Gastroplasty in morbid obesity: a progress report.

Abstract

AbstractThe lower mortality and morbidity rates of the gastric partitioning operations seem to be the primary reason for their increasing popularity among surgeons everywhere. Two hundred patients in our series underwent gastroplasty for morbid obesity. A measured 60‐ml proximal gastric pouch is formed as the TA‐90 is doubly applied across the upper stomach, just distal to the esophagogastric junction. The egress channel is located on the greater curvature, supported by a continued seromuscular inverting layer using 2‐0 polypropylene suture and a second interrupted inverting layer using 4‐0 Dacron® sutures. There were 154 females and 46 males in the series. The mean age was 34.2 years and the mean kg overweight, 67.4. The early postoperative complication rate was 19%, including 1 cardiac death, for a 0.5% mortality rate. Twelve percent revision rate included 15 staple line disruptions, 3 enlarged channels, 4 channel stenoses, and 2 enlarged pouches. Staple line dehiscence continues to be of concern with stapling in continuity. Liquid or pureed diet restriction for the first 12 postoperative weeks decreases the incidence of this complication. The second application of TA‐90 and the preservation of adequate blood supply to the pouch are important factors in the preservation of the integrity of the staple line. Ninety percent of total weight loss occurred at 12 months. Weight loss was maintained at 18 and 24 months.