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At least 19 recordsLinked to original sources
PubMed1991

Why the Operation I Prefer is Silastic Ring Vertical Gastric Bypass.

Silastic ring vertical gastric bypass is a composite operation which maximizes the advantages of the vertical banded gastroplasty and the gastric bypass operations. It is our operation of choice because it appears to date to be the only operation that addresses the medical and psychosocioeconomic problem of severe obesity. Acute complications include wound infection, wound seroma and anastomotic leaks. Late complications include marginal ulcers (6%), staple-line breakdown (4%), iron deficiency, vitamin B&inf1;&inf2; deficiency and anemia. The operation is relatively simple, safe, effective and acceptable to the patients and doctors.

Journal Article↗
PubMed1997

Silastic ring gastric bypass: results in 64 patients.

BACKGROUND: The silastic ring gastric bypass (SRGB) was introduced by Fobi in 1989, in an effort to combine the advantages of the Roux-en-Y gastric bypass with those of the vertical banded gastroplasty, while avoiding the disadvantages of each. METHODS: The results of our first 64 patients who underwent SRGB with a 5.5 cm ring have been reviewed with particular attention to weight loss, short- and medium-term morbidity and patient satisfaction. Most patients have had regular follow-up, and those not seen during the last 6 months were sent a postal questionnaire. RESULTS: The patients included 52 females and 12 males, ranging in age from 23 to 59 years (median age=39 years) at the time of surgery. Median preoperative weight, body mass index (BMI) and % excess weight were 126 kg (range 89-253 kg), 44 kg/m2 (range 36-78 kg/m2) and 113 (range 76-209) respectively. There were no serious postoperative complications and no deaths. Median hospital stay was 7 days (range 5-14 days). Eight patients (13%) are known to have had a staple-line dihiscence. Eighteen patients (28%) have had major difficulties with eating, and in nine (14%) of these the silastic ring has been removed with resolution of the eating problems, but some gain in weight. In the 54 patients with follow-up data at 2 years, median weight was 78 kg (range 55-137 kg), median BMI was 27 kg/m2 (range 20-43 kg/m2) and mean +/- SD % excess weight loss was 69+/-16. After 2 years of follow-up, eight of 54 patients (15%) were unhappy with the results of the procedure. CONCLUSION: SRGB is an effective, safe and well-tolerated procedure for achieving weight loss in the morbidly obese. The principal drawbacks relate to staple-line problems and eating difficulties related to the silastic ring. A 5.5 cm ring is probably too small to be ideal.

Adult↗
PubMed1990

Vertical Silastic ring gastroplasty: a 6-year experience.

Vertical Silastic ring gastroplasty was carried out in 71 patients as treatment for morbid obesity. The mean excess weight loss at 6 months (59 patients) and 2 years (43 patients) was 48 per cent and 65 per cent respectively. Subsequently the weight stabilized around this level with 58 per cent of the excess weight lost at 5 years (14 patients) postgastroplasty. Five patients (7 per cent) failed to lose weight. Sixteen patients (23 per cent) required revision for technical complications but continued to lose weight or to maintain a satisfactory weight. Vertical Silastic ring gastroplasty is an effective surgical method of achieving sustained weight loss.

Adolescent↗
PubMed1992

Comparison of silastic rings and electrocoagulation for laparoscopic tubal ligation under local anesthesia.

OBJECTIVE: To compare objectively the pain associated with tubal occlusion by Silastic rings versus electrocoagulation during laparoscopic tubal ligation under local anesthesia. METHODS: Consecutive patients scheduled for laparoscopic tubal ligation under local anesthesia were randomized to Silastic rings (N = 50) or electrocoagulation (N = 52) as the method of tubal occlusion. Sterilization was performed under local anesthesia in a standard fashion. Bupivacaine 0.5% was used as the local anesthetic agent. Operative pain was measured based on intraoperative anesthesia requirements and a modified McGill pain questionnaire. This questionnaire was used to assess pain at 15 minutes, 1 hour, and 24 hours postoperatively. RESULTS: Demographics were similar for the two groups. Operative time was shorter in the Silastic-ring group (16.7 versus 21.8 minutes; P = .001), and this group also required less intraoperative anesthesia (P = .004). There were no statistical differences between the groups in self-reported pain intraoperatively or postoperatively. No patient in either group required antiemetics or pain medication in the recovery room. CONCLUSION: Silastic rings appear preferable to bipolar electrocoagulation for laparoscopic tubal sterilization under local anesthesia when long-acting local agents are used for tubal anesthesia.

Adult↗
PubMed1996

Silastic Ring Vertical Gastroplasty Using a Modified TA 90 BNtrade mark.

Silastic Ring Vertical Gastroplasty (SRVG) is a well-established method in obesity surgery. In the last 5 years we performed SRVG on 76 patients who suffered from morbid obesity. Not included are those patients who received an SRVG as second or third gastric segmentation operation. In performing the first 27 silastic ring vertical gastroplasties using the TA 90BNtrade mark we repeatedly experienced difficulties in guiding the nasal tube along the lesser curvature through the notch. This problem stimulated us to develop a more simplified procedure of setting the staple-line. In co-operation with AutoSuture Deutschland GmBH, the notched part of the TA 90 BNtrade mark was bent in a 90 degree angle to the left side of the instrument. This way it is much easier to place the nasal tube exactly at the lesser curvature and through the bent notch of the newly developed TA 90 BNK. Thus, we were able to create a sufficient pouch along the lesser curvature. Of 76 patients 27 underwent the SRVG with a TA 90 BNtrade mark and 49 with the TA 90 BNK. The average age of the patients was 39 years, 83% women, 17% men. The overweight ranged from 40 kg to 177 kg, the BMI from 39 to 94. In 12 cases a staple-line rupture occurred, 26% with the TA 90 BNtrade mark and 10% with the TA 90 BNK. In nine patients a reoperative because of stoma stenosis was necessary, 11% with the TA 90 BNtrade mark and 12% with the TA 90 BNK.

Journal Article↗
PubMed2005

Endoscopic therapy for main pancreatic-duct rupture after Silastic-ring vertical gastroplasty.

BACKGROUND: Acute pancreatitis with pancreatic-duct rupture and fluid collections is a rare complication after Silastic ring vertical gastroplasty. It can be attributed to pancreatic trauma occurring during surgery. METHODS: Endoscopic therapy with transmural drainage of collections was performed in 4 patients who had undergone Silastic ring vertical gastroplasty and who had presented with acute pancreatitis with main pancreatic-duct rupture at the body of the pancreas. OBSERVATIONS: All patients had successful transmural drainage with cystogastrostomy, followed by stent insertion. Only one patient had a late recurrence because of stent migration. The major difficulty was related to positioning of the endoscope and the possible need of pneumatic dilation of the outlet channel to reach the puncture site. CONCLUSIONS: Endoscopic therapy is useful in acute pancreatitis with pancreatic-duct rupture after Silastic-ring vertical gastroplasty and, although technically difficult, could be considered as a first-line approach in the management of these patients.

Adult↗
PubMed1981

Pharmacokinetics and pharmacodynamic effects of vaginal oestradiol administration from silastic rings in post-menopausal women.

Silastic rings releasing approximately 200 microgram of 17beta-oestradiol per day were inserted into the vaginas of 4 post-menopausal women for one to three 21-day periods. Plasma concentrations of oestrone and oestradiol were analysed by radioimmunoassay. The effect of circulating oestrogens on FSH, LH and sex-hormone binding globulin (SHBG) levels as the well as on the endometrium was studied. During the first 24 h of treatment the plasma oestradiol levels were higher than the oestrone levels. But during the following days of the 21-day periods, the levels of the two oestrogens were almost equal, varying between about 100 and 200 pg/ml plasma, a pattern similar to that seen in fertile women. the release of oestradiol from the ring gave stable plasma oestrogen levels. The FSH and LH levels were clearly depressed while the SHBG levels did not change. Characteristics of oestrogen influence were found in endometrial biopsies. The rings were well accepted and could be inserted and removed easily by the women. Absorption of oestradiol from the vagina is good and more complete than after oral administration allowing lower doses to be used for treatment.

Estradiol↗
PubMed1994

Gastroscopically Assisted Balloon Tamponade for Massive Bleeding after Silastic Ring Vertical Gastroplasty.

We report a case of massive upper gastrointestinal bleeding after silastic ring vertical gastroplasty. The bleeding originated from the staple-line at the insertion point of the silastic ring. A Sengstaken-Blakemore tube tamponaded the area of bleeding, by a new technique whereby the gastroscope was inserted through the gastrostomy orifice and used to guide the placement of the occluding balloon.

Journal Article↗
PubMed1997

Silastic ring gastric bypass: a comparison of two ring sizes: a preliminary report.

BACKGROUND: The silastic ring (vertical) gastric bypass (SRGB) was introduced by Fobi in 1989, in an effort to combine the advantages of the Roux-en-Y gastric bypass with those of the VBG, while avoiding disadvantages of each. We remain unsure of the ideal ring size. METHODS: Sixty-four patients having SRGB between June 1990 and September 1994 had a 5.5 cm ring placed and 24 patients operated between October 1994 and September 1995 had a 6.0 cm ring placed. Weight loss and quality of eating data is compared 12 months after surgery. RESULTS: Median preoperative per cent excess weight was 113 (range 76-209) in the 5.5 cm group and 106 (range 79-196) in the 6.0 cm group. Weight loss was equivalent at 12 months, with median percent excess weight of 33 (range 8-109) and 27 (range 6-81) in the two groups respectively. Quality of eating data appears better in those with the larger ring size. Nine patients with a 5.5 cm ring have subsequently had their ring removed to improve their quality of eating and a further six may require this in the future. One patient with a 6.0 cm ring has had the ring removed and two others may require this be done. CONCLUSION: An SRGB with a 6.0 cm ring achieves equivalent weight loss to one with a 5.5 cm ring, but with better quality of eating, and less prospect of requiring ring removal. However, there remains a small proportion of patients in whom a 6.0 cm ring is poorly tolerated. For this reason a 6.5 cm ring should be tested.

Adult↗
PubMed2004

Long-term follow-up and factors influencing success of silastic ring vertical gastroplasty.

BACKGROUND: Careful selection of patients for the operation plays a major role in long-term results of silastic ring vertical gastroplasty. The objective of the current study is to identify predictive factors for the objective (excess weight loss) and subjective (satisfaction) success of silastic ring vertical gastroplasty (SRVG) for morbid obesity. METHODS DESIGN: Retrospective cohort study. SETTING: University hospital. SUBJECTS: 300 patients of 450 who were operated on between 1984 and 1997. Follow-up time was 4.4 +/- 2.3 years. INTERVENTION: SRVG. STATISTICAL METHODS: Correlations, multi-linear regression model. RESULTS: Average BMI (body mass index) loss: 13.6 +/- 7.4 kg/m(2), average excess weight loss was 67.4 +/- 33.0%. Satisfaction rate: 81.3%. Correlation was found between objective parameters of successes and the satisfaction of the patient (p < 0.001). Excess weight loss was correlated to younger age (p < 0.005), pre-operative weight and BMI (p < 0.005, p < 0.01, respectively), and shorter follow-up (p < 0.001). Multiple linear regression model revealed that age and preoperative weight were independent variables and correlated to the excess weight loss after SRVG (R(2) = 0.303, p < 0.01; R(2) = 0.026, p < 0.05). Social support was correlated to satisfaction (p < 0.05). CONCLUSIONS: SRVG is an operation with high rates of objective and subjective success rate. Younger and heavier subjects will mostly enjoy SRVG in terms of excess weight loss. Patients who have social support have the most satisfactory emotional outcome.

Adult↗
PubMed1981

A study of menstrual patterns following laparoscopic sterilization with silastic rings.

The menstrual patterns of 281 women undergoing laparoscopic sterilization with silastic rings were studied prospectively. A significant increase in dysmenorrhea and irregular periods was seen soon after sterilization but this was transient, returning to presterilization levels by 12 months. Menorrhagia was not observed and the amount of menstrual blood loss showed a trend towards normal following sterilization. No permanent adverse effects on menstrual patterns were seen in the 1st year after sterilization. It is suggested that factors other than the sterilization procedure may be responsible for the high prevalence of menstrual dysfunction that has been reported following sterilization.

Dysmenorrhea↗
PubMed1994

SILASTIC ring vertical banded gastric bypass for the treatment of obesity: two years of follow-up in 84 patients [corrected].

The SILASTIC ring vertical gastric bypass (SRVGBP) has evolved as the rational operation to control obesity. The operation consists of a proximal vertical gastric pouch < 30 cc in size. The pouch is banded with a 5.5-cm SILASTIC ring, and this functions as the stoma which does not stretch and is large enough to allow patients to eat all varieties of food, including vegetables and meats, with minimal incidence of postprandial emesis. The continuity of the gastrointestinal tract is formed with a Roux-en-Y gastroenterostomy with each limb about 60 cm long. The bypass of the gastroduodenal axis causes decreased digestion and thus decreased absorption of fats and carbohydrates, resulting in comparably more weight loss than seen in the standard restrictive gastroplasty. The dumping experienced in this operation, which prevents patients from becoming sweet eaters and thus provides long-term weight maintenance, is not as severe as in the regular gastric bypass with a dilatable stoma. In trained hands, the morbidity and mortality from this operation is comparable to that seen in the simple restrictive gastroplasty. The complications due to this operation include staple line breakdown, marginal ulcers, stenosis, incisional hernia, dumping, and iron, vitamins A, B12, D, and E deficiencies. These deficiencies are correctable by oral or parenteral supplements as necessary. This operation yields a 90% or higher success rate (> 40% excess weight loss) in the treatment of morbid obesity [corrected].

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↗
PubMed2001

Six years experience with minilaparotomy silastic ring vertical gastroplasty.

BACKGROUND: In 1994, we modified the silastic ring vertical gastroplasty (SRVG) procedure to be able to perform it through a small incision. We expected this MiniSRVG to reduce postoperative pain and discomfort, shorten hospital stay and cost, and reduce scars and overall morbidities. METHODS: From October 1991 to December 1999, 893 patients were operated for morbid obesity. From October 1991 to December 1993, 111 patients underwent the classic Eckhout SRVG. From January 1994 to February 1999, 782 patients underwent the MiniSRVG, in which the dissection is limited to the lesser curvature of the stomach and is done partly blindly. Certain technical maneuvers were done to facilitate the procedure and to shorten the incision. RESULTS: Immediate postoperative complications and overall morbidities were similar in both series. Long-term follow-up showed no significant differences in weight and BMI loss. The small incision in the MiniSRVG, however, shortened the median operating time (32.1 vs 38.1 minutes) and reduced greatly the incision size (6.5 vs 18 cm), the postoperative pain (1.2 vs 2.6 days), the hospital stay (3.0 vs 5.1 days), the evisceration rate (0.1 vs 2.7%) and incisional hernia rate (5.4 vs 15.8%). The only side-effect was an increase in seroma formation (11.8 vs 4.50%). CONCLUSIONS: The MiniSRVG was as safe and efficient as the classic SRVG, obtaining the same BMI reduction and satisfaction.

Adult↗
PubMed1997

42-month preliminary follow-up of the silastic ring vertical banded gastroplasty.

BACKGROUND: The authors review preliminary experience with silastic ring vertical gastroplasty (SRVG). METHODS: Of 202 patients who underwent SRVG, 191 are more than 3 months postoperation and of these 165 were accessible for review. RESULTS: Pouch volume could not be readily measured. The TA90BN stapler was occasionally difficult to apply exactly at the angle of His. There was one subphrenic abscess, one gastric bleed, and one dehiscence. Vomiting occurred in eight patients who required reoperation: ring removal, three; cholecystectomy, one; conversion to vertical banded gastroplasty, one; conversion to Roux-en-Y gastric bypass, three. There was no mortality. Weight loss has been satisfactory to 42 months. CONCLUSION: SRVG has been a relatively simple operation, with acceptable morbidity and weight loss thus far.

Abscess↗
PubMed2000

Silastic ring vertical gastroplasty by minilaparotomy.

BACKGROUND: The incision length has significant influence on the postoperative course after silastic ring vertical gastroplasty (SRVG). METHODS: A technique is described in which SRVG can be performed through a minilaparotomy incision. RESULTS: 110 patients were operated with this technique during 1996. No remarkable intraoperative or postoperative complications were encountered. Postoperative weight loss has been satisfactory. CONCLUSIONS: Performance of SRVG through a minilaparotomy is feasible. The technique is recommended for surgeons familiar with the operation through the formal incision.

Adult↗
PubMedDate not supplied

Silastic ring vertical gastric bypass: evolution of an open surgical technique, and review of 1,588 cases.

BACKGROUND: Silastic ring vertical gastric bypass (SRVGBP) has evolved from a stapled (SSRVGBP) to a transected (TSRVGBP), and finally to a transected pouch with jejunal interposition (TSRVGBP with J-I). The creation of the gastroenterostomy evolved from a hand-sewn to a stapled and finally to a combined stapled and hand-sewn anastomosis. The circumference of the ring was increased from 5.5 to 6.0 cm. We address the effect of these modifications on surgical outcome. METHOD: The records of 1,588 consecutive patients (mean BMI of 44.5) since 1990 who had a SRVGBP were indentified from a prospective data-base of all patients undergoing bariatric operations. 205 patients with a prior bariatric operation were excluded from the review, leaving 1,383 patients who had a primary SRVGBP. RESULTS: In the 193 SRVGBP patients, there was 1 gastric leak (0.5%) and 64 gastrogastric fistulas (33.2%). In the 165 TSRVGBP patients, there were 4 gastric leaks (2.4%) and 14 gastrogastric fistulas (8.5%). In the 1,025 patients with TSRVGBP with JI, there were 8 gastric leaks (0.8%) and no gastro-gastric fistulas. In the TSRVGBP with J-I, 367 patients had a hand-sewn, 16 a stapled, and 642 a combined stapled and hand-sewn anastomosis. Stricture rate was 3.8%, 31%, and 2.6% respectively. There were 7 ring migrations (0.7%), all in the totally hand-sewn group. Ring removal was necessary in 20 (5%) with a 5.5-cm and 4 (0.74%) with a 6.0-cm ring. CONCLUSION: TSRVGBP with J-I with a combined stapled and hand-sewn gastrojejunal anastomosis using a 6.0-cm ring decreased the incidence of complications, and is our current technique.

Adolescent↗
PubMed1996

Vertical Silastic Ring Gastroplasty with Nissen Fundoplication Prevents Reflux.

Optimal management of coexisting morbid obesity and gastroesophageal reflux is not known. Silastic ring vertical gastroplasty is an effective treatment for morbid obesity, and Nissen fundoplication is effective in treating gastroesophageal reflux. We combined these two procedures in an animal model and found protection against gastroesophageal reflux without any deleterious effects on pouch emptying.

Journal Article↗