Obesity Surgery, 1, 181-183

Why the Operation I Prefer is:

The Preferred Operation for Morbid Obesity

Through the ingenuity of the surgeon, many different operations have developed, in order to achieve lasting weight loss in a high percentage of patients. All operations have some failures and complications. Some operations involve gastric restriction, others involve malabsorption, and others involve a combination of the two. Some operations are variations on prior procedures. The complexities, complications, and effectiveness differ.

Accordingly, in this section, we have invited acknowledged experts to tell us briefly why they prefer the operation which they perform. This feature will be continued with the other commonly performed operations in the next issue.

M. Deitel

Why the Operation I Prefer is Vertical Banded Gastroplasty 5.0

Edward E. Mason, MD, PhD, FACS

Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, USA.

Vertical banded gastroplasty (VBG) is easy for the patient, requiring no nasal gastric tube, gastrostomy, feeding enterostomy, or central venous line. Clear liquids are begun the first morning and pureed foods the

second day. VBG with a 5.0 cm collar and a 13 ml pouch provides sufficient weight control with minimal risk and side effects. Splenectomy risk is 0.3%, peritonitis from leak 0.6% and operative mortality 0.24%. VBG causes no

malabsorption or bacterial overgrowth because there are no blind segments. VBG does not predispose to difficult to diagnose, lethal, closed segment obstruction because of the absence of exclusion. VBG minimizes risk of

acid peptic disease by preserving normal feedback control of acid secretion. Revisions have been less than

Reprint requests to: Edward E. Mason, MD, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City,

IA 52242, USA. Tel: 319-356-2779; fax 319-356-8378.

2% per year. The first 250 patients to be followed for 5 years with VBG-5.0 showed an 80% success in achieving 25% of excess weight loss without revision. For these

successful patients the average percentage excess weight loss was 60% for the morbid obese (MO 160 to 225% of ideal) and 52% for the super obese (SO over

225% of ideal). Absolute weight averages changed from 122 to 86 kg for MO and from 159 to 110 kg for SO.

Key words: Morbid obesity, risk, surgery, vertical banded gastroplasty.

There is no perfect operation for control of morbid obesity. Different operations have different advantages and drawbacks. As a result choices must be made. One of the first choices should be between achieving a normal weight and achieving a signifi-

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