Weight Loss and Complications After Vertical Banded Gastroplasty

Abstract

We have performed 124 vertical banded gastroplasties (VBG) according to Mason, except that we used a collar 5.5 cm in circumference. We carried out a midline incision In 68 cases and a left subcostal incision in 56, with double application of a 2-row stapler with reinforcement In the first 69 cases and a single application of a 4-row stapler in 55 (15 with reinforcement, 40 without). We have followed 107 (86.2%) patients for a mean of 30 months (range 3-84). The mortality rate was nil. The intraoperative complications were three spleen lacerations (splenectomy), and the early complications were two gastric leaks (re-intervention) and one gastric bleeding. The late complications were one gastric perforation (re-intervention), four outlet stenoses (one re-intervention), one bleeding by collar erosion and nine ventral hernias (occurring only with the midline incision). The percentage excess weight loss was 46.3 +/- 16.4 at 6 months, 53.4 +/- 17.9 at 1 year, 47.8 +/- 19.6 at 3 years, and 45 +/- 23.3 at 5 years. In 12 cases the weight loss was unsatisfactory (less than 30% of the initial excess weight). Often such failures were due to staple-line disruption. We have had no staple-line disruptions since we stopped performing the reinforcement. VBG has a low incidence of complications, but sometimes these may be serious. In our opinion, the technical procedures which offer a stronger vertical partition give better results for weight loss.

Endoscopic management of eroded prosthesis in vertical banded gastroplasty patients

“…The actual incidence of band erosion is not well known but several large series have reported band erosion rates varying between 1% and 7% [8][9][10]. Reported causes of band erosion include constricting bands, infection of the band material, suturing the band to the stomach, and reinforcement of the circular staple line [11].…”

“…This worked well for conductive material but is not feasible for nonconductive media such as gortex, silastic or other synthetic materials which often are found in gastric prosthesis. Endoscopic scissor transection, first reported in Europe [7], has been successfully applied in a small case series reported by Evans [8].…”

Laparoscopic mesh hiatoplasty for paraesophageal hernias and fundoplications

“…Numerous reports of intestinal erosions are found in the literature, wherein prosthetic materials, polypropylene in particular, have been placed in proximity to the bowel [14,32,34]. Additionally, we know that gastric and esophageal erosions have been reported with the use of the Angelchik prosthesis [26,39], in cases where pledgets are used for hiatal repair and Nissen fundoplication [1, 4,13], and with the use of both mesh and silastic vertical banded gastroplasties [12,35,36,42].…”

Band Erosion in Patients Who Have Undergone Vertical Banded Gastroplasty

“…Several series of patients who have undergone VBG have reported BE rates varying between 1% and 7%. [15][16][17] This complication generally occurred 1 to 3 years after surgery, and patients' initial symptoms were abdominal discomfort and vomiting. A few causes have been thought to produce BE, including excessively tight bands, contamination and infection of the band, and reinforcement of the circular staple line.…”