Which of the following statements regarding gastroplasty and gastric bypass for morbid obesity is/are correct?

a. Horizontal gastroplasty techniques that rely on a single horizontal application of a stapling device are associated with weight loss “failure” rates of 40% to 70%

c. Gastric bypass is associated with a “failure” of weight loss in 10 to 15% of patients

d. With three superimposed applications of a stapling device, gastric bypass staple line dehiscence occurs in less than 2%

Horizontal gastroplasties include a single application of a 90-mm stapling device without suture reinforcement of the “stoma’’ between upper and lower gastric pouches or a double application of staples with either a central or lateral prolenereinforced stoma. The failure rates (loss of less than 40% excess weight) for horizontal gastroplasty procedures ranges from 40% to 70%. The vertical banded gastroplasty (VBGP) is a procedure in which a stapled opening is made in the stomach with the stapling device 5 cm from the cardioesophageal junction. Two applications of a 90-mm stapling device are made between this opening and the angle of His, and a 1.5 5 cm strip of polypropylene mesh is wrapped around the stoma on the lesser curvature and sutured to itself.

Gastric bypass can be performed with placement of staples in a vertical or horizontal direction; the vertical direction is preferred because there is less risk of gastric pouch devascularization or splenic injury. With three superimposed applications of a 90-mm stapler, the incidence of staple line disruption has been less than 2%. Roux-en-Y gastric bypass has significantly better weight loss than VBGP. Although 10% to 15% of patients fail gastric bypass, weight loss seems to remain stable in most patients over 5 years or more after surgery.