title: Impartial long-term review of vertical banded gastroplasty in a low volume community hospital practice.
abstract: BACKGROUND
  There is some concern whether bariatric surgery can be done well at low volumes or in a community hospital setting. This paper reports an impartial assessment of 25 vertical banded gastroplasties (VBG) over 13 years in a 228-bed non-teaching community hospital.
  
  
  METHODS
  Charts were reviewed and patients interviewed by an independent investigator. Complications, weight loss, satisfaction and quality of life were assessed.
  
  
  RESULTS
  There were no fatalities, no splenic tears, no stomal stenosis and no symptomatic gastroesophageal reflux. Two reoperations and five incisional hernias were noted. Hypertension was eliminated in 57% and dyspnea in 55%. BMI fell from 44.3 to 34.9 kg/m2 after 6.2 years. BMI decreased more than 10 kg/m2 (10-30) for 15 patients and less than 10 kg/m2 for 10 patients (4-10 for 7, 0 for 1 and a gain for 2). 56% of patients were fully satisfied with the results. Quality of life indicated excellent physical function, physical role and lack of body pain, good general health, social function, emotional role and mental health, but lower vitality. 100% felt better than a year ago.
  
  
  CONCLUSIONS
  Results from a low-volume community hospital general surgical practice are similar to those from specialized series. Obesity is so common, its non-surgical treatment so ineffective and the VBG so well established, that excluding this intervention from community hospitals is untenable.
authors.affiliation: Department of Surgery, Scarborough Hospital, Grace Division, Scarborough, ON, Canada. avoitk@healthwest.nf.ca
authors.forename: A
authors.initials: A
authors.lastname: Voitk
authors.forename: J
authors.initials: J
authors.lastname: Tepp
authors.forename: J
authors.initials: J
authors.lastname: Joffe
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000379:methods / Q000706:statistics & numerical data*; D006555:Hernia, Ventral / Q000453:epidemiology / Q000209:etiology; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology*; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires