In reality this is not always feasible and psychological profiles may have little predictive value in terms of which patients will have a good outcome. The Gastrointestinal Surgeons of the Hospital of the University of Pennsylvania have special expertise in the surgical treatment of morbid obesity. Vertical gastroplasty involves stapling a vertical partition between the lesser curve of the stomach and the fundus and body to create a gastric pouch, the lower end of which is reinforced by prosthetic material. The bulk of the stomach is thus excluded from the dietary intake. Patients feel full after a small meal.
Most surgeons assess the optimal size of the gastric pouch visually.
The band is secured to itself with two rows of polypropylene sutures to give a collar circumference of about 5-7 cm. Too tight a stoma results in inadequate weight loss due to dehiscence of the vertical staple line, while a wide stoma fails to reduce weight because of failure to induce sufficient satiety. Stenosis of the gastric stoma occurs in up to 10 per cent of patients but usually yields to endoscopic dilatation. Tissue reaction to the synthetic material and local ischemia may contribute to stomal stenosis. The use of two rows of sutures permits subsequent endoscopic dilatation of the stomal orifice should stenosis develop without necessarily disrupting the band completely.