Horizontal and
vertical banded gastroplasty (GP) were compared as to their effectiveness and side-effects in patients pre-treated for
morbid obesity with a very-low-calorie formula diet (VLCD). The pre-treatment served to select the compliant patients, to minimize the surgical hazard, and to optimize the total
weight reduction. Seventy-four consecutive patients (median age 34 years, median
body weight 125.1 kg, and median
overweight 93 per cent) were included according to the criteria for entry. The median
weight loss on VLCD was 25.7 kg (range, 5.8-92.6 kg) and the median
overweight reduction reached 46 per cent of the initial
overweight (range, 9-83 per cent). Only few and mild side-effects were observed. Sixty-nine per cent of the patients fulfilled our criterion for surgery by reducing their initial
overweight by at least 40 per cent. Of these, 23 and 22 patients were assigned respectively to either vertical banded or to horizontal GP. Patients and dietitians were not informed of the assignment. A significant
weight loss occurred in both groups. Three months after surgery
weight loss after vertical banded GP proved to be the larger (P less than 0.001). The difference became even more pronounced due to an earlier regain among patients treated with the horizontal GP. Thus, at 12 months, the net
weight loss after surgery was 9.7 kg (range, -28.2-28.7 kg) in the vertical banded GP group and -1.0 kg (range, -15.0-36.5 kg) in patients treated with horizontal GP (P less than 0.0005). At this time, the total
weight loss in the groups was 48.5 kg (range, 6.4-104.0 kg) and 32.6 (range, 3.7-125.1 kg) respectively (P less than 0.02), and the total reduction of
overweight was greater in the group treated with vertical banded
GP (80 per cent (range, 10-96) versus 56 per cent (range, 8-92), P less than 0.005). There were no deaths, and side-effects to VLCD as well as to GP were generally mild. It is concluded that vertical banded GP is more effective than horizontal GP and that the former operation adds a significant
weight loss to that obtained by VLCD. The combined treatments offer a
weight reduction comparable to that observed after
jejunoileal bypass. However, some regain within 1 year makes it questionable if the vertical banded GP is sufficient to prevent weight regain.