Surgical complications of the Garren-Edwards Gastric Bubble.
A retrospective review of our initial experience with the Garren-Edwards Gastric Bubble (American Edwards Laboratories) was undertaken to study its surgical complications. Between 22 February and 30 August 1986, 250 patients had 275 gastric bubbles endoscopically inserted as an adjuvant treatment for morbid obesity. Profiles of the first 104 patients revealed a mean weight of 113.0 kilograms (74 per cent above ideal body weight) and a mean weight loss of 10.1 kilograms (0.76 kilogram per week) followed by a gain of 0.48 kilogram from the period of peak weight loss at 13.7 weeks to removal at 19.4 weeks. Thirty-three per cent had endoscopic removal and the remainder passed per rectum. Ninety-two had undergone previous abdominal operation. Five instances of obstruction of the upper part of the gastrointestinal tract (mean 18.3 weeks after insertion) required three operative removals, one endoscopic retrieval from the second portion of the duodenum and one hypaque small intestinal series with oral mineral oil to induce spontaneous passage. Four of the five patients had prior abdominal operations--cholecystectomy in one instance, appendectomy in one, cholecystectomy and appendectomy in one and exploratory laparotomy for multiple stab wounds in one. One (multiple stab wounds) had adhesions at the point of the obstruction. The patient who underwent endoscopic retrieval had premature deflation at 6.7 weeks presumably due to a defective bubble. The weight gain after peak weight loss at 13.7 weeks likely represents spontaneous bubble deflation. Prior abdominal surgical treatment appears to be a significant risk factor for the development of obstruction after bubble deflation. In addition, two of five patients have been lost to follow-up study after insertion. Proper patient selection and careful monitoring may be crucial in reducing the morbidity associated with the Garren-Edwards Gastric Bubble.