Bleeding from the upper gastrointestinal tract after Mason's vertical banded gastroplasty

Background: Gastric bleeding is a rare complication after a vertical banded gastroplasty (VBG). Only a few cases of gastric bleeding after a VBG have been reported, and there is discussion about its etiology. We present two c ases of gastric bleeding after a VBG, and discuss the etiology, diagnostic approach and management. Methods: During the period 1989-98, we treated two cases of gastric breedin g out of 328 morbidly obese patients that underwent a VBG. The first patien t was a 36-year-old woman with body mass index (BMI) 61.5. Gastric bleeding occurred on the 7(th) postoperative day, due possibly to the increased dos e of Low Weight Molecular Heparin (LWMH) which was administrated as prophyl actic anticoagulation. The second case concerns a 27-year-old man with 54.0 BMI. Gastric bleeding occurred on the 16(th) postoperative day and was att ributed to a stress ulcer. Results: Both patients were treated conservatively successfully. In the fir st patient, bleeding was stopped when LWMH was discontinued. In the second patient, bleeding was stopped by gastroscopic epinephrine injection in the bleeding spot. Conclusions: From our cases and review of the literature, gastric bleeding after a VBG is rare, may be treated easily with conservative measures. Tens ion of the mesh that surrounds the canal between the two compartments, gast ric mucosal irritation from the nasogastric tube and postoperative stress u lcer formation are the most frequent causes of this complication.