Surgery for morbid obesity in a provincial centre.

Forty-eight patients underwent surgery for morbid obesity, 20 had gastric bypass and 28 had gastric partitioning or stapling. Gastric bypass was effective in producing satisfactory weight loss. There were few long term sequelae. However, it was complex and difficult technically, with a substantial mortality--three deaths. Gastric partitioning was simpler and safer, no mortality or serious complications but it was less reliable in producing satisfactory weight loss. Eleven patients showing no sign of getting within 20 percent of their ideal weight; this includes four with staple disruption. A small stomach syndrome is produced with transient qualitative limitation of overeating. A degree of motivation and dietary reform is necessary to produce the qualitative changes that the dumping symptoms, associated with gastric bypass, compel. Important features of management are careful selection and counselling pre operatively and regular follow up by both surgeon and dietitian.