Gastric Surgery for Relief of Morbid Obesity

Since 1966 a total of 130 gastric bypasses and 56 gastroplasties were performed for control of severe exogenous obesity. Gastric bypass excludes the distal 90% of stomach and establishes gastrointestinal continuity through short-limb retrocolic gastroenterostomy. Gastroplasty maintains continuity of stomach through greater curvature tube 1.0 to 1.5 cm in diameter. Both provide extremely small proximal stomach pouches as reservoir, which empties slowly through a snug outlet into distal gastrointestinal tract. Gastric bypass provides added deterent of dumping when excessive carbohydrate-rich foods are ingested. While both were effective in producing weight loss, gastric bypass was associated with more progressive and sustained weight reduction. Overall mortality was 4.6% for gastric bypass and 2% for gastroplasty. This mortality occurred in the first three years of this six-year experience. Both operations can now be performed within acceptable limits of mortality and morbidity, and neither has been followed by long-term complications associated with various intestinal short-circuiting procedures.