Obesity surgery: discouraging long term results with Mason's vertical banded gastroplasty.

OBJECTIVE: To evaluate the long term results of Mason's vertical banded gastroplasty (VBG) using accepted criteria, and to find out which factors predicted success. DESIGN: Retrospective survey of a cohort of 40 severely obese patients (mean initial body mass index (BMI in kg/m2): 43, range 34-62). SETTING: General teaching hospital, The Netherlands. MAIN OUTCOME MEASURES: Success according to three definitions: weight loss of more than 25%; percentage of excess weight 50% or less; and BMI < 30. RESULTS: Mean follow-up was 7.4 years (range 0.5-10) or 85%. The distribution over MacLean and Reinhold criteria shows a shift towards unfavourable categories. The consecutive percentages of success at five years were 35%, 62%, and 35%. Logistic regression analysis of success at 5 years shows that the following factors significantly predicted success: Definition I: age odds ratio (95% confidence interval): 0.88 (0.78 to 0.99). Definition II: age: 0.84 (0.69-1.01), outlet > or = 5 cm: 176 (2.4 to 12774), percentage of ideal weight > or = 100%: 0.03 (0.002 to 0.48). Definition III: age: 0.86 (0.75 to 0.99), pouch size > or = 15 ml: 10.64 (1.48 to 76.6). CONCLUSION: The long term results of VBG are disappointing when assessed by the standard criteria.

Adjustable silicone gastric banding: can We continue the original technique of Kuzmak?

BACKGROUND: Kuzmak developed a horizontal gastroplasty for morbid obesity using his adjustable silicone gastric banding (ASGB). The aim of this study was to evaluate the efficiency at weight loss, early and late morbidity and mortality. METHOD: The records of 44 patients (mean age 36 years) were reviewed. The indication for ASGB was a BMI >40 (group A = 37 patients) or a BMI between 35 and 40 with obesity-related morbidity (group B = 7 patients). The mean preoperative BMI was 44 (+/-5). The paired t test was used to evaluate the BMI. RESULTS: Early complications occurred in 5 patients: splenic injury (n = 1), aspiration pneumonia (n = 1), wound infection (n = 1), gastric perforation (n = 2); mortality was 2%. Late complications occurred in 19 patients: 17 patients (39%) had a functional stenosis with pouch dilatation (FSPD) and 6 patients had an injection port leakage (14%). At the 1-year follow-up, the mean BMI (of the 39 patients available) was 30 (+/-5) and remained stable. At 36 months, 54% of group A and 100% of group B had a BMI <30. CONCLUSION: The original technique of Kuzmak is effective to lose weight. However the technique must be adjusted in order to decrease the unacceptable high incidence of FSPD.

[Bariatric surgery using an adjustable gastric band for morbid obesity: initial 30 patients in The Netherlands]. / Bariatrische chirurgie met een variabele maagband voor morbide obesitas: eerste 30 patiënten in Nederland.

OBJECTIVE: Early evaluation of efficacy and safety of Adjustable Silicone Gastric Banding (ASGB) in the treatment of morbid obesity. DESIGN: Descriptive. SETTING: Red Cross Hospital, Beverwijk, the Netherlands. METHOD: In the period September 1991-September 1993, 30 eligible patients (5 men and 25 women, median age 37 years (range 22-60), median excessive weight 63 kg (18-94), median body mass index (BMI) 43 kg/m2 (28-53)) were operated. A horizontal gastroplasty was performed resulting in a pouch of 25 ml and a new stomach outlet with a diameter of 12 mm. The volume of the band may be increased in order to diminish the diameter of the outlet according to clinical needs postoperatively. RESULTS: The follow-up was 10 months in 13 of the 30 patients. After 6 months median BMI was 33 kg/m2 (23-38) and median loss of excessive weight 53% (27-94), after 10 months these 28 kg/m2 (23-38) and 67% (27-98) respectively. No patients died perioperatively; 52 gastric band adjustments were necessary in 17 patients. Complications consisted of: band dislocation (1 patient), functional stenosis (2), gastric perforation (2) and wound infection (1). Four patients needed reoperation. CONCLUSION: In this short term follow-up ASGB gave a good weight reduction. Advantages of ASGB are the reversibility of the operation and the adjustable outlet.

The role of A-O-incompatible blood transfusions in porcine orthotopic liver transplantations.

The consequences of administrations of A-O-incompatible blood transfusions during porcine orthotopic liver transplantations (OLT) are described. Two series, both subjected to the same standard procedure except for the administration of compatible or incompatible blood, are compared. The striking differences in peroperative and direct post-operative morbidity, mortality, and causes of death between the two series are presented. Although not generally applied, blood transfusions in experimental surgery should undergo the same precautionary measures as blood transfusions in humans.