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| |  Vertical Gastrectomy Suggested as Weight-Loss Procedure of Choice for Older Obese Patients By W. A. Thomasson, PhD CHICAGO, IL -- May 20, 2005 -- For weight loss, vertical gastrectomy is the surgical procedure of choice for obese patients over 50 years of age, according to comparative data presented here May 16th at Digestive Disease Week (DDW). Crystine Lee, MD, director of laparoscopic and bariatic surgery, David Grant Medical Center on Travis Air Force Base, and a fellow at California Pacific Medical Center in San Francisco, California, presented the study findings. "This vertical gastrectomy seems so far to give the weight loss of the stronger operations...with the complication profile of the band," said Dr. Lee. However, interpretation of the study data is complicated by the fact that the patients in this nonrandomized trial who were chosen for the new procedure were significantly heavier than those undergoing the comparison procedures: Lap-Band, Roux-en-Y gastric bypass, and duodenal switch. In vertical gastrectomy, the stomach is stapled to create a tube approximately the same diameter as the esophagus and duodenum. The portion of the stomach outside the tube is then removed. The comparative study included 197 patients who were age 50 or older. Forty-five percent underwent gastric bypass, 28% the Lap-Band procedure, 20% vertical gastrectomy, and 7% duodenal switch. At operation, vertical gastrectomy patients weighed an average of 313 pounds. They lost 126 pounds over the following year. Average weight at surgery for the other procedures ranged from 248 to 280 pounds, with weight loss at 1 year ranging from 67 pounds for Lap-Band to 117 pounds for gastric bypass. Weight loss with Lap-Band was significantly less than with the other procedures. Based on evaluable data from 166 patients, weight loss as a percentage of weight at operation was 48% for vertical gastrectomy, 56% for Lap-Band, 76% for gastric bypass, and 78% for duodenal switch. In this population, there were no major complications with Lap-Band, 2 (6.3%) with vertical gastrectomy, 3 (2.6%) with gastric bypass, and 4 (31%) with duodenal switch. Two gastric bypass patients and 2 duodenal switch patients required reoperation. However, these numbers must be interpreted in light of the known higher complication rate among heavier as well as older patients. Dr. Lee noted that vertical gastrectomy, unlike gastric bypass and duodenal switch, is not associated with malabsorption. This may be important in older patients who are likely to be on multiple medications and may later develop cancer or other serious medical conditions. The advantage over Lap-Band is that there is no device to possibly cause later problems. "I would choose a band for patients who are of lower BMI -- say BMI 45 to 50," concluded Dr. Lee. "And, for more obese patients who are older -- say BMI 50 and above -- I would chose a vertical gastrectomy."
[Presentation title: The Best Laparoscopic Bariatric Operation for Older Patients: Comparison of Outcome After the Band, Vertical Gastrectomy (VG), Roux-en-Y Gastric Bypass (RGB), and Duodenal Switch (DS) Operations. Abstract 281]
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