Other surgical techniques

Here we describe briefly the two main techniques: calibrated vertical gastroplasty and the by-pass operation (also known as a gastric short circuit). These operations are irreversible, unlike the adjustable-ring gastroplasty technique.

Following this, we have provided the results of a comparative survey of the three techniques, to best select the operation to be performed in the first instance.

Calibrated vertical gastroplasty

Gastroplasty is stomach surgery. A vertical incision is made in the stomach, and a non-adjustable ring positioned at the base of the section opened. The principle here is the same as the adjustable-ring technique – to restrict the amount of food ingested. This technique accounts for around 7.5% of gastroplasties (adjustable ring + vertical gastroplasties) and 7% of obesity operations performed in France.

Picture of a calibrated vertical gastroplasty

By-pass operation

The first objective of this technique is to reduce stomach capacities, and the second to create a substantial short circuit in the intestinal digestion process. This reduces the volume of food, which is only partially digested.

The principle here, therefore, is restriction (in the same way as a gastroplasty) and low absorption. It accounts for about 3% of obesity operations performed in France.

Picture of a By-pass operation

Comparison of the three techniques

In February 2004 the National Health Insurance Bureau, Caisse Nationale d'Assurance Maladie, published a comparative survey of the three methods, and this showed a sizeable statistical slant against the adjustable-ring technique: almost half these rings were implanted by very inexperienced teams of surgeons (less than four rings implanted in two months), whereas the other techniques were used by more experienced surgeons.

However, the following observations were made:

  1. The rate of laparotomies (open-stomach surgery) :
    • adjustable ring = 1,2 %
    • calibrated vertical gastroplasty = 74,7 %
    • gastric by-pass = 26,7 %
  2. The rate of operating complications:
    • adjustable ring = 0,9 %
    • calibrated vertical gastroplasty = 4,4 %
    • gastric by-pass = 4,4 %
  3. Average hospitalisation period:
    • adjustable ring = 4,6 days
    • calibrated vertical gastroplasty = 7,1 days
    • gastric by-pass = 12,2 days

The survey therefore shows that the adjustable-ring technique is the least aggressive operation. It is also the only reversible technique.

We should point out that, for a surgeon with substantial experience of the adjustable-ring technique, the rate of laparotomies = 0%, the rate of operating complications = 0%, and the average hospitalisation period is around 2 days.

Choosing the operation

In view of the above, the choice is obvious: an adjustable-ring gastroplasty must be performed in the first instance.Contrary to the claims of certain surgeons who prefer the by-pass method, there are no restrictions on the adjustable ring caused by the Body Mass Index.

If the ring method fails, a by-pass may be considered..