Vertical Gastroplasty with Artificial Pseudopylorus: Analysis of 106 Cases

Background: Between January 1991 and December 1994, 106 consecutive morbidly obese patients (19 males and 87 females) underwent Vertical Gastroplasty with Artificial Pseudopylorus (VGAP). Methods: The mean age of the patients was 34 years (range 20-58), the mean percent excess body weight 122% (range 80-234), and the mean Body Mass Index (BMI) 51 kg/m⁻² (range 41-81). The technique of gastroplasty was relatively simple, avoiding the creation of the circular stapled window and the mesh banding of the outlet. The partition of the stomach was done by the use of three double-row staplers vertically downwards from His angle parallel to the lesser curvature of the stomach. The pseudopylorus was constructed by the use of two bands of silk No. 0, which were completely covered by stomach seromuscular coat. Results: Percent excess weight loss (± sd) on the 3rd, 6th, 18th, 24th, 36th and 48th month postoperatively was 32 ± 10, 51 ± 12, 71 ± 12, 78 ± 12, 82 ± 9, 80 ± 11 and 81 ± 10 respectively. Postoperative mean BMI (± sd) at the same times were 40 ± 7, 34 ± 7, 29 ± 6, 27 ± 5, 28 ± 3, 28 ± 4 and 28 ± 3 respectively. The early complication rate was 4.7% and the late, including incisional hernias, 6.6%. One patient (0.9%) died of massive pulmonary embolism. Conclusion: VGAP is a relatively simple and safe method which gives satisfactory results in body weight reduction, and avoids some complications of the other forms of vertical gastroplasty.