Complications of VBG and Gastric Bypass...

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Obes Surg 1996 Oct;6(5):421-425 Related Articles, Books

Vertical Banded Gastroplasty and Distal Gastric Bypass as Primary

Procedures: A Comparison.

Fox SR, Oh KH, Fox K

The Medical Services Organization, Tacoma, WA, 98498, USA.

[Record supplied by publisher]

BACKGROUND: Comparing primary vertical banded gastroplasty (VBG) and distal

gastric bypass (DGBP) patients might assist decision-making based on patient

profiles and desired outcomes. METHODS: A prospective study of 81 vertical

banded gastroplasty and 60 distal gastric bypass patients. Technical

aspects, complications, weight loss, post-op compliance and satisfaction are

reported. Length of follow-up is 48 months (VBG) and 36 (DGBP).

Lost-to-follow-up 41% (VBG) and 22% (DGBP). Ten per cent of VBGs were

revised, with 1% takedown. Three percent DGBPs were converted to proximal

GBPs. Demographics are comparable. RESULTS: Operative time was 40 min VBG

and 88 DGBP; blood loss 187 cc vs 335 cc; and hospital stay 3 versus 4 days.

Exclusive VBG complications include: 1% staple-line leak, 4% intra-abdominal

abscess, 1% respiratory failure, 5% pneumonia, 1% intra-abdominal bleed, 1%

small bowel obstruction, 2% infected incision, 2% fistula, 2% stenotic or

obstructed obstructed stoma, and 1% bezoar. Exclusive DGBP complications

include: 2% GI bleed, 12% marginal ulcer, 5% reflux esophagitis, 13%

hypocalcemia, 23% hypovitaminosis A and D (12% requiring B12 therapy).

Shared complications include hypoproteinemia 6% VBG versus 40% DGBP; excess

vomiting (>6 months post-op), 7% versus 10%, excess diarrhea 2% versus 20%,

dehydration 1% versus 8%, re-hospitalization 4% versus 15%

(hyperalimentation), post-op cholecystectomy 1% versus 5%, weight regain 48%

versus 1%. VBG experienced an average of 64% excess weight loss at 36 months

versus DGBP 89% excess weight loss. VBG follow-up compliance is generally

poor but good for DGBP. Compliance with diet and supplements is equivalent

(50%). Satisfaction is 85% and 93% respectively. CONCLUSION: The DGBP

provides better long-term weight loss, but nutritional deficiencies occur

more often and require close follow-up. The surgery is more complex, but as

a primary procedure there are few major complications.

RR

Rutledge, M.D., F.A.C.S.

The Center for Laparoscopic Obesity Surgery

4301 Ben lin Blvd.

Durham, N.C. 27704

Telephone #:

Fax #:

Email: DrR@...

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