Gastric surgery for morbid obesity.

Patients with 100 pounds of excess weight (BMI greater than 40) have sufficient risk of complications and impairment of function to warrant an operation. There is no operation that will bring all patients to a normal weight without risk. More complex operations may provide greater weight reduction, at least until compensatory changes occur that permit improved digestion and absorption of food. The more complicated the operation, the greater the risk of undesirable side effects. Vertical banded gastroplasty has evolved over the last 35 years as a simple, safe, and effective way to control excessive weight with a minimum risk. This simple operation will produce a normal weight in about 30% of patients and satisfactory weight control in 80% of patients, without need for revision surgery. Optimum results depend on intraoperative measurement of pouch volume and outlet reinforcement, education of patients in the care of their operation, and continual evaluation of the early and long-term effects of these operations.