Abstract
Gastric partition is advocated as a better operation than gastric bypass for treatment of morbid obesity (although this is poorly documented) because it is simpler and faster to perform; has a lower complication rate; is more physiologic; and because it is possible to examine the distal stomach by endoscopy and barium contrast studies after operation. It has not been established which of the different gastric partition operations is the best. Greater curvature gastroplasty (GP) was performed upon 47 and gastrogastrostomy (GG) upon 144 patients between May, 1979, and May, 1981, at North Carolina Memorial Hospital. The techniques used in performing the operations are described and illustrated. Postoperative complications occurred in 25.5% of the GP and 10.4% of the GG patients. There were no deaths. Reoperation was required because of stomal obstruction in 14.9% of the GP compared with 1.4% of the GG patients. The percentage of excess weight lost in 12 months following GP was 60.5% and 51.3% after GG, and at 18 months was 68.7% following GP and 53.9% after GG. These differences in weight loss following GP and GG are not statistically significant. Because of the statistically significant lower incidence of stomal obstruction requiring reoperation after GG, although weight loss appeared to be better with GP, GG is currently our preferred operation for the treatment of morbid obesity. The changes in the technique of GG introduced to improve weight loss are discussed and illustrated.
Résumé
La bipartition de l'estomac représente une opération préférable à la gastro-jéjunostomie pour traiter l'obésité morbide. Elle est plus simple, plus facile, plus physiologique. Elle présente moins de risques et elle a pour mérite de permettre l'exploration endoscopique de la poche gastrique inférieure si nécessaire. Quant à la meilleure desméthodes de bipartition gastrique elle reste à définir.
De mai 1979 à mai 1981 44 gastroplasties au niveau de la grande courbure et 144 gastro-gastrostomies furent pratiquées au North Carolina Memorial Hospital. 25,5% de complications furent observées après gastroplastie et 10,4% après gastrogastrostomies. Aucune mort ne fut à déplorer. Une intervention pour traiter la sténose de la bouche de communication fut nécessaire dans 14,9% des cas après gastroplastie et dans 1,4% des cas après gastro-gastrostomies. Le pourcentage de perte de poids après un an s'est élevé à 60,5% après gastroplastie et à 51,3% après gastro-gastrostomie. Après 18 mois il était de 68,7% dans le premier cas et de 53,9% dans la seconde éventualité.
Ces différences de chute pondérale en fonction des deux méthodes ne sont pas statistiquement significatives.
En raison de la fréquence moins grande de la sténose ostiale après gastro-gastrostomie et malgré que la chute pondérale soit plus nette soit preference après gastroplastie notre preference se porte vers la gastrogastrostomie.
Les modifications de la technique de la gastrogastrostomie apportées pour accentuer la perte de poids sont décrites et illustrées.
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Buckwalter, J.A., Herbst, C.A. Gastric partition for morbid obesity: Greater curvature gastroplasty or gastrogastrostomy. World J. Surg. 6, 403–410 (1982). https://doi.org/10.1007/BF01657667
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DOI: https://doi.org/10.1007/BF01657667