Complications After Vertical Gastroplasty with Artificial Pseudopylorus in the Treatment of Morbid Obesity: A 7-Year Experience

Background: Vertical gastroplasty with artificial pseudopylorus (VGAP) was designed to reduce the complication rate of other forms of gastroplasty. The purpose of this study was to analyze the complications of this approach for 7 years of surgical practice. Methods: A total of 156 morbidly obese patients (BMI 41-81 kg/m²) who underwent VGAP were analyzed retrospectively in terms of early and late complications and gastroplasty failure. Results: The early complication rate, operative and systemic, was 6.40% (10 patients) and the late complication rate was 12.16% (19 patients). Early complications: We observed two gastric leaks and subphrenic abscess formation with one gastrocutaneous fistula, one severe intraabdominal hemorrhage, one evisceration, two serious wound hematomas, one lobar pneumonia, one massive pulmonary embolism and two nodular erythemas. Late complications: There were two prepyloric ulcers, one pseudopyloric ulcer with stoma stenosis, seven wound hernias, four pseudopyloric dilatations with suture rejection and gastroplasty failure, and five staple-line dehiscences with endostomach channel formation and gastroplasty failure. One patient (0.64%) died from massive pulmonary embolism. Conclusions: The early and late complication rate was acceptable in this series. The applied technique of VGAP is simple, safe, and helps avoid many complications caused by the other forms of gastroplasty.