Gastroplasty in intractable obesity.

Three hundred patients underwent gastroplasty surgery for morbid obesity. The operation consisted of formation of a 45 to 60 millilitre (ml) proximal gastric pouch with a 10 to 12 millimeter (mm) channel located on the greater curvature of the stomach. The channel was supported by a continued seromuscular inverting layer of 2-0 polypropylene and a second interrupted inverting layer of 4-0 Dacron sutures. The early postoperative complication rate was 18.7 percent, including one cardiac death, for a 0.33 percent mortality rate. Late postoperative complication rate was 27.0 percent, with vomiting heading the list. Staple-line disruption continued to be of concern with stapling in continuity. Liquid or pureed diet restriction for the first 12 postoperative weeks decreased the incidence of vomiting which contributed to early staple-line dehiscence. Two applications of the TA 90 and preservation of adequate blood supply to the pouch were important factors in the prevention of this complication. The department of clinical nutrition was directly involved in the preoperative classes in nutrition designed to assist patients in making the proper psychological adaptation to the newly imposed dietary restrictions. Over 90 percent of total weight loss occurred at 12 months. At 24 months there was a 32.5 percent decrease from preoperative weight and a 63.4 percent excess weight loss.