Vertical Banded Gastroplasty (VBG), also known as stomach stapling, is an outdated restrictive weight loss surgery procedure, similar to Lap-Band. First developed in 1982 by Dr. Edward E. Mason, the father of obesity surgery, the procedure was devised as a surgical therapy for obese and morbidly obese.
Stomach stapling operation is not as effective as the current weight loss surgery types, like Vertical Sleeve Gastrectomy (VSG). Dr. Mason also developed the first gastric bypass surgery procedure.
Vertical Banded Gastroplasty has fallen out of favor due to its long-term problems, like band erosion and staple line failure, as well as the emergence of newer more effective procedures like gastric sleeve.
Experts find that Vertical Banded Gastroplasty is more efficient when combined with a malabsorptive technique in which portions of the digestive tract are bypassed. This leads to a reduction of the absorption of both nutrients and calories and extreme weight loss. Some examples of these combination surgeries include Roux-en-Y Gastric Bypass Surgery, Mini Gastric Bypass, and Duodenal Switch surgery.
Learn more about the history of bariatric surgery procedures
Introduction
Ultimately, Vertical Banded Gastroplasty is losing its appeal as more surgeons are using gastric sleeve surgery because it provides high expected weight loss with minimal complications and risks. The medical community considers Vertical Banded Gastrectomy as a dangerous and serious weight loss surgery.
Also, a large number of patients have experienced inferior long-term weight loss. Some statistics show that only 40-50% of patients lost half of their excess weight, and after five years following surgery, only 30% of patients maintained their weight loss at all.
How Does VBG Work?
During Vertical Banded Gastrectomy, both a band and staples are used to partition the stomach to create a small pouch on the patient. At the bottom of the pouch, a small hole is made through which the contents of the pouch can flow into the rest of the stomach and the gastrointestinal tract. Stomach stapling limits the amount of food that a patient can eat at one time (much like other restrictive surgery types) and shows how fast food moves through the track.
The pouch itself is reinforced with a band of mesh around the outlet of the pouch to prevent it from stretching and creating a full feel. The new stomach pouch is small and can only hold about a one-half ounce at a time.
During Vertical Banded Gastroplasty surgery, 2 to 5 small cuts will be made in the abdomen. A laparoscope is placed through the incisions so the surgeon can see inside the stomach. Most of the stomach will be removed. Whatever is left will be joined with surgical staples creating a long vertical tube. The surgery does not change or cut into the sphincter muscles that allow food to enter or leave the stomach itself. Surgery will take between one to two hours.
Advantages
One of the primary benefits of stomach stapling is that there is a lessened chance of malnutrition since the body itself is absorbing all minerals and vitamins, unlike other weight-loss operations. This means there is no risk of dumping syndrome. Also, this weight loss surgery procedure is 100% reversible.
Disadvantages
This weight loss surgery procedure requires a patient to follow a strict diet for them to succeed. Also, high fiber foods or more dense foods can be difficult to eat and digest. While the surgery itself is reversible, it can be an intense and complex operation. Also, staple lines can leak stomach fluid leading to severe infection if compromised after surgery.
The band around the stomach pouch also can be compromised and begin to erode directly into the stomach. Also, failure of the staple line to reconnect the pouch and the rest of the stomach can lead to serious health issues. In general, severe discomfort and vomiting can occur if food is eaten too quickly or not chewed properly. Also, unlike Lap-Band (gastric banding), the pouch is not adjustable.
Expected Outcome
Overall this weight loss surgery procedure has mixed results over time. Many patients have difficulty maintaining the tiny portions of food required to eat to keep their pouch small. When they begin to eat more, weight loss stops, and they start to gain weight. Also, the intestines are not bypassed in this surgery, and there is no change in the way the body digests, so there is no limit to the absorption of food in a long-term way.
Total weight loss and weight loss maintenance are the lowest for this surgery compared to other types of bariatric surgeries in the United States. This means that it is not recommended for patients who need to lose a considerable amount of weight or for those who are candidates for other types of weight-loss surgeries with better success rates.
Revision of Failed Vertical-Banded Gastroplasty
Vertical banded gastroplasty was once a common surgical option to cure obesity by restricting oral intake. Due to the complications such as band erosion, mesh erosion, and stenosis, the VBG procedure has fallen out of favor and has been replaced by procedures like gastric sleeve and RNY gastric bypass.
Conversion surgery in a patient with a previous VBG is a challenge. There is a high risk of a leak (12%-25%), stricture (7%-25%), bleeding (8% to 15%), and mortality (2%).
To revise a failed or complicated vertical banded gastroplasty procedure, here are the available options:
- VBG conversion to a Vertical Sleeve Gastrectomy (VSG)
- VBG Conversion to a Roux-en-Y Gastric Bypass (RYGB) or One-Anastomosis Gastric Bypass (OAGB)
- VBG Conversion to a Biliopancreatic Diversion w/ Duodenal Switch (BDP/DS) or Single-Anastomosis Duodenal Switch (SADi-S)
- VBG reversal/redo
Many of the previous gastroplasty procedures were done via open operation. When feasible, revisional surgeries can be performed laparoscopically. The repair of the VBG procedure endoscopically can also be a viable option.
FAQs about Vertical Banded Gastroplasty
You will have many questions about the process, and it’s important to discuss these extensively with your surgeon before committing to any surgery, not just Vertical Banded Gastrectomy.
Is removing the stomach safe?
The type of stomach removal used during this weight loss surgery has some risks, all of which should be discussed with a surgeon before surgery. Some of these risks include gallstones, breathing problems, blood clots in the legs, heart attack or stroke during the surgery itself, infection, gastritis, heartburn, stomach ulcers, injury to intestines, stomach or other organs, leakages, poor nutrition, scarring inside the belly and vomiting.
How big will my stomach be following surgery?
Ultimately the size of your stomach will vary depending on your particular surgeon. All doctors use a tube to guide them when stapling a patient’s stomach. The tube size can vary. Questions like these are important to ask your surgery before weight loss as the size of the tube may affect overall weight loss.
Will I regain weight?
No weight loss surgery can prevent weight gain. It’s important that patients are committed to a lifestyle change before surgery that involves a healthy diet and exercise. Those who snack often or who do not exercise are more likely to gain weight than other weight loss surgery patients.
What will my diet be like after surgery?
One’s diet will change over the course of a year following their Vertical Banded Gastroplasty surgery. The first 2-4 weeks following surgery will include liquid protein drinks and waters. Thicker food items will be gradually incorporated into the diet. After two months, patients should be able to eat eggs, cheese, protein, and other regular food. The diet is low calorie, just 500 calories per day. The calorie intake will increase over the first year leading to 900 to 1500 calories per day (depending on the patient).
Will I need to take vitamins daily?
While vitamin deficiencies are rare with these surgery types, it is recommended that patients take a calcium supplement, bariatric multivitamin, and even a B-12 vitamin following surgery.
What can I expect after my surgery?
You will probably go home in one to two days following surgery. You will need to be able to drink clear liquids on the day after surgery and a pureed diet before you can leave the hospital. You will be given pain medication and proton pump inhibitors to take regularly. A diet will be assigned to you that you must follow strictly to feel your best and to begin your weight loss journey.
I am wanting to go from a band to a sleeve. I need to save up for this surgery. I called today but the man that was talking to me said I needed to send 500. They would pick me up in San Diego and I would be fine. I don’t know that I understood what he was telling me.
Give us a call and speak to Leili, your patient coordinator at 855-768-7247 extension 148 and she can help you.