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At least 19 recordsLinked to original sources
PubMed1995

Gastric Mucosal Changes following Gastroplasty: A Comparative Study Between Vertical Banded Gastroplasty and Silastic Ring Vertical Gastroplasty.

BACKGROUND: Long-term changes of gastric mucosa following surgery for morbid obesity have never been studied, to the best of our knowledge. As 31 patients in our series presented with various gastrointestinal complaints following surgery, we used this opportunity to study mucosal changes. METHODS: Thirty-seven gastroscopies were performed on 31 patients, 20 patients following Vertical Banded Gastroplasty (VBG) and 11 patients following Silastic Ring Vertical Gastroplasty (SRVG) with various gastrointestinal complaints. Macroscopic appearance of the gastric mucosa was examined and biopsies taken from the proximal gastric pouch, the transitional zone and distal stomach. RESULTS: In most patients, macroscopic appearance of the proximal and distal pouches was normal. Pathological findings were mainly located in the transitional zone and were found mainly in the VBG group. CONCLUSIONS: This study indicates that damage to the gastric mucosa is related to the surgical technique, and mainly to the strip of mesh used in the VBG patients. Since hyperplasia and metaplasia were among the microscopic findings, a question is raised about the possibility of malignant transformation. We suggest that routine post-operative gastroscopies be considered, especially following VBG.

Journal Article↗
PubMed1985

Total fundoplication gastroplasty (Nissen gastroplasty): five-year review.

Gastroplasty was introduced by Collis in 1961 and has undergone several modifications. The combination of total fundoplication with gastroplasty was reported in 1977 and referred to as total fundoplication gastroplasty; however, the term Nissen gastroplasty also is commonly used. This article is an extension of the original 1977 report and, to our knowledge, represents the first 5-year review of total fundoplication gastroplasty. Three hundred fifty-one consecutive patients with intractable reflux were preoperatively evaluated by history, radiographic studies, manometric studies with determination of pH, and esophagogastroduodenoscopy prior to surgical management by total fundoplication gastroplasty. There were no operative deaths. Follow-up averaged 6.5 years with an effective clinical review available for 95.4% of the patients, radiographic studies for 92.3%, and manometric studies with pH evaluation for 70.7%. Among the 335 patients with 5 or more years of follow-up, 93.1% had excellent results with normal eating and no investigative evidence of recurrence of reflux, 4.0% had mild residual symptoms, and 2.9% had persistent or recurrent symptoms. With this technique, the problems of overcompetence and dysphagia are substantially reduced because the completion fundoplication is tailored to a length of 1 cm while anatomical stability is maintained with a long intraabdominal segment.

Adolescent↗
PubMed1984

Failed gastroplasty for morbid obesity. Revised gastroplasty versus Roux-Y gastric bypass.

Forty-six percent of 122 gastroplasties for morbid obesity failed. This included a failure rate of 71 percent for a single staple line without stomal reinforcement, 37 percent for a double staple line and a central stoma reinforced with 2-0 polypropylene, and 42 percent for the Gomez gastroplasty. Revisional procedures were performed in 44 patients. Ten underwent revision of a failed gastroplasty using a gastrogastrostomy and 34 had conversion to a Roux-Y gastric bypass. Patients who had revisional gastroplasty as a second procedure had a significantly higher failure and complication rate than those converted to gastric bypass. Four of these 10 patients were subsequently converted to gastric bypass as their third weight reduction procedure. Conversion of a failed gastroplasty to a Roux-Y gastric bypass is a difficult procedure that carried a significantly higher complication rate in our study than that of a group of 46 patients who underwent a primary gastric bypass procedure. Of 26 patients followed for more than 1 year after conversion to Roux-Y gastric bypass, the average weight loss was 66 +/- 18 percent of their excess body weight. This was comparable to 16 patients who had undergone a primary gastric bypass more than 1 year previously and had lost 69 +/- 17 percent of their excess body weight.

Clinical Trials as Topic↗
PubMed1998

Vertical gastroplasty: evolution of vertical banded gastroplasty.

The objective of this paper is to summarize the goals, technical requirements, advantages, and potential risks of gastroplasty for treatment of severe obesity. Gastroplasty is preferred to more complex operations, as it preserves normal digestion and absorption and avoids complications that are peculiar to exclusion operations. The medical literature and a 30-year experience at the University of Iowa Hospitals and Clinics (UIHC) provides an overview of vertical banded gastroplasty (VBG) evolution. Preliminary 10-year results with the VBG technique currently used at UIHC are included. At UIHC the VBG is preferred to other gastroplasties because it provides weight control that extends for at least 10 years and the required objective, intraoperative quality control required for a low rate of reoperation. It is recommended that modifications of the operative technique not be attempted until a surgeon has had experience with the standardized operation--and then only under a carefully designed protocol. Realistic goals for surgery and criteria of success influence the choice of operation and the optimum, lifelong risk/benefit ratio. In conclusion, VBG is a safe, long-term effective operation for severe obesity with advantages over complex operations and more restrictive simple operations.

Gastroplasty↗
PubMed1999

Gastroplasty procedures, particularly vertical banded gastroplasty.

Vertical banded gastroplasty (VBG), the most frequently performed restrictive procedure to control severe obesity, was developed by Mason in 1982. The procedure evolved from experiential trials of earlier concepts and the timely availability of instrumentation to allow stapled vertical partition of the stomach. Success requires precise technical mastery and optimal patient compliance to provide permanent governance of satiety. The objective of weight control--to reverse co-morbidities of obesity, while causing minimal metabolic deficiencies--has been achieved in a wide selection of patients. The super-obese may be a group whose needs fall beyond the control of the VBG. Vertical ringed gastroplasty (VRG) performs similarly to VBG. Other types of gastroplasty have yet to prove reliable over time. Laparoscopic banded gastroplasty is reversible, adjustable and attractive to patients. Laparoscopic VBG must prove equivalent technical precision to that of open procedures before it can be useful. Deterrents to success such as staple-line failure, band erosion, behavioural backsliding, lack of teeth, large pouch syndrome and a super-obese candidate underscore the tenacity of severe obesity, the disease, as an adversary. Control, not cure, is possible.

Equipment Failure↗
PubMed2005

Results of revisional operation following vertical banded gastroplasty performed due to morbid obesity--comparison between restoration of vertical banded gastroplasty and conversion of gastric bypass up to three years.

The aim of this study was to analyse incidence and efficacy of revisional surgery for failed vertical banded gastroplasty among 458 patients who underwent primary surgery between 1993 and 2003. Staple line disruption was diagnosed in 29 patients and was an indication for restoration of gastroplasty in 10 cases and a conversion to Roux-en-Y gastric bypass in 19 patients. In two cases of outlet stenosis the band was exchanged to enlarge the collar. In two cases of psychological intolerance of restriction the band was removed because of refusion by patients the conversion to Roux-en-Y gastric bypass. A substantial weight reduction without statistical differences between restoration and conversion group was recognized. In two patients (20%) after restoration and three patients (15.8%) after conversion we observed weight regain (p=0.57). In cases with removed band weight regained up to its value recorded before surgery. In patients with exchanged band weight was under control. No serious complications were observed. We could conclude that patients with weight regain after vertical banded gastroplasty should be offered conversion to Roux-en-Y gastric bypass. When malabsorption is refused, restoration of vertical banded gastroplasty could be also performed. Both of procedures are technically difficult but safe.

Adolescent↗
PubMed1988

Revision of failed horizontal gastroplasty by vertical banded gastroplasty.

Eighteen patients who had undergone horizontal gastroplasty experienced postoperative weight gain due to technical failure (large orifice in 10 patients, staple-line disruption in 7 and a large pouch in 1). A vertical banded gastroplasty was used to correct the problem, with a resulting operative morbidity of 38.9%. This included perforation with peritonitis (five patients) and complete outlet obstruction (two patients). These complications appear to result from poor blood supply to the area of the anastomosis necessary in this conversion. This study indicates that it is not safe to use vertical banded gastroplasty for the failed horizontal gastroplasty.

Adult↗
PubMed1994

Initial Experience with the Surgical Management of Morbid Obesity Associated with Symptomatic Gastro-esophageal Reflux: A Comparison between Gastroplasty Alone and Gastroplasty with Anterior Fundoplication.

The optimal management of patients with morbid obesity and gastro-esophageal reflux disease (GERD) remains an unresolved issue. We have performed a vertical banded gastroplasty combined with an anterior fundoplication (VBG + AF) in 28 selected morbidly obese patients with moderate or severe heartburn. The patients who underwent VBG +/- AF are compared to patients who had similar heartburn symptoms and underwent gastroplasty alone during this period. In the VBG + AF group there were two treatment failures (7%). In the gastroplasty group there were 63 patients with 15 treatment failures (24%). These differences were independent of demographic and weight loss variables. These results suggest that VBG +/- AF may provide a superior option for the management of morbidly obese patients with GERD.

Journal Article↗
PubMed1993

Complications of Vertical Banded Gastroplasty and its Modified Operative Mode, K-Gastroplasty: a preliminary report.

Based on the experiences in performing vertical banded gastroplasty (VBG) for 8 years, its results were analyzed and particularly its operative complications were examined. As a result, its weight-reducing effect and safety were favorable, but serious complications, although few, were observed. These major complications were the loss of gastric reduction effect due to staple-line dehiscence, gastric band exposure, reflux esophagitis, channel narrowing, pouch ulcer, etc. As a preventive measure against these complications, to supplement the defects of VBG without losing its characteristics, K-gastroplasty was devised and performed; its operative mode is discussed.

Journal Article↗
PubMed1998

Revisional surgery after failed vertical banded gastroplasty: restoration of vertical banded gastroplasty or conversion to gastric bypass.

BACKGROUND: An increasing number of patients with a failed primary bariatric procedure present themselves for secondary treatment. Only a few studies have investigated critically the success of revisional surgery. In the present study, the effectiveness of revisional surgery for failed vertical banded gastroplasty (VBG) is analyzed: restoration of the VBG (reVBG) is compared to conversion to a Roux-en-Y gastric bypass (RYGB). PATIENTS AND METHODS: From 1980 to 1996, 136 consecutive morbidly obese patients underwent primary RYGB (n = 20) or VBG (n = 16). Weight loss, indications and complications after revisional surgery were registered. The rate of revisional surgery after primary and secondary bariatric procedures was estimated by means of a Kaplan-Meier analysis. RESULTS: Kaplan-Meier analysis revealed that 56% of the patients will eventually require revisional surgery after initial VBG over a 12-year period compared to 12% after initial RYGB (P<0.01). After reVBG 68% will need revisional surgery over a 5-year period, while no further revisional surgery was required after conversion to a RYGB (P<0.05). Body mass index dropped significantly after reVBG or conversion to RYGB for insufficient weight loss (P<0.05), however, more revisional surgery was necessary after reVBG to achieve this result. The complication rate was comparable between reVBG and conversion to RYGB (33%). CONCLUSION: Conversion of a failed VBG to a RYGB is more effective than a reVBG, because conversion to RYGB provides satisfactory weight loss without requiring further revisional surgery.

Adult↗
PubMed1996

A technique for gastroplasty as a substitute for the esophagus: fundus rotation gastroplasty.

BACKGROUND: A new method of gastroplasty for the intrathoracic esophagus is described that requires resection of a small part of the gastric corpus only. All tributaries of the arterial arcade along the lesser curvature are preserved. RESULTS: The resulting gastric tube has three advantages over conventional techniques: an increase in length of the resulting gastric tube; an increase of blood flow at the tip of the gastric tube, where the anastomosis with the cervical esophagus is performed; and an increase of the gastric reservoir. STUDY DESIGN: Prospective clinical trial. CONCLUSIONS: The new technique described appears to be a safe method to substitute for the intrathoracic esophagus, although oncologic radicality and long-term follow-up results after esophagectomy for carcinoma need to be evaluated.

Adult↗
PubMed1991

[Gastroplasty calibrated by a silastic ring. A new technique of vertical gastroplasty in obesity].

Among the various procedures used for surgical treatment of morbid obesity, the vertical silastic ring calibrated technique is in full development. Using a linear suture stapler with 4 rows of staples makes it possible to create a gastric partition without excision of a gastric outlet. The channel is calibrated by means of a 4.5 cm long silastic ring. In a small series of 20 cases, the loss of excess weight over one year was 47 +/- 12 percent at 6 months and 59 +/- 21 percent at 12 months without mortality or morbidity.

Gastroplasty↗
PubMed1992

Horizontal and Vertical Gastroplasties: extended follow-up and late results.

In the late 1970s and early 1980s five individual series of gastroplasties were performed with sequentially smaller pouch and stoma sizes. Three of the series were horizontal gastroplasties and two were vertical gastroplasties. Stomas in all but the last series were banded with multiple strands of nylon and in the final series with a Teflon strip. Early and late weight loss results are presented. Mean follow-up for all groups ranged from 5.4 to 6.5 years, some patients being followed as long as 11.2 years. Weight loss results showed that mean greatest percentage excess weight loss for the groups was 60-70%, with losses ranging from unacceptable to ideal in all groups. Mean final percentage excess weight losses were below the level of success in all but the Teflon-banded vertical gastroplasties. The range of final data showed that percentage losses ranged from negative (greater than pre-operative weight) to near ideal across the groups. A small but significant number of patients in each group were considered early failures, never having achieved a weight loss level meeting the criterion of success. Maintained successful weight loss varied between the gastroplasty groups from 11 to 27%. This was after a mean follow-up of from 7.3 to 9.4 years. Stoma data showed a general trend to diminution in size as success increased; however, range data showed great variability in stoma size associated with success. Further analysis of stomas indicated that there was no absolute correlation between weight loss and stoma size. Many of the gastroplasty failures in all groups were converted to other types of procedures, the incidence varying from 27 to 46.5% between groups. It is concluded that while weight loss after 2 years of follow-up was successful in the majority of instances and with all types of gastroplasty, late follow-up indicated an ever-increasing failure rate that varied between the series from 73 to 89%. It is therefore recommended that authors reporting gastroplasty results take into account the foregoing facts and clearly define length of follow-up and, where possible, present late, complete follow-up data.

Journal Article↗
PubMed1980

The gastroplasty tube and its role in reflux control: an experimental and clinical study.

The gastroplasty tube has been used in the control of reflux since it was originally described by Collis in 1961. Several variations of the procedure have been reported indicating a low frequency of anatomic recurrence but a high frequency of reflux. Two forms of gastroplasty procedure are used: partial fundoplication in which gastric fundus incompletely wraps the gastroplasty and high pressure zone, and total fundoplication in which a circumferential wrap is constructed. The authors conducted a clinical review, using the patient's history, radiology and manometry, of 135 patients with partial fundoplication gastroplasty (PFG) and 250 patients with total fundoplication gastroplasty (TFG). In both groups the anatomic recurrence rate was low; however, with PFG the frequency of reflux was 44.6% and 25.7% of patients had notable symptoms. With TFG no patient had reflux. The response of the gastroplasty tube to meal-induced gastrin release and to neurogenic stimulation was tested. Basal tube pressure was low and showed no response to gastrin release and no augmented neurogenic response. It was concluded that the gastroplasty tube did not have intrinsic properties of value in controlling reflux and that reflux control depended upon the method of fundoplication. The role of the gastroplasty tube is in preventing anatomic recurrence.

Eating↗
PubMed1986

Surgical management of the failed gastroplasty.

Gastroplasty has been used in surgical management of reflux for 25 years. The creation of a gastric tube before fundoplication complicates further corrective procedures should the original operation fail. Experience has been gained with 51 patients, 34 having partial fundoplication gastroplasty and 17 having total fundoplication, who have had major persistent or recurrent symptoms. All were evaluated by history, radiology, endoscopy, manometry with pH, and acid perfusion testing before surgical management. The patients undergoing partial fundoplication gastroplasty had heartburn (85.3%), reflux (70.6%), and dysphagia (94.1%). Radiologic recurrence was present in 26.5%, endoscopic incompetence in 94.1%, and a stricture in 26.5%. The patients who had a total fundoplication gastroplasty had heartburn (52.9%), reflux (29.4%), and dysphagia (82.4%). Radiologic recurrence was present in 29.4%, endoscopic incompetence in 35.3%, and a stricture in 5.9%. On average, these patients had had 2.3 prior operations (range one to five operations). The dominant cause of failure (in the absence of anatomic recurrence) with partial fundoplication gastroplasty was continued or recurrent reflux and with total fundoplication gastroplasty, too tight or too long a fundoplication. All patients had a thoracoabdominal revision total fundoplication gastroplasty and a 1 cm completion fundoplication. Pyloromyotomy was added if not previously performed. There were no deaths or major morbidity. Follow-up in 51 patients averages 4.2 years (range 0.3 to 8.8 years). None has radiologic recurrence, one has minor reflux, one a traumatic diverticulum, and one has moderate esophageal obstruction. Of these patients, 82.4% are asymptomatic, 13.7% have minor symptoms, and 3.9% (two patients) have significant residual symptoms. This conservative surgical approach avoids the higher mortality of resection with interposition and provides satisfactory results.

Adolescent↗
PubMed1977

Intraoperative and postoperative esophageal manometric findings with Collis gastroplasty and Belsey hiatal hernia repair for gastroesophageal reflux.

The combination of a Collis gastroplasty with a Belsey Mark IV fundoplication has proved clinically effective in the management of certain patients with complications of gastroesophageal reflux. The present study measured the effect of gastroplasty and Belsey repair on intraluminal pressure changes in the gastroplasty and lower esophagus. Manometric studies were performed preoperatively, intraoperatively, and postoperatively. In each case the gastroplasty segment of the esophagus was found to function as a high pressure zone (HPZ). The pressure in this zone further increased following the fundoplication. It could be diminished with intravenous administration of Buscopan and augmented with intravenously given pentagastrin. The original lower esophageal sphincter in most instances was included in the upper segment of the gastroplasty tube, but the entire length of the gastroplasty tube functioned as an HPZ, and pressures in the tube were considerably higher than those originally present in the lower esophageal sphincter. These studies provide a physiological rationale for the effectiveness of gastroplasty and fundoplication.

Animals↗
PubMed1997

[Fundus rotation gastroplasty: fewer cervical suture failures after esophagectomy?].

Cervical leakage, occurring on average in 20-50% of the patients, is one of the major causes of morbidity following oesophagectomy for cancer. We report on a new technique of gastroplasty, namely fundus rotation gastroplasty which was used in 53 patients. There were 49 patients with oesophageal cancer and 4 with benign lesions. Hospital mortality was 5.7% (3/53) and the leakage rate 7.5% (4/53). The advantages of fundus rotation gastroplasty over conventional gastroplasty are the better blood supply and the greater length of the gastric tube. Controlled clinical trials will be necessary to confirm the advantages of fundus rotation gastroplasty versus conventional gastroplasty.

Adult↗
PubMed1991

Prospective evaluation of vertical banded gastroplasty as the primary operation for morbid obesity.

Our previous experience with vertical (nonbanded) gastroplasty proved disappointing because of unsatisfactory maintenance of weight loss. Vertical banded gastroplasty seemed to be an attractive alternative operation because it provided an externally reinforced (banded) stoma that would not enlarge over time. In this study, our aim was to determine prospectively the results of vertical banded gastroplasty used as a primary, weight-reducing procedure in patients with morbid obesity. Seventy consecutive patients with morbid obesity (mean weight, 139 kg), all of whom had obesity-related complications, underwent vertical banded gastroplasty and prospective follow-up. The hospital mortality was nil, and substantial morbidity occurred in 3% (two patients). Long-term achievement and maintenance of satisfactory weight loss, however, were variable. The median weight loss at 1 year after operation was 36.7 kg or 48% of excess body weight. At 3 years postoperatively, however, weight loss was only 32.4 kg or 40% of excess body weight, and only 38% of patients had achieved and maintained a weight loss of 50% or more of their preoperative excess body weight. Vertical banded gastroplasty caused major changes in eating habits, and many patients were unable to eat red meat or untoasted bread; moreover, approximately 30 to 50% of patients continued to vomit once or more per week. Despite theoretically attractive advantages as a weight-reduction operation, vertical banded gastroplasty does not seem to be the optimal procedure for most patients with morbid obesity.

Adult↗