title: Complications after vertical gastroplasty with artificial pseudopylorus in the treatment of morbid obesity: a 7-year experience.
abstract: BACKGROUND
  Vertical gastroplasty with artificial pseudopylorus (VGAP) was designed to reduce the complication rate of other forms of gastroplasty. The purpose of this study was to analyze the complications of this approach for 7 years of surgical practice.
  
  
  METHODS
  A total of 156 morbidly obese patients (BMI 41-81 kg/m2) who underwent VGAP were analyzed retrospectively in terms of early and late complications and gastroplasty failure.
  
  
  RESULTS
  The early complication rate, operative and systemic, was 6.40% (10 patients) and the late complication rate was 12.16% (19 patients). Early complications: We observed two gastric leaks and subphrenic abscess formation with one gastrocutaneous fistula, one severe intraabdominal hemorrhage, one evisceration, two serious wound hematomas, one lobar pneumonia, one massive pulmonary embolism and two nodular erythemas. Late complications: There were two prepyloric ulcers, one pseudopyloric ulcer with stoma stenosis, seven wound hernias, four pseudopyloric dilatations with suture rejection and gastroplasty failure, and five staple-line dehiscences with endostomach channel formation and gastroplasty failure. One patient (0.64%) died from massive pulmonary embolism.
  
  
  CONCLUSIONS
  The early and late complication rate was acceptable in this series. The applied technique of VGAP is simple, safe, and helps avoid many complications caused by the other forms of gastroplasty.
authors.affiliation: Aristotelian University of Thessaloniki, 3rd Surgical Department, AHEPA Hospital, Macedonia, Greece.
authors.forename: S T
authors.initials: ST
authors.lastname: Papavramidis
authors.forename: C
authors.initials: C
authors.lastname: Milias
mesh_terms: D000005:Abdomen; D018784:Abdominal Abscess / Q000209:etiology; D000328:Adult; D002423:Cause of Death; D003251:Constriction, Pathologic / Q000209:etiology; D017577:Cutaneous Fistula / Q000209:etiology; D004108:Dilatation, Pathologic / Q000209:etiology; D004890:Erythema / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005747:Gastric Fistula / Q000209:etiology; D015391:Gastroplasty / Q000009:adverse effects* / Q000145:classification; D006406:Hematoma / Q000209:etiology; D006547:Hernia / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000209:etiology; D011655:Pulmonary Embolism / Q000209:etiology; D011708:Pylorus / Q000601:surgery*; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000209:etiology; D013276:Stomach Ulcer / Q000209:etiology; D017792:Surgical Stapling / Q000009:adverse effects; D013529:Surgical Wound Dehiscence / Q000209:etiology; D017211:Treatment Failure; D016896:Treatment Outcome