Gregg H. Jossart

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

BackgroundThe 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.MethodsLaparoscopic 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.ResultsBetween 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.ConclusionThe 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.

Food Intolerance in the Sleeve Patient: Prevention, Evaluation, and Management

The laparoscopic sleeve gastrectomy has emerged over the last decade as a widely accepted bariatric surgical procedure. It is a purely restrictive stapling procedure that eliminates the foreign body risks seen with adjustable banding and the malabsorptive risks associated with intestinal bypass procedures. It is indicated as a lower risk, staged option in complex or higher BMI patients and as a primary procedure in lower BMI patients. The gastric resection may offer a unique hormonal benefit that modifies satiation to yield a more durable weight loss than anticipated. The sleeve gastrectomy pouch is a narrow, high-pressure tube that often yields early postoperative food intolerance and dysphagia. This narrow sleeve pouch is also at risk for developing stenosis which will lead to progressive dysphagia and vomiting that must be diagnosed and treated. This chapter explains the spectrum of food intolerance from improper eating to vomiting and drooling from severe stenosis and how to diagnose and treat these problems.

Reoperative Options After Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy has become a common procedure for the management of obesity. It is touted by its proponents for being low in complications, while remaining very effective at achieving the goals of weight loss surgery. This chapter will review the reasons for failure following sleeve gastrectomy including surgical-, anatomic-, and compliance-related issues. We will also discuss the strategies to avoid failure, how to evaluate failing patients, and both the surgical and nonsurgical options for management.

4. Laparoscopic Sleeve Gastrectomy

The laparoscopic sleeve gastrectomy has emerged over the last decade as a widely accepted bariatric surgical procedure. It is a purely restrictive stapling procedure that eliminates the foreign body risks seen with adjustable gastric banding and the risks associated with intestinal bypass procedures. It is indicated as a lower risk, staged option in complex or higher BMI patients and as a primary procedure in lower BMI patients. The gastric resection may offer a unique hormonal benefit that modifies satiation to yield a more durable weight loss than anticipated. Currently, the main controversy surrounding this procedure is the lack of standardization of pouch size and the limited weight loss results beyond 5 years.