Gastric bypass is an extensive gastric exclusion operation used in patients who are more than twice their ideal weight. Most of the early postoperative deaths observed in 3% of 442 patients during the initial 9 years, could have been prevented by more attention to operative technique and early recognition and correction of leaks when they occurred. The best weight loss can be produced by adherence to three components of the operation: 1) Bypass of stomach and duodenum, 2) a small fundic segment and 3) a small (12 mm diameter) gastroenterostomy stoma. The average patient of 142 kg can expect to have a weight of around 107 kg at 1 year 103 kg at 5 years. Revision of a large stoma to a smaller (9 mm) diameter can induce further weight loss in some patients whose loss has been inadequate. The 1.8% incidence of stoma ulceration may be lowered with the present emphasis on a smaller fundic pouch, but could increase with longer observation. Presently stoma ulcers occur once in every 140 patient years at risk.

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This report reviews 25 patients 20 yr of age or younger who were treated for morbid obesity by gastric bypass or gastroplasty. Eighteen genetically normal obese adolescents averaged 15% body weight loss 6 mo after operation and 25% weight loss 36 mo postoperatively; the eight males lost more weight than did the ten females. Seven younger children had Prader-Willi syndrome; six of them lost weight postoperatively although not so dramatically as the genetically normal obese patients. Four patients required later revisions to reduce the size of the gastric pouch or stoma. These operations were performed with acceptable morbidity and no mortality. Growth in height was not interrupted and no metabolic problems were encountered postoperatively. Gastric bypass is a safe and effective method of controlling body weight in morbidly obese children and adolescents.

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Seven adult, morbidly obese patients scheduled for bariatric surgery were studied in an identical manner preoperatively and postoperatively. Six patients underwent gastroplasties, and one patient underwent a gastric bypass procedure. A single 250-mg dose of erythromycin as a Filmtab was administered orally after an overnight fast. Multiple venous blood samples were collected over a 12-hour period. After surgery, each patient had a decrease in peak concentration and an increase in the time to reach peak concentration compared to presurgery values. Mean peak concentration was reduced from 1.04 micrograms/ml preoperatively to 0.55 micrograms/ml postoperatively, and the mean time to peak increased from 3.9 hours to 6.7 hours. Mean weight-corrected AUC was reduced 41 per cent, with two patients having no detectable serum levels postoperatively. The results suggest that the erythromycin product evaluated is of questionable value for use in bariatric surgery patients.