Analysis of the vertical isolated gastroplasty: a new bariatric operation.

We read the very interesting paper about a new bariatric operation Vertical Isolated Gastroplasty with Gastro-enteral Bypass: Preliminary Results by Munir Alamo Alamo, Cristián Sepúlveda Torres and Luis Zapata Perez from Chile (Obes Surg 2006; 16: 353-8).1 The vertical isolated gastroplasty (VIG) consists of a longitudinal gastroplasty with the gastric tube similar to that of the duodenal switch (DS) or the sleeve gastrectomy, without amputation of the remnant stomach. In this technique, a long limb of 300 cm is anastomosed to the preserved stomach and a Rouxen-Y is performed with the jejunum 40 cm distal to the ligament of Treitz, leaving 200 cm of common channel (Figure 1). The VIG is similar to the Digestive Adaptation with Intestinal Reserve operation created by the Brazilian surgeon Sérgio Santoro,2 with the difference that Santoro resects the remnant stomach and greater omentum, and performs an enterectomy that leaves the first 40 cm of jejunum and the last 260 cm of ileum (thereby leaving 3 meters of small bowel); the digestive reconstruction creates a bipartition in the transit of digestive tract nutrients, and avoids exclusion of segments, with the intention of causing minimal to no malabsorption. Santoro created two variations of the operation (Figures 2 and 3). The authors compare the VIG to the RYGBP in the paper most of the time.1 The VIG is a hybrid, combined or mixed bariatric operation3 according to the authors’ comments. In reality, it has a moderate Correspondence