Perioperative complications of gastric restrictive operations.

It has not been established which gastric restrictive operation produces the lowest postoperative morbidity. Of a total of 565 morbidly obese patients who underwent various operations, perioperative complications occurred in 70 patients who underwent gastric bypass with loop gastrojejunostomy, 192 patients who underwent Roux-Y gastrojejunostomy, 47 patients who had greater curvature gastroplasty, 226 who had gastrogastrostomy and 40 who had vertical banded gastroplasty performed on a total of 565 morbidly obese patients. Twenty (3.5 percent) of the patients had intraoperative complications that were not related to the specific procedure. The exception was splenic injury which should not occur with vertical banded gastroplasty. Twenty-five (4.4 percent) of the patients had general postoperative complications that were not related to differences in techniques of the five operations. Two postoperative deaths were caused by massive pulmonary embolism and one by cardiopulmonary arrest. When the complications specifically related to the five different operative techniques were compared, there was a 14.3 percent incidence with gastric bypass with loop gastrojejunostomy, a 14.5 percent incidence with Roux-Y gastrojejunostomy, a 23.4 percent incidence with greater curvature gastroplasty, a 10.2 percent incidence with gastrogastrostomy, and no incidence with vertical banded gastroplasty. The potentially most serious complication, leak from the stomach, was most common with the two types of gastric bypass operations but it also occurred with greater curvature gastroplasty and gastrogastrostomy. This study has indicated that vertical banded gastroplasty is the safest operation. Our 1 year follow-up findings indicate it is as effective as any of the other operations in helping patients lose weight.