A randomized comparison of horizontal and vertical banded gastroplasty: what determines weight loss?

Pouch volume, stoma diameter, and pouch emptying rate were measured postoperatively and after 6 months in 45 morbidly obese patients who had been assigned to either horizontal gastroplasty (HGP) or vertical banded gastroplasty (VBGP) after pretreatment with diet alone. Pouch volume and stoma diameter were measured by a standardized radiographic method with blinded assessment by two observers. Pouch emptying rate was determined by a standardized scintigraphic method and expressed as the mean transit time (t60). Pouch volume and stoma diameter did not change, whereas t60 decreased by 36% during the first 6 months after HGP (p less than 0.001). Pouch volume was larger after HGP (p less than 0.001). Pouch emptying was faster after VBGP (p less than 0.001), but these patients had the better weight loss (p less than 0.001). Variation in weight loss after either operation was unrelated to pouch volume, stoma diameter, and t60. Stoma diameter was not correlated with t60. The study provides further evidence against the significance of stoma diameter and pouch emptying rate as determinants of weight loss after gastroplasty. The much smaller pouch volume after VBGP may favor weight loss.