Pouch outlet obstruction following vertical ring gastroplasty for morbid obesity.
We have experienced a 14% (38 of 264 patients) incidence of pouch outlet obstruction following vertical ring gastroplasty. Initial management consisted of dilatation in 34 of 38 patients (94%). Ten of 34 patients (29%) were spared reoperation by 1 to 3 dilatations. Non-passage of an endoscope through the stoma immediately following dilatation predicted the need for surgery; 4 of 11 patients (36%) with passage underwent reoperation compared with 17 of 20 patients (85%) without passage (p less than 0.02). Surgical findings included "tipped bands" in 9 of 28 patients (32%); fibrous reaction to the band in 10 of 28 patients (36%); adhesions with angulation of the pouch in 2 of 28 patients (7%); and no identifiable cause of obstruction in 7 of 28 patients (25%). Surgical therapy consisted of removal of the band (2 patients), removal of the band and replacement with a similar length or larger band (20 patients), "tacking" the band in the horizontal position (4 patients), or conversion to a Roux-Y bypass (2 patients). The first three options were associated with an unacceptably high rate of weight regain and/or continued symptoms, whereas the last-named procedure met with good success.
Hocking
M P
MP
Department of Surgery, University of Florida College of Medicine, Gainesville.
Bennett
R S
RS
Rout
W R
WR
Woodward
E R
ER
D000713:Anastomosis, Roux-en-Y; D003251:Constriction, Pathologic / Q000601:surgery / Q000628:therapy; D004106:Dilatation; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D013270:Stomach / Q000473:pathology* / Q000601:surgery