Vertical banded gastroplasty: Long-term results comparing three different techniques

Background: Vertical banded gastroplasty (VBG) has been our procedure of choice for the treatment of morbid obesity from 1981-1995, at which time it was replaced by laparoscopic gastric banding. Three different techniques have been used for banding: silastic band, marlex mesh, adjustable sphincter. The purpose of this paper is to present the long-term results. Methods: The charts from all patients operated on during the aforementioned period were reviewed and the data analysed retrospectively. Results: This series comprises 197 patients, 172 females and 25 males, with a mean initial excess weight of 94.8% (6-300%) and a mean initial Body Mass Index (BMI) of 42.9 kg/m(2) (23-88 kg/m(2)). 73 patients had a silastic band, 40 Marlex mesh, and 84 an adjustable sphincter. Overall excess weight loss was 66% after 12-24 months, and remained between 50 and 60% up to 9 years postoperatively. There was no difference between the 3 groups. 82 patients (41%) developed a total of 117 complications during follow-up. Among them were stenosis 20%, staple-line disruption 11%, incisional hernia 13%, severe esophagitis 7% and band migration 1.5%. Stenosis developed more often with a silastic band or an adjustable sphincter, and severe esophagitis was more prevalent after the adjustable sphincter. 58 patients required one or more procedures for correction, including dilatation in 21, band removal in 17, band replacement in 15, restapling in 19 and incisional hernia repair in 11 patients. Overall, 29.4% of patients had to be reoperated. There were more reoperations in the silastic and adjustable sphincter groups compared with the Marlex mesh group. Conclusions: VBG is associated with a rapid weight loss that is relatively well-maintained over time, although there is a tendency to slight weight regain after 2 years. The price for these results is high if complications and further necessary procedures are considered, especially after banding with a silastic band or an adjustable sphincter. Marlex mesh represents the banding material of choice if VBG is chosen.