LAPAROSCOPIC ANTERIOR GASTROPLASTY - A PRELIMINARY-REPORT OF A NEW TECHNIQUE

Background: The treatment of the morbidly obese patient is difficult b ecause compliance with dietary regimens is poor. As a result, most wei ght reduction programs fail very quickly. Surgical treatment, on the o ther hand, provides a reliable method for sustained weight reduction. The most frequently performed procedure has been the vertical banded g astroplasty. Adaptation of the standard open procedure to laparoscopic techniques has been technically difficult and imprecise. We have deve loped, in the laboratory, an anterior wall banded gastroplasty that ca n be performed precisely and reproducibly using laparoscopic technique s. Methods: Five Yorkshire pigs were used in attempt to laparoscopical ly perform the standard vertical banded gastroplasty. The procedure wa s difficult and was associated with a risk of staple Line leak and wit h bleeding along the lesser curvature of the stomach. Furthermore, a r eproducible pouch of proper dimension could not be created reliably. F ifteen animals were then used to develop a new technique using a small gastric pouch based on the anterior gastric wall. Results: A reproduc ible pouch, 4 cm in length, was created over an 18-Fr nasogastric tube . A standard polyproylene band of 5.2 cm in length was utilized at the gastric pouch outlet. Conclusions: This operation can be reproduced a ccurately and has not demonstrated any leaks on postmortem examination .