complications. Divided gastric bypass avoids the problem of staple line dehiscence while providing a safe physiologic approach for maximum weight loss in the morbidly obese patient.