Weight loss following vertical banded gastroplasty: Intermediate results of a prospective study

Background: Morbidly obese patients who undergo purely restrictive bariatri c operations may fail to maintain satisfactory long-term results. In an att empt to achieve the best possible outcome after restrictive procedures, we have employed preoperative selection criteria and are following this select ed patient group over time in order to evaluate longterm success. Materials and Methods: From June 1994 through August 2000, 166 morbidly obe se patients underwent various bariatric procedures at our institution. Of t hese patients, 35 underwent vertical banded gastroplasty (VBG) based on sel ection criteria, including degree of obesity and dietary habits and eating behavior. All patients were seen at 1, 3, 6, 9, and 12 months postoperative ly and yearly thereafter. Average follow-up time now is 4.1 years(29-75 mos ,), and follow-up is 100%, A multivitamin and mineral supplement is adminis tered to all patients for at least 6 months. Radiology examination is perfo rmed in all patients on the 4th postoperative day and at each yearly visit, in order to check for staple-line disruption and stomal stenosis, Results: Early postoperative morbidity was 5.7%, Late postoperative morbidi ty was 22.8%, A significant number of patients had some degree of stomal st enosis as shown by radiology examination, but to date there has been no nee d for surgical revision. There has been no early or late mortality. Weight loss results expressed as average percent excess weight loss (% EWL) were a s follows: 61% (28-90) at 1 year, 61% (20-90) at 2 years, 57% (13-91) at 3 years, 56% (25-87) at 4 years and 37% (24-59) at 5 years following surgery. A significant number of patients with excellent weight loss had a high fre quency of vomiting. Evaluation by BAROS showed that 25% of patients had an overall unsatisfactory outcome. Anemia and iron deficiency were found in 46 % and 32% of VBG patients respectively. Recurrence of preexisting comorbidi ties was significant if lost weight was regained. Conclusions: In spite of preoperative selection of patients for VBG, a sign ificant percentage of patients had poor overall results in terms of weight loss, quality of life, and resolution of preexisting comorbidities. For the se reasons and based on the longterm results published by others, VBG is no longer our preferred surgical option in morbidly obese patients.