Vertical Gastroplasty with Artificial Pseudopylorus: A Modification in the Treatment of Morbid Obesity. Early Results

A new technique of vertical gastroplasty was applied in 50 morbidly obese patients. Eight of them were male and 42 female with a mean age of 34 years (range 20-58). The mean excess body weight was 77 kg (range 52-133) and the mean Body Mass Index 51 kg/m² (range 42-81). Under direct vision the hepatogastric and gastrophrenic ligaments were divided and two TA-90 double-row staplers were passed together through the lesser sac vertically downwards from His angle parallel to the lesser curvature of the stomach. An additional TA-90 stapler was applied between the two double rows. The pseudopylorus was constructed 3-4 cm below the stomach angle by the use of two bands of silk No. 0 which were covered by stomach serosa, thus creating a reinforced outlet having the shape of a pylorus which we called ‘artificial pseudopylorus’. The circumference of pseudopylorus was 4.8 cm and the total volume of the vertical pouch of stomach 15-20 ml. The percentage excess weight loss on the 3rd, 6th, 12th, 18th and 24th month postoperatively was 35, 51, 68, 80, and 82 respectively. One patient died 12 days after operation. One other patient was re-operated because of staple-line breakdown and acute abdomen formation. It is concluded that vertical gastroplasty with artificial pseudopylorus is a simple and safe method that avoids complications of other forms of gastroplasty, and is of value in the treatment of morbidly obese patients.