Aspects of surgical treatment of morbid obesity : Clinical studies

Abstract: Common methods used for surgical treatment of morbid obesity are silicone adjustable gastric banding (SAGB), vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGBP). The role of laparoscopy in complex bariatric procedures such as RYGBP is unclear. In the first study patients treated with SAGB were evaluated two years postoperatively with gastroscopy. The results revealed 56% esophagitis and 11 % band erosion, complications which led to an abdominal reoperation rate of 32%. In the second study patients underwent conversion to RYGBP because of failures of SAGB, VBG or gastric banding. Follow-up at two years showed an improved weight loss and rapid resolution of esophagitis symptoms. We advocate conversions to RYGBP also after failures with SAGB. In the third study patients were randomized to laparoscopic or open RYGBP to evaluate the role of laparoscopy. The laparoscopic group had a shorter recovery, but there was an unexpectedly high incidence of small bowel obstruction and a 20% conversion rate to open surgery. Thus, laparoscopic RYGBP has not proved to be superior to open RYGBP in our hands. In the fourth study the incidence of deep venous insufficiency of the lower limb in morbidly obese patients was investigated with duplex scanning preoperatively. In the fifth study the duplex scanning was repeated postoperatively for the investigation of deep venous thrombosis (DVT). The results showed that the incidence of deep venous insufficiency and postoperative DVT was rare in morbidly obese patients.