Improvement of weight loss and metabolic effects of vertical banded gastroplasty by an added duodenal switch procedure.

BACKGROUND: Some patients who underwent vertical banded gastroplasty (VBG) need revisional operations because of poor weight loss and remaining comorbidities. The duodenal switch (DS) procedure with partial gastrectomy is known as an effective method for treatment of severe obesity and related dyslipoproteinemias and diabetes mellitus type 2 (DM2). Other investigations have shown that DS without gastric resection similarly corrects hypercholesterolemia and DM2 in the "less than" morbidly obese patients. METHODS: Based on this knowledge, we performed a DS simultaneously with hernioplasty and panniculectomy in a 63-year-old woman with a fair EWL (36.4%), with remaining hypercholesterolemia and DM2 4 years after VBG. The pouch stoma diameter was 13 mm, and there was no pouch dilation nor staple-line disruption. The previously partitioned stomach was left in place. H2-blockers and polyvitamins were prescribed after operation. RESULTS: 1 year after DS there were no postoperative complications and undesirable effects except slight anemia. DS allowed improvement in weight loss, improved carbohydrate handling without need for insulin or other hypoglycemic agents, and corrected severe hypercholesterolemia. CONCLUSION: DS per se in the case presented had a decisive effect on DM2 and hypercholesterolemia. DS should be kept in mind as a second-step malabsorptive procedure after a failed purely restrictive operation.

Successful bariatric surgery in a patient who underwent more than 100 various operations.

A 44-year-old woman who weighed 130 kg (height 158 cm, BMI 52) with a complicated psychiatric history was referred for obesity surgery because of severe sleep apnea, obesity hypoventilation syndrome with frequent pneumonias, arterial hypertension, diabetes mellitus, polyarthralgia and back pain, venous insufficiency, dysmenorrhea, severe heartburn, and incisional hernia. From childhood until 1983, she had undergone 106 operations, mainly for septic/pyemic and intra-abdominal abscesses, 86 of them under general anesthesia. In the 4 years before undergoing bariatric surgery, she had gained 40 kg, nonoperative attempts at weight reduction had failed. Some months before obesity surgery she could fall asleep while standing, and she noticed an entire loss of capacity for work. Respiratory disturbance index measured during sleep by Mesam-4 device was 68 events per hour. Preoperative controlled positive airway pressure (C-PAP) therapy was used. Vital indications for weight reduction were established. Bariatric surgical steps included six operations: (1) vertical banded gastroplasty (VBG); (2) relaparotomy with suspicion of peritonitis, no complications found; (3) hernioplasty simultaneously with panniculectomy; (4) revision and removal of additional flap because of marginal skin necrosis; (5) bilateral thigh dermatolipectomy simultaneously with right-side saphenectomy; and (6) removal of intramammary abscess. Twenty-four months after VBG, she had lost 39 kg (56.5 % EWL) and was doing rather well. Obesity-related diseases except back pain were relieved.

[Vertical gastroplasty as a treatment method in morbid obesity]. / Vertikal'naia gastroplastika kak metod lecheniia morbidnogo ozhireniia.

Since November 1992 in the RRCS. RAMS 38 patients aged 16-61 years (mean body mass 149.9 kg) for obesity of 3-4 grade underwent operation of vertical gastroplasty (VGP) by E. Mason's method. In 78.9% of patients uncomplicated course of early postoperative period was observed. One patient died due to thromboembolism of pulmonary artery. Two patients underwent regastroplasty due to tearing away of the staples of vertical mechanical suture and restoration of body mass (BM). Up to now stabilization of BM was detected in 19 patients. In this group mean values of surplus BM lowering made up 54.1% and maximal--60.1%. Positive influence of performed operations on the course of majority of the concomitant diseases in the absence of serious metabolic after-effects was observed. Initial results of operations seemed to be favourable, but for final conclusions about the effectiveness of VGP in far off period the accumulation of the experience and prolongation of follow-up period together with standardization of operation procedure are necessary.

[Surgical treatment of chronic calculous cholecystitis and its complications]. / Khirurgicheskoe lechenie khronicheskogo kal'kuleznogo kholetsistita i ego oslozhnenii.

Introduction of endoscopic and laparoscopic methods in surgical treatment of chronic calculous cholecystitis and its complications has changed not only the character of surgical interventions, but the surgical policy as well. The operation of choice in uncomplicated calculous cholecystitis is laparoscopic cholecystectomy, which whenever indicated, is advisable to be combined with other surgical interventions allowing the recovery from the concomitant surgical diseases. In complicated calculous cholecystitis in dependence on the character of bile ducts disorder and patient's condition, 3 versions of surgical interventions are possible: one stage radical correction of all pathologic changes of the biliary tract and surgical treatment, including 2-3 separate, less traumatic and more tolerable procedure. The choice of optimal policy of treatment reduces the risk of operation, decreases postoperation mortality rate and complications.

Vertical banded gastroplasty: first experience in Russia.

BACKGROUND: The first experience of vertical banded gastroplasty (VBG) in the Russian National Research Center of Surgery is presented. METHODS: From November 1992 to October 1996, 24 morbidly obese patients (mean body weight 147.7 kg, BMI 52.1 kg/m2) underwent VBG according to Mason. RESULTS: The early complication rate was 20.8%. The mean excess weight loss (EWL) after weight stabilization (first 12 patients) was 48.0% in the whole group and 53.9% (range 36.0-73.0%) in 10 patients without staple-line disruptions. Significant positive changes in obesity related diseases were noted. Nine of 23 patients presented with incisional hernias some months after operation. CONCLUSION: The impression of VBG is favorable; however, gaining further experience with the standard techniques and increasing the long-term results are necessary.

[X-ray study of the stomach after vertical gastroplasty in the treatment of morbid obesity]. / Rentgenologicheskoe issledovanie zheludka posle vertikal'noi gastroplastiki pri lechenii morbidnogo ozhireniia.

The operation vertical gastroplasty is used to treat the so-called morbid obesity. It ends with the formation of a small stomach. Some experience gained with X-ray of the stomach is analyzed in 17 patients undergone vertical gastroplasty. X-ray evaluates the status of the small stomach arranged as a tube in the upper portions in the vicinity of the lesser curvature of the stomach. The shape, sizes, outlet of the small stomach, as well as emptying rates and the state of an internal vertical suture of the stomach are to be studied.

[First experience with vertical gastroplasty in the treatment of patients with 4th-degree obesity]. / Pervyi opyt vertikal'noi gastroplastiki v lechenii bol'nykh ozhireniem IV stepeni.

The article discusses four operations for vertical gastroplasty performed for the first time in Russia at the Research Centre of Surgery, RAMS, for degree IV obesity (the body weight of the patients ranged from 115 to 183 kg). The suturing instruments CEEA-28, TA-90, and CIA-90 manufactured by Auto Suture Instruments, USA, were used. Subsequent examination of patients in follow-up periods of as long as 4 months showed a favorable effect of the operations: body weight reduced, the patient's health and the course of concomitant diseases was milder.

[Chronic non-calculous cholecystitis]. / Khronicheskii beskamennyi kholetsistit.

Experience with the surgical treatment of 340 patients with chronic acalculous cholecystitis is described. In 56,5% of observations it was complicated by the involvement of organs of the hepatobiliopancreatic group. The authors stress the importance of a complex instrumental pre- and intra-operative examination which can reveal lesions not only in the gallbladder but also in the major bile ducts, liver and pancreas. The volume of operation in patients with acalculous cholecystitis must include measures correcting lesions of the hepatobiliopancreatic organs in addition to cholecystectomy. Long-term results were studied in 238 patients. Good results were obtained in 129 patients, satisfactory--in 80 patients, unsatisfactory results were noted in 29 patients which were due to chronic recurring pancreatitis.