The weight reduction operation of choice: Vertical banded gastroplasty of gastric bypass

BACKGROUND: Despite important advances in the field of bariatric surgery over the last 40 years, no single operation has clearly emerged as the optimum procedure. Over the last decade, however, attention has focused on vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RGB). PATIENTS AND METHODS: We compared 329 VBG procedures consecutively performed in 328 patients, and 623 VBG-RGB operations in 560 patients for mortality, early and late complications requiring reoperation, and for weight loss up to 5 years. In 272 VBG-RGB operations, the gastric segments were stapled in continuity, and in 351 cases, the gastric segments were stapled and completely separated. RESULTS: Early complications were few for both procedures, Unsatisfactory weight loss was the most frequent late complication among VBG patients, whereas revision for staple-line disruption was the most common cause for late reoperation in the VBG-RGB group. The incidence of staple-line disruption was 22% for VBG-RGB patients when gastric segments were stapled in continuity and 2% when gastric segments were completely divided (P <0.0001). Weight loss for the VBG patients and VBG-RGB patients at 5 years was 47% and 62%, respectively (P <0.0001). CONCLUSION: Our data suggest, as others have shown, that RGB is a better weight-loss operation than VBG. A lesser curvature vertical pouch stapled in continuity with the excluded stomach can be associated with a high rate of staple-line disruption in RGB. Separation of gastric segments appears to significantly diminish this complication (P <0.0001). Late complications now are fewer, and VBG-RGS is our weight-reduction procedure of choice.