Gastric partitioning for morbid obesity: postoperative weight loss, technical complications, and protein status.

The study of 325 patients who underwent gastric partitioning (stapling) was undertaken to assess the complications and weight-loss records over a 5-year period. A subgroup of 15 patients was studied to determine protein status preoperatively and 2, 4, and 6 months after surgery. Laboratory tests, anthropometric measures, and food records were used to assess patient health and nutritional status. Four operative techniques have been used by a surgeon in Reno, NV, since 1979. The main postoperative complication in the first two procedures, a nonreinforced horizontal staple line (Groups 1 and 2), was staple line disruption and, therefore, poor weight-loss results. The staple line was reinforced in the next 193 patients (Group 3), and the patients followed a blenderized diet for 8 weeks postoperatively. Persistent vomiting was the most common problem in that group; 24% required dilatation of the stoma via gastroscopy. The vertical staple procedure was adopted for the next 48 patients (Group 4) to further minimize disruption and severe vomiting. Other operative complications were relatively few. At 48 and 18 months, respectively, Groups 3 and 4 showed an average weight loss of 27% of the preoperative weight. Eating patterns and food tolerances changed dramatically postoperatively, and protein intake dropped significantly. Mean protein intakes below standard recommended dietary allowance (RDA) were observed in a subgroup of Groups 3 and 4. However, the mean total lymphocyte count and albumin values demonstrated that patients were not compromising visceral proteins. The mean creatinine height indexes and arm muscle areas showed no significant difference in somatic protein status.(ABSTRACT TRUNCATED AT 250 WORDS)

Results and complications of gastric partitioning. Four year follow-up of 300 morbidly obese patients.

Two-hundred seventy-seven morbidly obese patients were followed 6 to 48 months through three modifications of gastric partitioning. Technical failures caused poor results in 75 percent of patients in Groups I and II. Group III patients were operated on using a single TA-90 application with three midlateral staples removed. The proximal staple line was reinforced by a row of interrupted 2-0 silk sutures and a circumferential 1-0 silk suture supported with Teflon pledgets around the stoma. This technique effected good or excellent weight loss in 70 percent of the patients. Complications were minimal except for stomal dilatation through the gastroscope required in 22 percent of the patients and staple line disruption despite reinforcing maneuvers in 7 percent. Because of the dilatations and the 7 percent technical failure, I recently adopted the vertical gastroplasty as described by Eckhout and Prinzing [5]. Long-term follow-up by an experienced team consisting of a surgeon, gastroenterologist, dietition, and supportive staff is essential for the continued success of the surgical management of the morbidly obese patient.

Food supplement usage by the elderly.

A variety of food supplements were taken by 66 percent of the elderly persons in this study. Ascorbic acid and vitamin E were the most popular choices. Some supplements may have improved nutritional status, while others were probably inappropriate or unnecessary. The findings indicate that the elderly have a number of erroneous beliefs about the efficacy of food supplements. Reasons for supplementation were often inappropriate, and unreliable sources of information were used. In addition, substantial amounts of money were spent on food supplements by those already existing on a limited budget. Nutrition education is needed to demonstrate the relationship between adequate diet, good health, and appropriate versus inappropriate food supplement consumption.