Transthoracic gastric stapling. Effective new surgical approach to morbid obesity.

"There is a consensus that jejunoileal bypass is no longer an acceptable operation for the treatment of morbid obesity because of well-documented serious complications." Over the past 3 years, experience with the gastric stapling procedure has shown it to be a safe and effective operation for the surgical treatment of morbid obesity. The purpose of the operation is to establish a very small proximal gastric reservoir with a tiny outlet for passage of digested food into the distal stomach. By permitting a comfortable intake of only 2 ounces at a time, the procedure affords an average weight loss of 8 pounds per month. At the Naval Regional Medical Center, Oakland, California (NRMC-O), a new approach to gastric stapling using a transthoracic, transdiaphragmatic technique has been initiated. The transthoracic approach offers the following advantages over the transabdominal approach: (1) better and easier exposure, (2) less chance of splenic injury, (3) a thinner layer of subcutaneous fat through which to dissect, (4) decreased problem with postoperative ileus, and (5) decreased incidence of wound infection and dehiscence. Twenty patients have undergone this procedure at NRMC-O over the past 16 months with no significant morbidity and no deaths. Th average operative time is 2 hours and the average hospital stay in 8 days. Beneficial metabolic and endocrine effects of weight loss have been recorded through our computerized data bank. The data confirm that gastric stapling is a safe and effective procedure and that the transthoracic approach offers ease of exposure and minimizes postoperative complications.

Adenocarcinoma in the columnar-lined (Barrett) esophagus. Case report and review of the literature.

As of 1975, forty-nine cases of adenocarcinoma arising in the columnar-lined lower esophagus (CLLE) were reported in the literature. We add three more cases, including the youngest male to our knowledge. All survived esophagogastrectomy and radiotherapy, but each had metastatic disease and a guarded prognosis. Review of the literature revealed a male/female ratio of 3:1 for this disorder with a mean age for men of 53 years, less than that for women, (61 women). Columnar-lined lower esophagus is seen in up to 11% of patients with reflux esophagitis and probably does not regress, once present. Adenocarcinoma later develops in 2.4% to 8.5%. The CLLE is not rare and should be followed up as carefully as any other premalignant lesion.