QUESTION ABOUT FAILED VERTICAL GASTROPLASTY - Forum

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Dottore

QUESTION ABOUT FAILED VERTICAL GASTROPLASTY - Ärzteforum

Post#1 »

I operated upon an 18 year old female obese patient(120 kilos) about 18 months ago.Did an open Vertical gastroplasty using to staple the stomach vertically after having used the circular stapler to create the gastric window the US Surgical reusable linear stapler. Technically speaking my group and I think everythink went smoothly. The results durind the first 4 months PO were great and the patient lost about 24 kilos. Afterwards I lost contact with her because she and her family being negligent,I think. After about a month ago she reappeared her mother complaining to us in a bad mood that her daughter had regained about 10 kilos weight. I asked for an upper GI Barium swallow and an Endoscopy. Althouhg the patient hasn't gone back to my office ,her mother called me a couple of days ago and told me that they had done the endoscopy and that it seemed that the staples had broken and that the stomach had gone back not counting the gastric window at the lower stomach level,back to normal. I hadn't heard of that possibility before and therefore would be gratefull to hear opinions from all of you.


canadian

Re: QUESTION ABOUT FAILED VERTICAL GASTROPLASTY - Ärzteforum

Post#2 »

Loosening of the staple line is not, in my opinion, a rare complication
of vertical stapled gastroplasty. That is one of the reasons we recently
abandoned this procedure in favor of the 'lap band' (adjustable silicone
band ), wich is perfectly reversible, adjustable to the patient's
evolution and can be placed by laparoscopy. We have the best experience
with the Swedish model (Obtech).
Maybe the lap band is a solution for your patient.

Hans

Re: QUESTION ABOUT FAILED VERTICAL GASTROPLASTY - Ärzteforum

Post#3 »

I think that if you operate on such patients you get what you deserve - the
logic of such procedures still escapes me - the cause of the problem is not
surgical, there is nothing wrong with the stomach or the whole intestinal
tract for that matter so why in the name of good medicine operate on it!!!!!
Sure they need help, but the last thing they need is surgery.

Poland

Re: QUESTION ABOUT FAILED VERTICAL GASTROPLASTY - Ärzteforum

Post#4 »

Could you please send references on the "Lapband" you mention for Morbid
Obesity and particularly the Obtech model address of manufacturer.

Marcel

Re: QUESTION ABOUT FAILED VERTICAL GASTROPLASTY - Ärzteforum

Post#5 »

This operation represents one of the biggest money-making scams in
the field of medicine, and the amount of money being made off of these
desperate patients is directly proportional to the vigor with which the
responses will be telling me how wrong I am--watch and see! Not one iota of
evidence that this major surgery is any better than nonop means of weight
reduction--no better than the snake oil of last century! Please--anyone who
wants to disagree with me show us all the data. This is a major intervention
frought with significant risk--it's lack of medical indication or proof of
benefit is shown by the fact that it is not insured, and like all other
cosmetic surgery (none of which is so drastic!) requires full pay up
front--good I guess for the doc who has a couple of beach condos to pay off
real quick. And again--before the righteous indignation starts up--if you
can't justify the case, you can't defend yourself against the above
implication! Platitudes about how much you are really doing this for the
patient won't cut it!

User avatar
Surgeon

Re: QUESTION ABOUT FAILED VERTICAL GASTROPLASTY - Ärzteforum

Post#6 »

Let me open up another can of worms here, which I was hoping to let go by
until I saw this statement just once too often in the past couple of days
Do the other surgeons on this list ever do this in fresh postop rectal
anastomoses?
Do you not feel this is an unnecessary stress of an already fragile anastomose
which can get you little info if any at great risk? I have seen too many
disrupted anastomoses follow this maneuver, and too many leaks despite not
being detected by this misguided maneuver. Isn't a gentle introduction of
betadine or methylene blue or air while the anasomosis is under water during
the case. thru a soft rubber catheter, a much more accurate and gentle way to
test the seal before you close, and a gastrograffin enema postop if you
suspect a leak? As I ask my residents who have done this, what is this urge
to SEE the staple line when it is the least accurate, and most dangerous, way
of determining a leak? Also--if I detect a staple line leak before
closing--that is automatically an indication to do a diverting colostomy--I've
learned the hard way not to just try fixing it and close--inevitably it
leaks--anyone else feel this way?

User avatar
Sweden surgeon

Re: QUESTION ABOUT FAILED VERTICAL GASTROPLASTY - Ärzteforum

Post#7 »

About surgery for morbid obesity: I agree that it can only be justified for
patients with a BMI in excess of 40 and only when sustained medical treatment
fails. The question of the morality of such procedures is a matter for
society to decide upon; I remind you that the first cause of death worldwide
still is malaria. Altough there certainly is a learning curve, laparoscopic
gastric banding is a minimally invasive procedure with very low morbidity. It
is effective in most patients (ref: The swedish adjustable gastric banding
for morbid obesity: nine years follow-up of patients operated with a new
adjustable band. Forsell P, Hellers G. Obes Surg 2017; 4: 345-351).

User avatar
Schom

Re: QUESTION ABOUT FAILED VERTICAL GASTROPLASTY - Ärzteforum

Post#8 »

It is often observed in patients that willfully try to overeat and stretch
their pouch. Was a TA90B (four row stapler) used? You might try to re-staple
or convert to roux-en-y gastric bypass

Dottore

Re: QUESTION ABOUT FAILED VERTICAL GASTROPLASTY - Ärzteforum

Post#9 »

Not trying to defend my action I have to say the
next things: I never operate upon obese patients. This young lady's
family and herself came at the beginning to me, desperate,after having
tried almost everything. I never thought of taking advantage of anything
and sent her to a complete psychiatric consultation,talked with the
physicians that had treated her before and consulted with other surgeons
about her possibilities and after that,and only after all that I decided
to do what I did. Maybe not having operated upon obese patients before I
should had sent her someplace else,maybe that was my mistake. On the
other side,I followed her and after some time she simply dissapeared
and did not come back even after myself having looked for her. Now the
only thing I want is to see what really happened and help her. A friend
of mine told me that maybe the staples are there and the endoscopist
thinks that a stomach that distended over time is what really isn't a
normal stomach. Wouldn't a stalpe brake up give any symptoms?

User avatar
Old surgeon

Re: QUESTION ABOUT FAILED VERTICAL GASTROPLASTY - Ärzteforum

Post#10 »

Opening of the staple line, even with the 90-B stapler, does occur. I
myself don't like these operations, but three of my colleagues here have
about 1600 cases between them. The last 900 are all SRVG except for 30
laparoscopic banding procedures. They used to oversew the staple line with
2-0 prolen, but they found no change in the rate of this
complication, so they don't anymore.

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