BARIATRIC SURGERY AT THE 1ST SURGICAL DEPARTMENT IN PRAGUE - HISTORY AND SOME TECHNICAL ASPECTS

Background: Obesity has been increasing in the Czech Republic over the last 20 years. In 1983 we were one of the first surgical departments in the country which performed bariatric surgery on a regular basis. M ethods: From 1983 to 1986 we performed vertical banded gastroplasty (V BG). Because of a high rate of various complications arising both from the stomach and the wound, we switched in 1986 to 'less aggressive' n onadjustable gastric banding (GB). In 1993 we performed the first lapa roscopic nonadjustable banding, and in 1994 we started laparoscopic pl acement of adjustable gastric bands. Results: In the group of 52 patie nts who underwent VBG and were followed-up, acceptable weight loss res ults (-40.5 kg) were achieved in the 24 months following surgery. The postoperative complications were high; 17.3% gastric staple-line disru ption and 15.3% wound complications (incisional hernias, discharge, et c.). Since 1986, we have performed nonadjustable GB in 150 patients an d achieved weight loss of -38.4 kg in the 24 months following surgery. There was no change in the wound complication rate, but the complicat ions arising from the stomach and the band decreased to 6.3%. Since Ju ne 1993, we have performed 268 procedures laparoscopically, either wit h nonadjustable bands or, since 1994, with the adjustable bands. The w ound complication rate decreased to 0.9%, and one complication (6.6%) was related with the adjustable band. Conclusions: Because of the high rate of postoperative complications in our experience with VBG, we st arted GB in 1986. Since then the number of complications arising from the stomach has decreased substantially. With the laparoscopic techniq ue, there was a further decrease in wound healing problems. With the a djustable GB, a significant decrease in the stomach-related complicati ons occurred. Shorter hospital stays were possible with the laparoscop ic technique. Long-term weight loss results have not been significantl y different among the above mentioned procedures.