Vertical gastrectomy for morbid obesity in 216 patients: report of two-year results

Abstract

The vertical gastrectomy (VG) is the restrictive part of the technically difficult biliopancreatic diversion with duodenal switch operation (DS). The VG was originally conceived of as an independent operation—the first stage of a two-stage DS that would reduce mortality and morbidity in the high-risk superobese because of a shorter operating time and no anastomoses. This article presents two-year data after VG. Laparoscopic VG was performed in a nonrandomized fashion in obese patients that met the NIH criteria for bariatric surgery. By using 5–7 firings of 45–60-mm linear 3.5-mm GI staplers along a 32-Fr bougie, a greater-curvature gastrectomy is performed and a 60–80-ml gastric tube is created. VG was compared to adjustable Lap-Band^® placement, Roux-en-Y gastric bypass (RGB), and DS. Between November 2002 and August 2005, 216 patients underwent VG. The mean age was 44.7 years (range = 16–64) and 173 (80%) were female. The mean preoperative weight and body mass index (BMI) was 302 ± 77 lbs and 49 ± 11 kg/m², respectively. Of the 216 patients, 5 (2.3%) had a BMI > 80 kg/m², 6 (2.8%) had a BMI of 70–80 kg/m², and 25 (11.6%) had a BMI of 60–70 kg/m². The mean operative time was 66 ± 11 min (range = 45–180) and the mean length of hospital stay was 1.9 ± 1.2 days. Complications occurred in 20 (6.3%) patients (vs. 7.1% after Lap-Band). Leaks occurred in 3 (1.4%) VG patients, reoperations were performed in 6 (2.8%), and no conversions to open or deaths occurred. Weight loss on par with the DS and RGB was achieved with just the VG alone. The VG operation is able to achieve significant weight loss comparable to the RGB and DS operations but with the low morbidity profile similar to that of Lap-Band placement.