Overview of the Vertical Banded Gastroplasty Weight Loss Procedure
The Vertical Banded Gastroplasty (VBG) is a restrictive weight loss surgery which helps to promote weight loss in individuals who have the operation performed. When patients undergo the vertical banded gastroplasty, their upper stomach portion is stapled vertically which creates a smaller stomach pouch. The pouch outlet is restricted by a band that acts to slow the emptying of the stomach thereby making the individual feel full for a longer period of time.
Gastroplasty, the first purely restrictive weight loss surgery, was developed in the early 1970's to be a safer alternative to roux-en-y gastric bypass surgery and the now abandoned jejunoileal bypass surgery. The original gastroplasty procedure involved stapling the stomach horizontally into a smaller stomach pouch and leaving a small opening between the upper stomach and lower stomach for the passage of food. The surgery was made possible with the invention of the mechanical stapler and led to it's nickname, stomach stapling. This form of gastroplasty was eventually abandoned as it did not result in sufficient long-term weight loss.
The original (horizontal) gastroplasty surgery evolved into the vertical banded gastroplasty, a variation developed in 1980 by Dr. Edward E. Mason at the University of Iowa. Dr. Mason also developed the original gastric bypass procedure in 1966 and is recognized as the "father of obesity surgery" due to his pioneering work in the field of bariatrics.
With vertical banded gastroplasty, the upper stomach is stapled vertically on the lesser curvature of the stomach and a silicone band (or polyurethane band as was predominantly used in the 1980's and 90's) is placed around the new outlet in the upper stomach. The smaller stomach pouch limits the amount of food that can be eaten at any one time and the smaller stomach outlet slows the flow rate of food from the upper stomach to the lower stomach, increasing the feeling of fullness. The food then continues through the digestive process normally as no changes are made to the intestines.
Advantages of Vertical Banded Gastroplasty
- Food passes through the digestive system (small intestine) normally, allowing nutrients to be fully absorbed by the body, thus causing no nutritional deficiencies or malnutrition
- Smaller stomach limits the amount of food that can be eaten at any one time
- Food moves through stomach outlet slower, increasing the feeling of fullness
- No Dumping Syndrome
- Studies show that after surgery 10 years patients can maintain 50% excess weight loss if they are willing to eat healthy and participate in regular physical activity
Disadvantages of Vertical Banded Gastroplasty
- Staple-line failure, resulting in leakage and serious infection requiring medical treatment
- Silicone band may cause obstruction or perforation, requiring surgical intervention
- Silicone band is not adjustable as with newer adjustable gastric banding surgeries
- Weight loss requires patient compliance with healthy eating and regular exercise
- Vomiting and severe discomfort may occur if food is not properly chewed or eaten too quickly
- Healthy high fiber foods and fibrous fruits and vegetables can be difficult to eat
- Stomach pouch may stretch, allowing patients to eat too much food
- Sweets and high fat foods can be eaten as dumping syndrome does not occur
Weight Loss Results of Vertical Banded Gastroplasty
Long-term weight loss studies have shown that on average about 80% of VBG patients achieve some level of weight loss, about 30% of these patients achieve a normal weight, and about 40% of patients have lost less than half of their excess weight. While many patients are able to lose at least 50% of their excess weight and keep it off long-term, some patients regain weight. As with the adjustable gastric band and roux-en-y gastric bypass, long-term weight loss success is very dependent on a patient's willingness adopt healthy eating habits and exercise consistently.
Reversing Vertical Banded Gastroplasty
The reversal of a vertical banded gastroplasty is a very intensive surgical process. If a reversal surgery is performed, the silicone/polyurethane band as well as any scar tissue caused by the band must be removed. Also, the staples separating the two stomach pouches must be removed and the sections stitched back together. It is much more complex than getting the VBG and should only be considered if there are serious medical issues.
Vertical Banded Gastroplasty VS Adjustable Gastric Banding
The vertical banded gastroplasty was once the most commonly performed restrictive weight loss surgery, but it's popularity has declined in favor of the newer adjustable gastric banding operations. The adjustable gastric band procedures do not require stomach cutting or stomach stapling and are much safer options. The newer gastric bands, such as the LAP-BAND and the REALIZE Band, are also adjustable and have shown to be more effective at long-term weight loss.