Gastric Partitioning for Morbid Obesity

Abstract

The complication rate in jejunoileal bypass for morbid obesity is unacceptably high. Gastric bypass is technically difficult. In our series, 115 patients have undergone gastric partitioning for morbid obesity. The operation consists of stapling across the stomach below the gastroesophageal junction, leaving a gastric food reservoir of 50--60 cc. A 1 cm opening is left in the central portion of the staple line, allowing slow emptying into the distal stomach. The result is a reduced eating capacity and frequency which produce loss in weight. Three-quarters of the patients are women, and the age range is 17--62 years. Preoperative weights averaged 147 kg. Mean operative time was 48 minutes, and postoperative stay was 6.2 days. All patients were extensively evaluated preoperatively with upper GI series, cholecystogram, a number of blood chemistry tests, and endocrinologic and psychiatric consultations. All patients underwent a preoperative Minnesota Multiphasic Personality Inventory test. Cholecystectomy for cholelithiasis was performed on 18% of the patients at the time of operation. Of the seven patients operated on more than one year ago, five have lost an average of 31.6% of their preoperative weight. Of the 12 operated on less than one year but more than six months ago, eight have lost an average of 21% of their initial weight. The early failure rate of 33% has been reduced to 15% at present. One death occurred from pulmonary embolus 10 days following discharge, giving a mortality rate of .08%. The complication rate is 10%, comprising two pulmonary emboli, two psychoses, one wound dehiscence, one wound hernia, and ten wound infections, six of which were minor. There have been no complications of ulcer disease, reflux esophagitis, liver disease, renal disease, or metabolic disorders. Gastric partitioning is a safe, fast effective alternative for the surgical treatment of morbid obesity.

“Reversible gastric banding” in surgical treatment of morbid obesity — results of animal experiments

“…These ulcerations, however, were located throughout the whole gastric mucosa and not limited to the area of the cuff. This particular observation and clinical experience with different methods using Silastic or Teflon grafts to obtain stenosis [4,7,9] indicates that ulcerative gastritis in pigs (which are known to have a very sensitive and vulnerable gastric mucosa) is caused rather by stress situation than by mechanic irritation of the cuff.…”

“…As reported in the literature, the diameter of the stenoses should not be more than 12 mm to result in a sufficient oblay of gastric passage [4,7,9]. The difficult evaluation of the extent of stenosis in the animal, which can only be measured by means of either multiple puncture of the valve under sedation or radiologic investigations under general anesthesia should not be a major problem when applied clinically.…”

“…The gastric partitioning operation [7], first reported in 1979, was followed by a m e t h o d described as vertical banded gastroplasty, which is the method mostly used nowadays [4]. The main principle of gastroplasty is the creation of a gastric reservoir of 30-60 ml by means of vertical stapling of the stomach along the lesser curvature with an outlet of no m o r e than 12 mm.…”

Bariatric Surgery in Saudi Arabia

“…Gastric partitioning procedure described by Mason and Ito [1] and Gomez [2] was accepted as the most optimal procedure. Nevertheless, this procedure has undergone numerous modifications [3][4][5]. In 1982, Mason described the vertical banded gastroplasty (VBG) which is now considered one of the operations of choice for weight reduction [6].…”

Suture line ulceration: A complication of gastric partitioning

“…A recently popularized procedure is gastric partitioning [1][2][3][4][5][6][7][8][9][10]. In this operation, a proximal gastric pouch is created by an interrupted transverse staple line and reinforced by sutures [5,8,10,11].…”