Silastic ring vertical gastric bypass: evolution of an open surgical technique, and review of 1,588 cases.
BACKGROUND
Silastic ring vertical gastric bypass (SRVGBP) has evolved from a stapled (SSRVGBP) to a transected (TSRVGBP), and finally to a transected pouch with jejunal interposition (TSRVGBP with J-I). The creation of the gastroenterostomy evolved from a hand-sewn to a stapled and finally to a combined stapled and hand-sewn anastomosis. The circumference of the ring was increased from 5.5 to 6.0 cm. We address the effect of these modifications on surgical outcome.


METHODS
The records of 1,588 consecutive patients (mean BMI of 44.5) since 1990 who had a SRVGBP were indentified from a prospective data-base of all patients undergoing bariatric operations. 205 patients with a prior bariatric operation were excluded from the review, leaving 1,383 patients who had a primary SRVGBP.


RESULTS
In the 193 SRVGBP patients, there was 1 gastric leak (0.5%) and 64 gastrogastric fistulas (33.2%). In the 165 TSRVGBP patients, there were 4 gastric leaks (2.4%) and 14 gastrogastric fistulas (8.5%). In the 1,025 patients with TSRVGBP with JI, there were 8 gastric leaks (0.8%) and no gastro-gastric fistulas. In the TSRVGBP with J-I, 367 patients had a hand-sewn, 16 a stapled, and 642 a combined stapled and hand-sewn anastomosis. Stricture rate was 3.8%, 31%, and 2.6% respectively. There were 7 ring migrations (0.7%), all in the totally hand-sewn group. Ring removal was necessary in 20 (5%) with a 5.5-cm and 4 (0.74%) with a 6.0-cm ring.


CONCLUSIONS
TSRVGBP with J-I with a combined stapled and hand-sewn gastrojejunal anastomosis using a 6.0-cm ring decreased the incidence of complications, and is our current technique.
Salinas
Alberto
A
Hospital de Clínicas Caracas, Caracas, Venezuela. asalinas@clinicaracas.com
Santiago
Edwin
E
Yegüez
José
J
Antor
Mariemma
M
Salinas
Harry
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004129:Dimethylpolysiloxanes; D004867:Equipment Design; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D005763:Gastroenterostomy / Q000379:methods; D015391:Gastroplasty / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D012828:Silicones; D017792:Surgical Stapling / Q000379:methods*; D016896:Treatment Outcome
D004129:Dimethylpolysiloxanes; D012828:Silicones; C013830:baysilon