Laparoscopic vertical banded gastroplasty for morbid XXXX . Assessment of efficacy.

@entity1 @entity353 @entity28 @entity7502 @entity1346
BACKGROUND: The advantages of treating morbidly @entity28 @entity1 via the laparoscopic approach have been demonstrated, in particular, for adjustable @entity1346 gastric banding, but this operation is associated with a high rate of late complications. Gastric bypass and malabsorbitive procedures are feasible via the laparoscopic approach, but they entail a prolonged operating time and a consistently high morbidity rate. Laparoscopic vertical banded gastroplasty represents an effective alternative. METHODS: We performed 250 consecutive LVBG between November 1995 and February 2000. The procedure consisted of a personal technique designed to reproduce, by laparoscopy, MacLean's modification of the standard open Mason vertical-banded gastroplasty, with a calibrated transgastric window, a complete division between the staple lines, and a 5-cm-circumference @entity7502 collar. RESULTS: The operative time was 95 min and the conversion rate was 0.8%. Operative mortality was nil; early and late complications, respectively, were 4.4% and 4%; the reoperation rate was 2%. Global results at 4 years were as follows: excess @entity353 (EWL) 61%, success rate (excess weight <50%) 76.9%, body mass index (BMI) 29.4 kg/m2. In morbidly @entity28 @entity1 , the EWL at 4 years was 62.2%, with a 77.4% success rate and a 28.4 kg/m2 BMI; in superobese @entity1 , the EWL at 4 years was 54.9% with a 50% success rate and a 35.5 kg/m2 BMI. The overall follow-up rate was 92%. CONCLUSIONS: LVBG is an effective and safe operation in morbidly @entity28 @entity1 , providing good @entity353 with a low morbidity rate, no mortality, and minimum discomfort. However, in superobese @entity1 , the @entity353 results are disappointing; in these @entity1 , LVBG is questionable and more complex procedures should be considered.
