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Bariatric surgery at the 1st Surgical Department in Prague: history and some technical aspects
M Fried1, M Peskova, M Kasalicky
11st Surgical Department, Charles University Teaching Hospital, Prague, Czech Republic.
Insights
Bariatric surgery in the Czech Republic evolved from vertical banded gastroplasty to gastric banding, reducing complications. Laparoscopic adjustable gastric banding offers further improvements in safety and recovery for obesity treatment.
Area of Science:
- Bariatric Surgery
- Obesity Management
- Surgical Techniques
Background:
- Rising obesity rates in the Czech Republic necessitated advanced surgical interventions.
- The department pioneered bariatric surgery in the region starting in 1983.
Observation:
- Vertical banded gastroplasty (VBG) showed acceptable weight loss but high complication rates (17.3% staple-line, 15.3% wound).
- Nonadjustable gastric banding (GB) reduced stomach complications to 6.3% while maintaining similar weight loss.
- Laparoscopic approaches, including adjustable gastric bands, significantly decreased wound complications to 0.9% and shortened hospital stays.
Findings:
- Weight loss outcomes were comparable across VBG, nonadjustable GB, and adjustable GB procedures.
- Complication rates significantly decreased with the transition from VBG to GB, and further with laparoscopic techniques.
- Adjustable gastric banding demonstrated a notable reduction in stomach-related complications.
Implications:
- The evolution of bariatric surgical techniques has led to improved patient safety and outcomes.
- Laparoscopic adjustable gastric banding represents a less invasive and safer option for long-term obesity management.
- Continued refinement of surgical methods is crucial for addressing the growing public health challenge of obesity.
Background:
Obesity has been increasing in the Czech Republic over the last 20 years. In 1983 we were one of the first surgical departments in the country which performed bariatric surgery on a regular basis.
Methods:
From 1983 to 1986 we performed vertical banded gastroplasty (VBG). Because of a high rate of various complications arising both from the stomach and the wound, we switched in 1986 to 'less aggressive' nonadjustable gastric banding (GB). In 1993 we performed the first laparoscopic nonadjustable banding, and in 1994 we started laparoscopic placement of adjustable gastric bands.
Results:
In the group of 52 patients who underwent VBG and were followed-up, acceptable weight loss results (-40.5 kg) were achieved in the 24 months following surgery. The postoperative complications were high; 17.3% gastric staple-line disruption and 15.3% wound complications (incisional hernias, discharge, etc.). Since 1986, we have performed nonadjustable GB in 150 patients and achieved weight loss of -38.4 kg in the 24 months following surgery. There was no change in the wound complication rate, but the complications arising from the stomach and the band decreased to 6.3%. Since June 1993, we have performed 268 procedures laparoscopically, either with nonadjustable bands or, since 1994, with the adjustable bands. The wound complication rate decreased to 0.9%, and one complication (6.6%) was related with the adjustable band.
Conclusions:
Because of the high rate of postoperative complications in our experience with VBG, we started GB in 1986. Since then the number of complications arising from the stomach has decreased substantially. With the laparoscopic technique, there was a further decrease in wound healing problems. With the adjustable GB, a significant decrease in the stomach-related complications occurred. Shorter hospital stays were possible with the laparoscopic technique. Long-term weight loss results have not been significantly different among the above mentioned procedures.