Silastic Ring Vertical Gastroplasty Research Articles

Short-Term (30-Day) Morbidity of Biliopancreatic Diversion Compared to Roux-en-Y Gastric Bypass as Revisional Procedures for Failed Vertical Banded Gastroplasty.

Silastic ring vertical gastroplasty (SRVG) and vertical banded gastroplasty (VBG) are associated with a high failure rate due to weight regain and complications at long-term follow-up. Consequently, surgical correction for such procedures is warranted. Controversy exists as to which surgical procedure is the ideal choice for such correction. Our aim is to compare short-term outcome of Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) repair for failed VBG/SRVG bariatric procedures. The medical records of patients with failed SRVG who underwent corrective procedures at our institute between 2004 and 2018 were retrospectively reviewed. Patients characteristics, surgical approaches, and intraoperative and post-operative complications were examined and compared. Sixty patients in total underwent a surgical corrective procedure for failed SRVG. Thirty-one patients underwent RYGB, and 29 patients underwent BPD. Major complications were seen more in the RYGB group (35% = 11) compared to the BPD (6.9% = 2). Even though anastomotic leak rates were not statistically significant (p = 0.053), an apparent tendency for such a complication was noted in the RYGB group. RYGB procedure had an increased 30-day complication rate (p = 0.055) compared to RYGB. Laparoscopic approach had statistically fewer complications than open approach. No mortality was observed in either group. Our study showed that BPD is a safe option with less complication rates than RYGB in the short-term period for surgical correction of failed VBG/SRVG procedures.

One Anastomosis Gastric Bypass for Revision of Restrictive Procedures: Mid-Term Outcomes and Analysis of Possible Outcome Predictors.

Revisional one anastomosis gastric bypass (OAGB) for insufficient weight reduction following primary restrictive procedures is still investigated. We report mid-term outcomes and possible outcome predictors. Single-center retrospective comparative study of revisional OAGB outcomes (2015-2018) following laparoscopic adjustable gastric banding (LAGB) and sleeve gastrectomy (SG); silastic ring vertical gastroplasty (SRVG) is separately discussed. In all, 203 patients underwent revisional OAGB following LAGB (n = 125), SG (n = 64), and SRVG (n = 14). Comparing LAGB and SG, body mass index (BMI) at revision were 41.3 ± 6.6 and 42 ± 11.2kg/m2 (p = 0.64), reduced to 31.3 ± 8.3 and 31.9 ± 8.3 (p = 0.64) at mid-term follow-up, respectively. Excess weight loss (EWL) > 50% was achieved in ~ 50%, with EWL of 79.4 ± 20.4% (corresponding total weight loss 38.5 ± 10.4%). SRVG patients had comparable outcomes. Resolution rates of type 2 diabetes (T2D) and hypertension (HTN) were 93.3% and 84.6% in LAGB compared with 100% and 100% in SG patients (p = 0.47 and p = 0.46), respectively. In univariable analysis, EWL > 50% was associated with male gender (p < 0.001), higher weight (p < 0.001), and BMI (p = 0.007) at primary surgery, and higher BMI at revisional OAGB (p < 0.001). In multivariable analysis, independent predictors for EWL > 50% were male gender (OR = 2.8, 95% CI 1.27-6.18; p = 0.01) and higher BMI at revisional OAGB (OR = 1.11, 95% CI 1.03-1.19; p = 0.006). Revisional OAGB for insufficient restrictive procedures results in excellent weight reduction in nearly 50% of patients, with resolution of T2D and HTN at mid-term follow-up. Male gender and higher BMI at revision were associated with EWL > 50% following revisional OAGB. Identification of more predictors could aid judicious patient selection.

Combined laparoscopic Roux-en-Y gastric bypass reversal and gastric banding to treat severe hyperinsulinemic hypoglycemia: A case report and surgical video.

Non insulinoma pancreatogenous hypoglycemia syndrome (NIPHS) is a recently described complication of Roux-en-Y gastric bypass (RYGB) characterised by pathologic features of nesidioblastosis and hyperinsulinemic hypoglycemias that can occur months to years after surgery. Increased incretin production appears to be one of the involved mechanisms. Currently, there is no Gold Standard treatment. We present the case of a 57-year-old woman with a history of silastic ring vertical gastroplasty (SRVG) converted into RYGB who suffered from severe daily episodes of neuroglycopenia due to NIPHS, with poor response to conservative and medical treatments. At first, as it is suggested in recent literature, we decided to evaluate whether reversal would efficiently reduce episodes of hypoglycemia by attempting gastrostomy tubing of the remaining stomach. Since gastrostomy proved to be efficient, we reversed the RYGB laparoscopically and added a gastric banding to keep control over the patient's weight. After an asymptomatic period of two months, mild hypoglycemias recurred, on average once every three weeks, easily managed by sugar ingestion. A preexisting gastroparesis was worsened by the intervention, possibly caused by vagus nerve injury secondary to the multiple gastric procedures. A year later, the patient returned to a regular lifestyle. Her weight gain was limited to 8 kg thanks to appropriate adjustments of the gastric band. Treatment of NIPHS includes appropriate diet, pharmacotherapy and surgical procedures; partial or total pancreatectomy, laparoscopic reversal of RYGB (with or without sleeve gastrectomy) and gastric banding have been proposed. This is the first described case of severe NIPHS after RYGB successfully treated with combined laparoscopic reversal of gastric bypass and gastric banding to avoid weight regain. We expect this novel approach will help to overcome hypoglycemic episodes from NIPHS, while maintaining weight control and preventing the resurgence of obesity-related comorbidities. Further studies with long term follow-up are necessary. • Non insulinoma pancreatogenous hypoglycemia syndrome is a recently described complication of Roux-en-Y gastric bypass • Currently, there is no Gold Standard treatment. • In this case, we successfully performed a combined laparoscopic reversal of gastric bypass and gastric banding

Roux-en-Y Gastric Bypass Versus One Anastomosis Gastric Bypass as a Preferred Revisional Bariatric Surgery After a Failed Silastic Ring Vertical Gastroplasty.

Over the years, the silastic ring vertical gastroplasty (SRVG) has shown poor long-term outcomes with both weight regain and complications. Therefore, most bariatric surgeons have been presented with the need to perform a successful and safe conversion procedure. Yet the preferred and recommended conversion surgery regarding weight loss, comorbidity improvement, and postoperative complications remains under debate. The aim of this study is to compare the outcomes of conversion from SRVG with either Roux-en-Y gastric bypass (RYGBP) or one anastomosis gastric bypass (OAGB). A retrospective study was conducted from our bariatric surgery units' database. We reviewed the files of patients who underwent either a RYGBP or OAGB after a previous SRVG. Demographics, obesity-related comorbidities, BMI before and after the procedure, postoperative complications, and length of hospital stay were analyzed. Between May 2008 and August 2018, fifty-four patients underwent conversion from a failed SRVG. Twenty-one patients underwent conversion to OAGB (39%), and thirty-three patients underwent conversion to RYGBP (61%). Major complications were reported in 9.5% of the OAGB group and 15.1% of the RYGBP group. At a mean follow-up of 28months, the OAGB group achieved a 78.5% excess BMI loss compared with 57.6% in the RYGBP group (p = 0.137). One patient (4.7%) of the OGBP group and 5 (15.1%) of the RYGBP group needed reoperations due to complications (p = 0.224). The OGBP is gaining popularity and evidence as an effective and safe procedure. Here we show the successful utilization of the OGBP, when compared with RYGBP, as a revisional procedure after SRVG.

Long-Term (over 13Years) Follow-Up of Vertical Band Gastroplasty.

Silastic ring vertical gastroplasty (SRVG) was a popular restrictive procedure 2 and 3 decades ago. However, it was associated with severe complications and a high rate of reoperation due to failure. Examination of long-term outcomes of those patients that underwent SVRG is limited. The aim of our study was to determine the long-term outcomes (over 13years) of SRVG in our institution and to review the literature of long-term outcomes following SVRG. Following IRB approval, we reviewed patients who underwent SRVG between 1996 and 2001. Weight loss parameters, preoperative comorbidities, were compared to the follow-up data. In total, 92 patients underwent SRVG, and 89 met the inclusion criteria. Mean age was 52.4 ± 10.6years and body mass index (BMI) was 46.1 ± 6.5Kg/m2. Preoperative comorbidities rate included diabetes mellitus (19.1%), hypertension (32.5%), hyperlipidemia (21.3%), joints disease (6.7%), mood disorders (7.8%), and dyspeptic disorders (3.3%). Mean length of follow-up was 208.5 ± 16.8months. Thirty-eight patients (43%) had to be reoperated due to complications and 24 (30%) had an additional bariatric surgery. Follow-up BMI was 34.2 ± 9.8Kg/m2 (p< 0.001). There was no improvement in any of the comorbidities; incidence of joint disease and dyspeptic disorders were significantly higher at the follow-up (p= 0.03, p< 0.001, respectively). SRVG procedure was associated with high rates of reoperations and revisions. The majority of our patients showed poor resolution of comorbidities and even worsening of some. Our data confirms that SRVG is not suitable as a bariatric procedure.

Weight Loss and Late Complications after Silastic Ring Vertical Gastroplasty. A 10 Year Follow-up.

Severe obesity is a public health care system challenge that requires bariatric surgery. Among the plethora of bariatric surgery techniques silastic ring vertical gastroplasty (SRVG) is a safe and efficient restrictive method that has been successfully used previously. However, it's performance by open approach has been abandoned and replaced by other methods using the laparoscopic method. The aim of the present study was to investigate patients with severe obesity submitted to open SRVG and to report our results over a period of 10 years in terms of weight loss, late complications and surgical re-interventions. 112 severely obese patients submitted to open SRVG between years 2008- 2009 were investigated retrospectively for body mass index (BMI), percent excess BMI loss (%EBMIL), late surgical complications and reoperations. 41.96% of the patients were followed up 10 years after SRVG. Results: The initial mean BMI was 47.38 +- 7.59 kg/m2 and dropped statistically significant (p 0.001) to 31.05 +- 6.54 kg/m2 by the first year after SRVG. The mean BMI was rather stable along the first 5 years after SRVG when it started to increase gradually, reaching 35.93 +- 7.20 kg/m2 by the 10th year of follow-up when it remained still significantly lower (p 0.001) as compared to the mean baseline value. The %EBMIL was 79% at one year after surgery and reached 51% by the 10th year of follow-up. The most frequent late complications after SRVG were stoma stenosis (8.92%), enlargement of the stoma (8.03%) and incisional hernia (3.36%). As a consequence of stoma stenosis the ring has been removed in all cases. In 2 cases, after the ring removal, the patients underwent gastric bypass. SRVG is a safe and efficient restrictive technique of bariatric surgery open to many options to be revised, leading to a successful sustained long term weight loss and maintenance. Stoma stenosis, enlargement of the stoma and incisional hernia are the most frequent late complications after SRVG requesting reoperations.

The Impact of Technical Surgical Aspects on Morbidity of 984 Patients after Sleeve Gastrectomy for Morbid Obesity.

To evaluate early complications after LSG in regard of staple line reinforcement (SLR), bougie size, previous bariatric surgery and surgeon experience. A retrospective cohort study of LSG patients at the Soroka University Medical Center (SUMC). Data was collected from digitalized database. Nine hundred eighty-four LSG cases were performed by three surgeons. Seventy-eight complications were observed (7.9%): 44 mild (4.5%) and 34 severe (3.4%). Over-sewing of staple line was performed in 689 cases (76.2%), and no SLR in 217 cases (24.0%) without significant impact on mild or severe early morbidity. Bougie size 36 Fr or smaller was used in 635 cases (73.0%) without significant differences in early complications compared to 235 cases (27.0%) with larger bougie. LSG, as revision bariatric surgery, was performed in 273 cases (27.7%). Concomitant removal of a gastric band was performed in 199 of these cases (72.9%). History of silastic ring vertical gastroplasty (SRVG) was recorded in 10 cases (1.0%). Previous bariatric surgery was a significant risk factor for early mild complications (OR=1.14, p value=0.02), but not for severe ones (OR=0.79, p value=0.09). Concomitant removal of gastric band did not affect this result. The risk for mild complication was significantly reduced with surgeon experience achieving 100 cases. SLR or bougie size is not affecting LSG morbidity, but previous bariatric history and surgeon experience are significant factors for early mild complications.

Laparoscopic conversion of failed vertical banded gastroplasty to Roux-en-Y gastric bypass or biliopancreatic diversion

BackgroundThe Silastic ring vertical gastroplasty (SRVG), a modification of Mason’s vertical banded gastroplasty (VBG), was the restrictive procedure of choice for many bariatric surgeons. The reoperation rate for failure/complications reported in long-term studies is approximately 50%. ObjectiveWe report our experience in laparoscopic conversion of failed SRVG to Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD). SettingA single surgeon’s experience at a university-affiliated hospital. MethodsBetween March 2006 and April 2014, 39 patients underwent conversion of SRVG to laparoscopic RYGB (n = 25) or BPD (n = 14). The outcomes were retrieved from a prospectively collected database and analyzed. ResultsMost (89%) of the conversions were completed laparoscopically. The mean operative time was 195 and 200 min for RYGB and BPD, respectively. There was no mortality. Complications occurred in 11 patients (28%), 5 in RYGB (19%) and 6 in BPD (42%). At the 3-year follow-up, the mean body mass index decreased from 47±8 kg/m2 to 26±4 kg/m2 for BPD, and from 43 kg/m2 to 34 kg/m2 (P = .05) for RYGB. Weight (kg) decreased from 110 to 84 and to 92, and from 123 to 81 and 68, at 1 and 3 years for RYGB and BPD, respectively. ConclusionsThe weight loss for RYGB and BPD was equal at 1 year but tended to be better for BPD at 3 years postoperatively. Laparoscopic conversion of failed VBG to RYGB or BPD was feasible, but it was followed by prohibitively high complication rates in BPD patients. The risk:benefit ratio of these procedures in this series is questionable.

Laparoscopic Conversion of Failed Silastic Ring Vertical Gastroplasty (SRVG) and Vertical Banded Gastroplasty (VBG) Into Biliopancreatic Diversion (BPD)

BackgroundThe Silastic ring vertical gastroplasty (SRVG), a newer modification of Mason’s vertical banded gastroplasty (VBG), was the restrictive procedure of choice for many bariatric surgeons before the advent of the laparoscopic adjustable gastric banding. However, a high rate of reoperations for failure and severe complications was reported in long-term studies. Around 50 % of the patients underwent conversion to other bariatric procedures. ObjectivesThe aim of this study is to report our experience in laparoscopic conversion of failed VBG and SRVG to biliopancreatic diversion (BPD). SettingsThe setting of the study was at the University hospital. MethodsBetween March 2010 and July 2013, 12 patients underwent laparoscopic conversion of VBG and SRVG to BPD. Using a prospectively collected database, we analyzed their data and outcomes. ResultsEighty-six percent of the conversions were successfully completed laparoscopically. The mean operative time was 220 min. There was no mortality. Perioperative complications occurred in four patients (33 %). One (9 %) late complication, an adhesional small bowel obstruction, was encountered later than 30 days postoperatively. The follow-up rate was 100 %, but only three patients reached 3 years at the time of this writing. At a mean follow-up of 19 (3–40) months, the mean body mass index (BMI) decreased from 45.3 to 27.8 kg/m2. Percent excess weight loss (EWL) was 65.7, and 86.3 % at 1 and 3 years, respectively. ConclusionLaparoscopic conversion of failed VBG to BPD is feasible and effective in further reducing weight in morbidly obese patients. Weight loss continues beyond the first postoperative year. However, the complication rate is much higher than in the primary procedure.

Obstetric outcomes after restrictive bariatric surgery: What happens after 2 consecutive pregnancies?

BackgroundThe objective of this study was to compare the outcomes of 2 consecutive pregnancies of the same women who conceived after restrictive bariatric surgeries. MethodsA retrospective study comparing consecutive pregnancy outcomes of the same women, who conceived before and twice after a restrictive bariatric surgery, was conducted. ResultsThis study included 109 women, and therefore, 327 paired pregnancies: 109 pregnancies preceded and 218 followed restrictive bariatric surgery (87% had laparoscopic banding, and 13% had silastic ring vertical gastroplasty). Both prepregnancy and predelivery body mass index were significantly lower after bariatric surgery (36.7±4.4 versus 31. 5±5.5, P<.001; 40.6±5.5 versus 35.3±6.1, P<.001; respectively). This effect was preserved at the subsequent pregnancy (31.5±5.5 versus 31.3±6.3, P = .609, and 35.3±6.1 versus 35.1±5.9, P = .706, respectively). The rates of hypertensive disorders and gestational diabetes mellitus were significantly lower after the bariatric operation, for the first and the second pregnancy (21% versus 7.4% and 4.7%, P = .009, and 19% versus 5.6% and. 6.6%, P = .007, respectively). The rate of macrosomic newborn was significant lower in the second postbariatric pregnancy (11.1% before versus 1.1% after second pregnancy, P = .02). Using multiple logistic regression models controlling for maternal age, prepregnancy body mass index, and the type of surgery, the reduction in hypertensive disorders (adjusted odds ratio (OR) .3, 95% confidence interval (CI) .12–.82; P = .018 for the first postoperative pregnancy and adjusted OR .2, 95% CI .06–.64; P = .007 for the second postoperative pregnancy), and gestational diabetes mellitus (adjusted OR .2, 95% CI .06–.48; P = .001 for the first postoperative pregnancy and adjusted OR .3, 95% CI .05–.51; P = .002 for the second postoperative pregnancy) remained significant. ConclusionsA significant decrease in pregnancy complications, such as hypertensive disorders and gestational diabetes mellitus, is achieved after a restrictive bariatric surgery. This improvement is maintained at the second subsequent pregnancy.

Nitric Oxide, Oxidant Status and Antioxidant Response in Morbidly Obese Patients: the Impact of 1-Year Surgical Weight Loss

The aims of this study were to evaluate nitric oxide (NO) metabolites (nitrite/nitrate NO x ) as proinflammatory parameter and total oxidant status (TOS) as well as total antioxidant response (TAR) as oxidative stress (OS) markers in morbidly obese (MO) patients in comparison with normal-weight healthy (NWH) subjects and to determine the post-bariatric surgery changes of NO x and OS indicators in relation with weight loss. We examined serum NO x , TOS, and TAR in a bariatric group of MO patients and a NWH control group (n = 23 each group). In the NWH group, serum was examined once, while in the MO group, serum was examined before and at 3, 6, and 12months after silastic ring vertical gastroplasty (SRVG). Serum NO x and TOS values were higher (p < 0.001), while TAR level was lower (p < 0.001) in MO patients as compared to the NWH group. No significant changes occurred at 12months after surgery in the MO group as far as the NO x (p = 0.93), TOS (p = 0.11), and TAR (p = 0.15) levels were concerned as compared to baseline values. However, NO x increased at 6 months after surgery (p < 0.008) and then decreased by the 12th month after SRVG (p < 0.008), reaching almost baseline values. At baseline, there was a high production of proinflammatory and OS markers in MO patients. SRVG surgical weight loss was not accompanied by significant changes of these parameters at 1year after surgery.

Laparoscopic Gastric Banding as Revisional Procedure to Failed Vertical Gastroplasty

Vertical gastroplasty (VG) was worldwide and until recently a very popular restrictive bariatric procedure. Unfortunately, many patients required revisional surgery for failure of this technique. The present study aimed to evaluate retrospectively the feasibility, safety, and efficiency of conversion of failed VGs to laparoscopic adjustable gastric banding (LAGB). Forty patients underwent LAGB as revisional surgery between August 2001 and June 2008. Preceding VGs were performed either by open procedure {silastic ring vertical gastroplasty (SRVG, n = 21) and vertical-banded gastroplasty (VBG, n = 10)} or by laparoscopy {laparoscopic silastic ring vertical gastroplasty (L-SRVG, n = 9)}. The delay between initial and revisional surgery was significantly shorter for SRVG (5.5 +/- 1.7 years; p < 0.001) as compared to VBG and L-SRVG (9.2 +/- 2.3 and 9.4 +/- 1.8 years, respectively). The reasons for failure of the VG were: disruption of the staple line (n = 23), excessive enlargement of the gastric pouch (n = 15) and inefficient stoma (n = 2). Patients were qualified for revisional surgery in case of uncontrolled weight regain with or without frequent vomiting. There were three conversions from laparoscopy to laparotomy (7.5%). There was no mortality. Minor morbidity was 12.5%. There were two major complications (5%); one incarcerated port-site hernia requiring small bowel resection, and one band erosion necessitating band removal. The mean BMI dropped from 38.9 kg/m(2) before revision to 30.7 kg/m(2) after conversion to LAGB (follow-up 6-88 months). Conversion of failed VGs to gastric banding is safe and efficient. The morbidity rate is acceptable. Gastric banding to correct failing VG is a reasonable option when performed in selected patients.

Pregnancy Outcome in Patients Following Different Types of Bariatric Surgeries

The objective of this study was to investigate pregnancy outcome of patients following different types of bariatric surgery. A population-based study includes all pregnancies of patients with bariatric surgeries delivered during 1988-2008. Pregnancy outcome was compared between the different types of surgeries. This retrospective study included 449 deliveries: 394 deliveries following pure restrictive operations-laparoscopic gastric banding (LAGB; n = 202), silastic ring vertical gastroplasty (SRVG; n = 136), and vertical-banded gastroplasty (VBG; n = 56)-and 55 deliveries following restrictive and malabsorptive Roux-en-Y gastric bypass (RGB). While no significant differences were noted between the groups regarding body mass index (BMI) before the bariatric operations or prepregnancy BMI, patients following LAGB had significantly higher BMI before delivery (36.8 +/- 5.9 kg compared to the SRVG 33.4 +/- 6.0, VBG 34.2 +/- 5.4, and RGB 34.9 +/- 6.8 groups; p < 0.001). Following LAGB, patients had higher weight gain during pregnancy (13.1 +/- 9.6 kg) compared to the SRVG (8.8 +/- 7.4), VBG (8.5 +/- 8.0), and RGB (11.6 +/- 9.6; p < 0.001) groups. The interval between operation and pregnancy was shorter in the LAGB group (22.8 months) compared to the SRVG (41.0) and the VBG (42.1) groups and was significantly higher in the RGB group (57.4; p < 0.001). Birth weight was significantly higher among newborns of patients following RBG (3,332.8 +/- 475.5 g) compared to the restrictive procedures (3,104.3 +/- 578.7 in the LAGB, 3,086.7 +/- 533.1 in the SRVG, and 3,199.2 +/- 427.2 in the VBG groups). No significant differences in low birth weight (<2,500 g) or macrosomia (>4,000 g), or low Apgar scores or perinatal mortality were noted between the groups. There is no difference in the affect on pregnancy outcome among the different forms of bariatric surgeries; all procedures have basically comparable perinatal outcome.

Feasibility of Sleeve Gastrectomy as a Revision Operation for Failed Silastic Ring Vertical Gastroplasty

Restrictive bariatric operations are efficient with low morbidity but entail high rate of failure on follow up of several years. We present our experience in laparoscopic revision of patients who previously underwent silastic ring vertical gastroplasty (SRVG) into laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB). Data on 12 patients who underwent revisional operations after SRVG was prospectively collected. Six patients underwent LRYGB and six patients underwent LSG. The pathogeneses for failures of SRVG were disruption of staple line, enlargement of gastric pouch, and opening of the ring. The average age and body mass index (BMI) were 39 and 43, respectively, in the LSG group versus average age and BMI of 39 and 45, respectively, in the LRYGP group (p = 0.45 and p = 0.35, respectively). The average operative time were 206 and 368 min in the LSG and LRYGB groups, respectively (p < 0.01). There were five postoperative complications among LSG group versus two complications in LRYGB group (p < 0.01). Patients who underwent LSG suffered from the following complications: staple line leak in two patients, intra-abdominal hematoma in one patient, intra-abdominal collection in one patient, and gastric outlet obstruction in one patient. Anastomotic leak and wound infection were the complications seen among patients underwent LRYGB. All complications were treated conservatively without necessitating immediate reoperations. Follow-up has shown adequate reduction of body weight and improved quality of life in both groups of patients. Revisional bariatric operation is a challenging laparoscopic procedure with higher morbidity compared to primary bariatric operations. Morbidity of LSG compared to LRYGB as a revisional procedure for SRVG is significantly higher.

Changes in Blood Lipid Levels following Silastic Ring Vertical Gastroplasty

The purpose of this study was to evaluate the effect of the Silastic Ring Vertical Gastroplasty (SRVG) operation on blood lipid levels in obese men and women during the first year following surgery. 25 patients (11 men and 14 women) age 17-50 (mean 33 years) who suffered from morbid obesity (BMI >40, range 45.9+/-4.7 kg/m2) underwent SRVG. Blood samples were collected before operation and 3, 6 and 12 months following surgery and tested for: triglycerides, total cholesterol, HDL-C, LDL-C, VLDL-C, and Lp(a). Both men and women lost weight significantly. Mean BMI decreased from 48.0 to 32.5 kg/m2 in men and from 44.3 to 29.0 kg/m2 in women (P<0.01). Blood lipid levels 1 year following surgery demonstrated the following changes: In women, triglycerides, total cholesterol, LDL, VLDL cholesterol and Lp(a) decreased from 160.7 mg/dL to 67.7 mg/dL (P<0.01), from 220 mg/dL to 189 mg/dL, from 138.3 mg/dL to 111 mg/dL, from 17 mg/dL to 12 mg/dL, and from 77.5 mg/dL to 18.5 mg/dL (P<0.01), respectively, and HDL increased from 45 mg/dL to 50.5 mg/dL. In men, triglycerides, total cholesterol, LDL, VLDL cholesterol and Lp(a) decreased from 246 mg/dL to 140 mg/dL (P<0.01), from 206 mg/dL to 170 mg/dL (P<0.01), from 134 mg/dL to 112 mg/dL (P<0.05), from 25 mg/dL to 15 mg/dL (P<0.01), and from 30.3 mg/dL to 11.6 mg/dL (P<0.01), respectively, and HDL increased from 31.3 mg/dL to 37.4 mg/dL (P<0.05). SRVG improved blood lipid profile in obese patients during the first year following surgery. Reduction in cholesterol and its fractions reaches statistical significance only in men.

Long-term Follow-up on the Effect of Silastic Ring Vertical Gastroplasty on Weight and Co-Morbidities

Silastic ring vertical gastroplasty (SRVG) is a simple, effective and reproducible restrictive operation for the treatment of morbid obesity. Over the last years, it has lost its popularity due to the development of adjustable gastric banding systems performed laparoscopically. In order to evaluate the long-term effect of SRVG on weight loss and co-morbidities, we reviewed the results of SRVG operations in our institution. We reviewed SRVG operations performed in our University-affiliated General Hospital. Data was collected from the patients' in-patient records, their outpatient-clinic files, and from a telephone interview. Between 1989 and 2001, 162 patients were operated upon. Complete follow-up was obtained of 115 patients (71%). The mean follow-up was 7.1 +/- 3 years (range 4 to 16 years). Mean preoperative BMI was 47 kg/m2 (range 34 to 69 kg/m2). Maximal weight loss was obtained within 1 year to a mean BMI of 29 kg/m2, with a mean excess BMI loss of 67%. Subsequently, there was a small increase in BMI, which stabilized at 34 kg/m2 up to 15 years after the operation. A rapid, significant improvement in obesity-related co-morbidities was observed regarding hypertension (81%), diabetes (100%), sleep disorders (90%), osteoarthritis (83%) and ischemic heart disease (75%). There was no peri-operative mortality. Early complication rate was 10%. Late complications included postoperative ventral hernia (18%), esophagitis (31%), ring stricture (19%), ring erosion (2 patients), failure of staple line (8%) and obstruction of the pouch with food (19%). 35 patients (30%) required another procedure, 8 of them were eventually converted to other bariatric operations, and 2 patients had the ring removed and refused another bariatric procedure. The overall satisfaction rate was 86%. SRVG is a simple, safe and effective bariatric operation in selected patients with morbid obesity. It results in a rapid, excellent effect on obesity-related co-morbidities and good long-term effect in weight loss, which compares positively with other, more complicated bariatric operations.

Endoscopic therapy for main pancreatic-duct rupture after Silastic-ring vertical gastroplasty

Acute pancreatitis with pancreatic-duct rupture and fluid collections is a rare complication after Silastic ring vertical gastroplasty. It can be attributed to pancreatic trauma occurring during surgery. Endoscopic therapy with transmural drainage of collections was performed in 4 patients who had undergone Silastic ring vertical gastroplasty and who had presented with acute pancreatitis with main pancreatic-duct rupture at the body of the pancreas. All patients had successful transmural drainage with cystogastrostomy, followed by stent insertion. Only one patient had a late recurrence because of stent migration. The major difficulty was related to positioning of the endoscope and the possible need of pneumatic dilation of the outlet channel to reach the puncture site. Endoscopic therapy is useful in acute pancreatitis with pancreatic-duct rupture after Silastic-ring vertical gastroplasty and, although technically difficult, could be considered as a first-line approach in the management of these patients.

Inhibin B in Men with Severe Obesity and After Weight Reduction Following Gastroplasty

Although the effect of obesity on some gonadal functions in men is known, its effect on Sertoli cell function has not been reported. We tested the hypothesis that the serum inhibin B level is decreased in men with severe obesity, and that this change persists after significant weight loss. We measured gonadal hormones in 17 obese men before (baseline) and after weight reduction following silastic ring vertical gastroplasty (SRVG). Their baseline body mass index (BMI) was 44.3 ± 1.7 kg/m2, mean ± standard error of the mean (SEM). Seven of 16 obese men (44%), compared to 8 of 69 reference men (12%), had a baseline inhibin B level below 100 pg/ml (p < 0.01). A weak inverse association was found between inhibin B and BMI before weight reduction (r = −0.494, p = 0.072). Furthermore, FSH levels, which were weakly inversely associated with inhibin B levels (r = −0.482, p = 0.059), were inappropriately unelevated in 5 of the 7 obese men with low (below 100 pg/ml) inhibin B. After a weight reduction of 40 ± 2.6 kg, mean ± SEM, following surgery, the obese men’s BMI was 31.6 ± 1.5 kg/m2, mean ± SEM, and inhibin B normalized in 3 of the 7 patients with low inhibin B. Despite weight reduction, FSH remained inappropriately unelevated in 2 of the 4 patients whose inhibin B remained low. This study also confirmed previously published findings that obese men have low serum total and free testosterone and relative hypogonadotropic (low LH) hypogonadism that may persist after weight reduction. In conclusion, Serum inhibin B levels in obese men may be low. This may be due to relative hypogonadotropic (also low FSH) hypogonadism.

Nutritional Behavior as a Predictor of Early Success after Vertical Gastroplasty

Patients' nutritional habits are seldom taken in account in planning surgery for clinically severe obesity. Our proposed hypothesis is that the patient's nutritional behavior may influence the outcome of bariatric surgery. The impact of nutritional behavior on the postoperative weight-loss was evaluated before and after bariatric surgery. A 6-month prospective consecutive case study was carried out on patients undergoing a Silastic ring vertical gastroplasty (SRVG). Patients were interviewed and examined before and at 1, 3 and 6 months after surgery. Demographic and clinical data were collected from the patients' medical charts. Nutritional data collected from a self-filled questionnaire included information on hunger and satiety perception, nutritional behavior (intake, eating habits and maximum consistency of consumed food) and concomitant symptoms. The sample included 69 patients: 56 were women (81%); average age was 32 years (range 18 50). Average preoperative BMI was 43.4 +/- 5.3 kg/m2 (range 35-58). 6 months after surgery, BMI was 30.3 +/- 3.8 kg/m2 (range 21-42). Weight loss forecast models showed a statistically significant role of factors related to: anthropometrical preoperative data, hunger perception, prevalence of oral mucosal sore, and nutritional behavior. The short nutrition outcomes after gastric restrictive surgery were looked at, with their impact on weight-loss success. The Eating Status concept should be part of a systematic profiling of morbidly obese patients for preoperative nutritional behavior and postoperative nutritional education, to achieve the best comprehensive treatment in regard to weight loss and quality of life.

Results of Silastic Ring Vertical Gastroplasty More Than 6 Years after Surgery: Analysis of a Cohort of 214 Patients

Among the different techniques of surgical treatment for morbid obesity, silastic ring vertical gastroplasty (SRVG) is an alternative, effective and easily reproducible technique. The aim of this study is to evaluate a cohort of patients >6 years after SRVG for morbid obesity. From 1991 to 1996, 273 consecutive patients were eligible for SRVG. The evaluation criteria included weight loss, evolution of co-morbidities, long-term morbidities, satisfaction of patients and quality of life. Among these 273 patients, 1 patient died in the postoperative period (0.4%). Postoperative morbidities occured in 27 patients (10%). The long-term follow-up involved 213 patients (78%). Late postoperative complications consisted of outlet stoma stenosis (14%), staple-line dehiscence (5.6%) and incisional hernia (8.5%). 23 patients (10%) needed a re-do operation. Co-morbidities drastically improved. BMI fell from 45.3 to 30.7. Failure of SRVG was statistically associated with male gender and super-obese patients. 69% of the patients were satisfied, and 73% would recommend this operation. SRVG is very effective in a selected group of morbidly obese patients.