Authors: Essam Abdel -Galil, MD
Background: The restrictive bariatric procedures (vertical banded gastroplasty, Gastric band and sleeve gastrectomy) are effective procedures for the long term control of morbid obesity especially for the bulk eaters. The cardinal complications after these procedures are weight regain due to pouch dilatation, solid food intolerance, and reflux disease due to the tubular shape of the pouch.
Methods: From Jan 2007 through Jan 2017, laparoscopic Butterfly gastroplasty was attempted in 2000 patients. Median age was 32, with median preoperative BM I48. The Butterfly gastroplasty (micro funell shaped pouch) was constructed using Two 60 blue endo-cutter cartridges, the first one placed from angle of His downward and the second is applied just below the level of the first branch of the left gastric the outlet (1.2 cm) is between the ends of the previous Cartridges. The outlet of the pouch was banded with a prolene mesh.
Results: Average excess weight loss at one year was 70%, 81% at second year, 85% at third year. 90% at the fourth and fifth years then 10% start to gain weight (about 50% of the lost weight) at the sixth and seventh years. While 20% start to gain weight at the eighth & ninth year. While at the tenth years 25% of patients start to gain weight. The mean operating time was 45 min. The outlet calibration was accurate and easy. There was complete cure of diabetes type 2 in 92% of cases, and 96% of cases showed cure of hypertension. Problems of infertility solved in 88% of cases and there was marked decrease of Ghrelin level in all cases. There was no leak or mortality.
Conclusion: Butterfly gastroplasty, (micropouchfunell shaped pouch) using the gastric cardia only is an effective way to prevent pouch dilatation and therefore prevent the weight regain occurred in a high percentage of patients under went the original VBG of Mason. The pouch being micro. Funnel rather than tubular-shaped prevent solid food intolerance and reflux disease. The way of construction of the butterfly allow easy accurate outlet and less cost. 2000 cases with ten years follow up with such Results, is evidence that this technique is perfect in morbidly obese patients.
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