Hand-assisted laparoscopic vertical banded gastroplasty: technique and analysis of the first 140 cases.

Background: The use of laparoscopic surgery to perform bariatric operations offers advantages to morbidly obese patients. Between January 1999 and June 2001, 140 patients underwent hand-assisted laparoscopic VBG using the Handport System.

Methods: In the 110 females (78.6%) and 30 males (21.4%), mean age was 38 years (range 19-65), mean body weight 115.8 kg (range 89-200), and mean BMI 41.8. Severe obesity was present in 41%, morbid obesity in 41% and super obesity in 9% of the patients. Comorbid conditions included hyperlipidemia in 70% of patients, arthritis in 44%, hypertension in 38%, COPD in 18%, GERD in 12%, impaired glucose tolerance and diabetes in 10%, sleep-apnea in 5% and coronary heart disease in 1%.

Results: There was no operative mortality. Mean excess weight loss was 60.7% at 12 months and 63% at 18 months. Mean BMI was 30.8 at 12 months and 30.4 at 18 months. A decrease in BMI of 11 kg/m2 was reached at 12 months. According to the Reinhold Classification (residual excess weight < 50%), good to excellent results were achieved in 75.7% at 1 year and in 77.7% at 18 months. Early postoperative complications were 4 wound infections, 3 atelectasis or pneumonia, 1 deep vein thrombosis, 1 subphrenic abscess and 1 wound hematoma. Late postoperative complications were 2 incisional hernias, 2 esophagitis, 1 symptomatic gallstones, 1 staple-line fistula, 9 protracted vomiting and 6 band-related problems.

Conclusions: The short-term results compare favorably with the literature on open VBG. Because of the reduction of perioperative risks with the laparoscopic approach, bariatric surgery should be performed laparoscopically if the expertise is available.