VERTICAL BANDED GASTROPLASTY BY LAPAROSCOPIC TECHNIQUE IN THE TREATMENT OF MORBID-OBESITY

From October 1993 through May 1994, 38 consecutive morbidly obese pati ents underwent a laparoscopic vertical banded gastroplasty (VBG). Duri ng the operation a gastric window was made by a 25-mm circular stapler ; and the vertical staple line, establishing the gastric pouch, was co nstructed by using a 60-mm, four-row linear stapler. The outflow stoma was reinforced by a Gore-Tex band and calibrated to have an internal diameter of 9 mm. Three patients had to be converted to open surgery d uring the initial laparoscopic procedure because of insufficient opera tive access. Another three patients had to be reoperated during subseq uent postoperative courses, one laparoscopically to reinforce a vertic al staple line defect caused by a transected nasogastric tube, another because of an open reoperation during the first postoperative day for a rupture in the vertical staple line, and, finally, a patient was re explored because of the present of postoperative fever with a left-sid ed pleuropneumonia and subphrenic accumulation of fluid. However, duri ng the operation no leakage or any other local complications were dete cted. The subsequent postoperative courses were uneventful in all thes e patients. Compared with the reference group comprising the latest co nsecutive 17 obese patients operated with open VBG before the introduc tion of the laparoscopic technique, the laparoscopy group had less pos toperative pain and had mobilization sooner. In the latter group, we r ecorded an improved respiratory status during the early postoperative period, as reflected by increased oxygen saturation and peak exspirato ry flow rates as well as a lower body temperature. In conclusion, lapa roscopic VBG is technically feasible and can be safely performed. Our early postoperative experiences suggest that these patients have a sho rter and less cumbersome postoperative recovery period compared with c onventionally operated obese patients. The long-term follow-up of thes e patients will determine whether these initial advantages of the lapa roscopic approach are corroborated by comparable effects on weight con trol.