THE WEIGHT-REDUCTION OPERATION OF CHOICE - VERTICAL BANDED GASTROPLASTY OF GASTRIC BYPASS

BACKGROUND: Despite important advances in the field of bariatric surge ry over the last 40 years, no single operation has clearly emerged as the optimum procedure. Over the last decade, however, attention has fo cused on vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypa ss (RGB). PATIENTS AND METHODS: We compared 329 VBG procedures consecu tively performed in 328 patients, and 623 VBG-RGB operations in 560 pa tients for mortality, early and late complications requiring reoperati on, and for weight loss up to 5 years. In 272 VBG-RGB operations, the gastric segments were stapled in continuity, and in 351 cases, the gas tric segments were stapled and completely separated. RESULTS: Early co mplications were few for both procedures, Unsatisfactory weight loss w as the most frequent late complication among VBG patients, whereas rev ision for staple-line disruption was the most common cause for late re operation in the VBG-RGB group. The incidence of staple-line disruptio n was 22% for VBG-RGB patients when gastric segments were stapled in c ontinuity and 2% when gastric segments were completely divided (P <0.0 001). Weight loss for the VBG patients and VBG-RGB patients at 5 years was 47% and 62%, respectively (P <0.0001). CONCLUSION: Our data sugge st, as others have shown, that RGB is a better weight-loss operation t han VBG. A lesser curvature vertical pouch stapled in continuity with the excluded stomach can be associated with a high rate of staple-line disruption in RGB. Separation of gastric segments appears to signific antly diminish this complication (P <0.0001). Late complications now a re fewer, and VBG-RGS is our weight-reduction procedure of choice.