Surgery for morbid obesity: indications, complications, alternatives

Suture line ulceration: a complication of gastric partitioning

Gastric partition with formation of a proximal pouch by staples and reinforced sutures is a well-accepted operation for obesity. Experience at this institution has included 2 cases of ulcers occurring at the partition line, a complication not well-described previously. These ulcers were located on the lesser curvature, appeared benign, and were characterized by chronic, severe pain. A suture associated with the ulcer was demonstrated endoscopically in 1 patient, although it could not be removed perorally.

Prospective metabolic evaluation of 150 consecutive patients who underwent gastric exclusion

The effect of weight loss produced by gastric exclusion on the metabolism of previously morbidly obese persons was examined. A standardized gastric exclusion procedure was performed in 150 morbidly obese patients during a 6 year period. These patients were followed for from 6 to 60 months (mean 27.8 months). The mean excess weight loss was 75 percent and was maintained from 2 to 5 years. A small but significant decrease was noted during the first 3 to 6 postoperative months in the parameters of protein metabolism examined. Although this may reflect mild depletion in protein stores, of greater importance was the demonstration that these parameters spontaneously corrected themselves by 12 months. Mild abnormalities in serum electrolyte concentrations were noted in the postoperative period. They appeared to be related to dehydration, were not clinically significant, and also resolved spontaneously. Clinically significant abnormalities in divalent ions were absent. Significant and sustained reductions in blood pressure, fasting glucose concentration, serum triglyceride values, and uric acid and hepatic enzyme concentrations were demonstrated in the entire population. A small and non-sustained decrease in cholesterol was seen. Hypertension was eliminated in 96 percent of the affected subpopulation, diabetes in 100 percent, gout in 100 percent, hyperlipidemia in 92 percent, and improved hepatic function was found in 95 percent. These changes should reduce the overall morbidity and mortality of the patient population in the future.