Bariatric surgery at First Surgical Department in Prague--Czech Republic--history and some technical aspects of the procedures.

BACKGROUND

There is an increasing number of obese population in the Czech Republic in last twenty years. In 1983 we were one of the first surgical departments in the country who started with bariatric surgery on regular basis.

METHODS

In the period from 1983 to 1986 we performed vertical banded gastroplasties (VBG) in our department. Because of high rate of various complications arising both from the stomach and from the wound we switched in 1986 to less "aggressive" non-adjustable gastric banding. In 1993 we performed the first round the world laparoscopic non-adjustable banding. In 1994 we started with laparoscopic placement of adjustable gastric bands.

RESULTS

In the group of 52 patients who underwent VBG and were followed-up, acceptable weight loss results (-40.5 kg) were achieved in 24 months following surgery. The postoperative complications were high, 17.3% of gastric staple line disruption and 15.3% of wound complications--incisional hernias, discharge etc. Since 1986 we performed non-adjustable gastric banding in 150 patients with the weight loss of -38.4 kg in 24 months following surgery. There was no change in the wound complications rate, but the complications arising from the stomach and the band decreased to 6.3%. Since June 1993 we performed 268 procedures laparoscopically either with non-adjustable bands or since 1994 with the adjustable bands. The wound complication rate decreased to 0.9% and one complication (6.6%) was connected with the adjustable band.

CONCLUSIONS

Because of the high rate of postoperative complications connected in our experience with VBG we started with gastric bandings in 1986. Since than the number of complications arising from the stomach decreased substantially. With the laparoscopic technique used in bariatric surgery there was another decrease in wound healing problems. With the adjustable GB a significant decrease in the stomach related complications occurred. Shorter hospital stay is related to the laparoscopic technique. The long-term weight loss results are not significantly different among the procedures mentioned above.