Modification of the gastric partitioning operation for morbid obesity

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.

Failure rate with gastric partitioning for morbid obesity

One hundred twenty-two morbidly obese patients were selected for gastric partitioning from a multidisciplinary obesity clinic over a 4 year period. Initial early success was not a guarantee against cessation of weight loss or the regaining of lost weight. By emphasizing criteria for success and failure, both from our series and the literature, we showed an alarming increase in the failure rates for this procedure which is predicated on the fact that those lost to follow-up were probably failure patients. Numerous articles in the literature contain inadequate data because they refer to pounds rather than percentage of weight loss, they fail to consider revisions as failures, they do not provide 24 month follow-up data, and they do not take into account the possibility that those lost to follow-up are failure patients. The operation carries mortality and serious morbidity rates of 0 to 3 percent and 4 to 10 percent, respectively, with an average 28 percent weight loss at 24 months and a minimal failure rate of 50 percent. The alarming increase in the number of these procedures being carried out across the continent makes it mandatory for surgeons to accurately collect and register their data until the long-term effects and results are known. Gastric partitioning, although probably not experimental, is still developmental. The widespread use and possibly abuse of these operations may result in discreditation of the surgical approach to morbid obesity which would be unfortunate since it is the only practical method at this time for dealing with the problem.