Vertical banded gastroplasty (VBG) is among the oldest surgical weight loss procedures. It is a restrictive gastric surgery, which means that it works by restricting the amount of food consumed, but does not interfere with the digestive system. Surgery is an option for patients who struggle with severe obesity and failed in previous attempts to lose weight either alone or through medically-supervised weight loss programs, which include diet and exercise, pre-packed meals and pharmacotherapy, in addition to surgery.
Vertical Banded Gastroplasty Procedure
During the surgery, the physicians staple the upper stomach near the esophagus vertically in order to create a small pouch. The pouch is located along the inner curve of the organ, while the rest of the stomach is limited with a band and a hole is created in the upper-middle part of the stomach due to the stapling. The procedure limits the amount of food that can be ingested, while it increases the feeling of satiety faster and with less amounts of food.
Vertical banded gastroplasty, which is also known as stomach stapling or gastric stapling, is a particularly long procedure that lasts about three and a half hours. When performed with small incisions in the abdomen, which is called a laparoscopic vertical banded gastroplasty, patients usually need to stay in the hospital for two or three days after the surgery is complete, while when conducted in an open surgery, the hospital stay is prolonged to four to five days.
Evolution of Vertical Banded Gastroplasty
The procedure was first developed during the 1970s and was investigated in the following decades. It was designed and advanced alongside progress made in the use of mechanical surgical staplers and was the first surgical method solely used to treat severe obesity. Vertical banded gastroplasty features several benefits, including a low risk of malnutrition or dumping syndrome, while the procedure leaves the body’s anatomy intact and is reversible with an additional surgery.
Vertical banded gastroplasty is an alternative to Roux-en-Y gastric bypass and jejunoileal bypass surgeries, and it has a lower mortality rate and lower risk of complications related to nutritional deficiencies or infection. Following several years of popularity, it became a less frequent procedure and is now considered outdated.
A study titled “15-year follow-up of vertical banded gastroplasty: comparison with other restrictive procedures” and published in June 2015 analyzed the vertical banded gastroplasty procedure, operative complications, weight loss, and late complications of a group of 652 morbidly obese patients who were treated between June 1998 and May 2002. The study authors concluded that “VBG was an operation with acceptable outcome for treating morbid obesity and metabolic disorders. It sets a standard for new restrictive procedures.”
Vertical Banded Gastroplasty Risks and Complications
Despite the fact that vertical banded gastroplasty is considered safe, there are still a series of risks and complications associated with the procedure. The surgery has a low mortality rate, close to zero, but about 5% of the patients suffer early complications due to the surgery and 21% suffer late complications. The main problems include gastroesophageal reflux, stomal stenosis, incisional hernia, staple-line disruption, erosion or intolerance to the band, gastric leak, bleeding from peptic ulcer, fistulas, pulmonary embolus and peritonitis.
In addition to the risks, there are a series of lifestyle changes, which are required for the long-term success of the surgery. Patients need to commit to a strict diet in which fiber can be difficult to digest and need to be careful to chew properly and not to eat too fast to avoid vomiting. Despite the fact that the operation can be reversed, it involves a very complex and intensive additional procedure.