"No punch" technique of laparoscopic vertical banded gastroplasty for morbid obesity

Background: This report describes the technical details and an initial eval uation of laparoscopic vertical gastroplasty modified for morbid obesity. A fter a surgical experience in 150 patients with open vertical banded gastro plasty (Mason's procedure), it was decided to perform a modified banded ver tical gastroplasty. Materials and methods: Six patients were treated by this laparoscopic appro ach in 1997-1998. AII patients were women with a mean age of 28 years (rang e 20-46). The mean body weight was 128 kg (range 105-146), and the mean BMI was 42.7 kg/m2 (range 35.6-53.0). Four or five 10- or 12-mm trocars were u sed. For all the dissection we used atraumatic ultracision (harmonic scalpe l). In this procedure the technique of laparoscopic gastroplasty is perform ed without a circular gastric window. During the operation, 3 omental openi ngs were made and the vertical staple-line was constructed by using a 30-mm 3-row linear stapler twice, establishing the gastric pouch. The outflow st oma was reinforced by a Gore-Tex band and calibrated to have an internal di ameter of 10-15 mm. The band was sutured to itself. Results: There were no deaths or complications. Operating time was 200 min (150-240). The nasogastric tube was removed at 1-2 days. The postoperative course was characterized by normal respiratory function and minimal pain in all cases. Patients were discharged 5-6 days after operation. Conclusions: Our technique excluded the circular gastric window (i.e., "no- punch") technique in the development of an effective and simple laparoscopi c procedure to treat morbid obesity.