Horizontal and Vertical Gastroplasties: extended follow-up and late results.
In the late 1970s and early 1980s five individual series of gastroplasties were performed with sequentially smaller pouch and stoma sizes. Three of the series were horizontal gastroplasties and two were vertical gastroplasties. Stomas in all but the last series were banded with multiple strands of nylon and in the final series with a Teflon strip. Early and late weight loss results are presented. Mean follow-up for all groups ranged from 5.4 to 6.5 years, some patients being followed as long as 11.2 years. Weight loss results showed that mean greatest percentage excess weight loss for the groups was 60-70%, with losses ranging from unacceptable to ideal in all groups. Mean final percentage excess weight losses were below the level of success in all but the Teflon-banded vertical gastroplasties. The range of final data showed that percentage losses ranged from negative (greater than pre-operative weight) to near ideal across the groups. A small but significant number of patients in each group were considered early failures, never having achieved a weight loss level meeting the criterion of success. Maintained successful weight loss varied between the gastroplasty groups from 11 to 27%. This was after a mean follow-up of from 7.3 to 9.4 years. Stoma data showed a general trend to diminution in size as success increased; however, range data showed great variability in stoma size associated with success. Further analysis of stomas indicated that there was no absolute correlation between weight loss and stoma size. Many of the gastroplasty failures in all groups were converted to other types of procedures, the incidence varying from 27 to 46.5% between groups. It is concluded that while weight loss after 2 years of follow-up was successful in the majority of instances and with all types of gastroplasty, late follow-up indicated an ever-increasing failure rate that varied between the series from 73 to 89%. It is therefore recommended that authors reporting gastroplasty results take into account the foregoing facts and clearly define length of follow-up and, where possible, present late, complete follow-up data.
Salmon
PA
Department of Surgery, University of Alberta, Edmonton, Alberta T6G 2B7 Canada.
McArdle
MO