The Journal of Thoracic and Cardiovascular Surgery, Vol 81, 57-60, Copyright © 1981 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Transthoracic gastric stapling. Effective new surgical approach to morbid obesity
JS Lozner, RR O'Reilly, RM Deaner and WJ Storz
"There is a consensus that jejunoileal bypass is no longer an acceptable
operation for the treatment of morbid obesity because of well-documented
serious complications." Over the past 3 years, experience with the gastric
stapling procedure has shown it to be a safe and effective operation for
the surgical treatment of morbid obesity. The purpose of the operation is
to establish a very small proximal gastric reservoir with a tiny outlet for
passage of digested food into the distal stomach. By permitting a
comfortable intake of only 2 ounces at a time, the procedure affords an
average weight loss of 8 pounds per month. At the Naval Regional Medical
Center, Oakland, California (NRMC-O), a new approach to gastric stapling
using a transthoracic, transdiaphragmatic technique has been initiated. The
transthoracic approach offers the following advantages over the
transabdominal approach: (1) better and easier exposure, (2) less chance of
splenic injury, (3) a thinner layer of subcutaneous fat through which to
dissect, (4) decreased problem with postoperative ileus, and (5) decreased
incidence of wound infection and dehiscence. Twenty patients have undergone
this procedure at NRMC-O over the past 16 months with no significant
morbidity and no deaths. Th average operative time is 2 hours and the
average hospital stay in 8 days. Beneficial metabolic and endocrine effects
of weight loss have been recorded through our computerized data bank. The
data confirm that gastric stapling is a safe and effective procedure and
that the transthoracic approach offers ease of exposure and minimizes
postoperative complications.
