title: A gastroplasty that avoids stapling in continuity.
abstract: BACKGROUND
  Staple line perforations have been the principal cause of failure after vertical-banded gastroplasty in patients followed at least 4 years at our institution. In the present study an operation was devised that created a vertical-banded gastroplasty not dependent on staple lines to avoid this complication.
  
  
  METHODS
  One hundred two patients with a body mass index (BMI) greater than 35 kg/m2 underwent vertical-banded gastroplasty from Jan. 1 to Dec. 30, 1986, with an orifice size of 45 to 47 mm external circumference and division between the vertical staple lines to prevent gastric pouch to gastric fundus fistula.
  
  
  RESULTS
  Ninety-eight of the patients have been followed up for a minimum of 4 years. Sixty-two percent of patients obtained an excellent or good final result after 4.5 +/- 0.1 years. This was a BMI of less than 35 kg/m2 or less than 50% excess weight. This acceptable long-term result was achieved 90% of the time if the patient was obese (BMI, 35 to 40 kg/m2) before surgery and in 75% of patients who were morbidly obese (BMI, 40 to 50 kg/m2) but in only 30% of patients who were superobese (BMI > 50 kg/m2) before surgery. Staple line disruption was markedly reduced; however, stenosis or failure to lose weight or late weight gain required reoperation in 36% of the patients.
  
  
  CONCLUSIONS
  Gastric bypass was superior to reversal or revision of the gastroplasty as a remedial operation. This study again questions the value of vertical-banded gastroplasty in the treatment of obesity even when staple line disruption is markedly diminished.
authors.affiliation: Department of Surgery, Royal Victoria Hospital and McGill University, Montreal, Quebec, Canada.
authors.forename: L D
authors.initials: LD
authors.lastname: MacLean
authors.forename: B M
authors.initials: BM
authors.lastname: Rhode
authors.forename: R A
authors.initials: RA
authors.lastname: Forse
mesh_terms: D000328:Adult; D015992:Body Mass Index; D004032:Diet; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D012086:Reoperation; D013528:Surgical Staplers; D015431:Weight Loss