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Vertical Banded Gastroplasty (VBG)

Vertical banded gastroplasty, also referred to as "stomach stapling," is a major surgical procedure that drastically reduces the size of the stomach. While VBG can help some morbidly obese individuals lose weight (especially when other weight loss methods fail), as with all bariatric surgeries, VBG does have some associated risks.

A VBG is not the most prevalent method of surgical weight loss intervention, nor is it the newest. In fact, the American Medical Association has deemed VBG to be a "severely dangerous" operation. Other techniques, specifically "roux-en-Y," use newer, safer techniques and, therefore, are generally used instead of VBG.

Vertical Banded Gastroplasty Procedure

A VBG operation typically lasts between one and two hours if it is an open (laparotomy) single-incision surgery. Laparoscopic procedures that involve multiple incisions generally require about two to five hours in the operating room.

During the procedure, the surgeon will take the following steps:

The surgeon makes one (open) or more (laparoscopic) incisions in the upper abdomen.
A portion of the upper stomach area is re-sectioned to create a hole, much like a disproportioned donut.
An area to the side of the hole is stapled vertically to close off that section of the stomach.
A plastic band is stitched into place as a "constrictor" just below the newly formed stomach pouch. The new pouch is significantly smaller with a one-half cup to one-cup capacity. The banding process allows food to pass slowly through and does not stretch with use.

Basically, the procedure uses staples to close off a section of the stomach while a restrictive band reduces the flow rate of food through the new, smaller sac. This leads to a feeling of being full in spite of reduced food intake.

The Best Candidates for VBG

Candidates for vertical banded gastroplasty surgery must meet certain criteria. Today, insurance companies recognize that obesity is a serious health risk and may cover some or all of the procedure.

One or more of the following issues may indicate the need for a VBG:

body mass index (BMI) of 40 percent or more: A BMI over 40 or more indicates that a patient is at least 100 pounds over his or her ideal weight. In some cases, patients with a BMI of 35 percent can still qualify for the surgery if their weight interferes with their ability to work or impedes their daily functioning.

comorbidity risks: These include mild to life-threatening illnesses or diseases that result from being obese.

inability to lose weight through diet and exercise: Some conditions, including endocrine disorders, can prevent a patient from being able to maintain a normal weight. To be considered for surgery, a patient must also have undergone and failed a medically supervised weight loss program.

Potential patients also undergo psychological evaluations to ensure they understand and are prepared for the surgery and recovery process. The success of any bariatric surgery depends on the patient's willingness to change his lifestyle. This includes the mental strength and desire to adhere to very strict eating habits.

Pros and Cons of VBG

Patients can expect to see weight drop quickly in the first six months after having VBG. A successful surgery with lifestyle changes can result in up to a 50 percent loss of excess weight 18 to 24 months after the surgery. As opposed to stomach bypass surgeries, a VBG allows for the natural absorption of nutrients, reducing complications from malnutrition.

The main disadvantage of VBG is that it is an antiquated procedure. Patients considering VBG should talk with their doctors about other types of bariatric surgery before undergoing VBG.

If, however, doctors and patients agree that VBG is the right type of bariatric surgery, the patient must adhere to a strict diet to maintain long-term weight loss. If eating and exercise habits do not change, the small stomach pouch enlarges, and patients will regain weight.

Vertical Banded Gastroplasty Risks

Certain risks exist with any surgical procedure, but a VBG may leave patients susceptible to specific, but rare, issues. These include:

band stricture: Also known as stenosis, band stricture is an abnormal tightening of the plastic band that can sometimes cause scar tissue to develop.
digestive issues: Nausea, vomiting and other digestive issues can be long-term and may occur when an individual eats too fast or does not chew properly.
gall stone development: Those who experience faster weight loss may develop gallstones. Some surgeons remove the gall bladder at the time of bariatric surgery to prevent this complication.
incisional hernias: These occur more often during an open procedure, when a weakened area forms at the incision site.
staple failure: Also known as dehiscence, staple failure may loosen the closure to the upper portion of the stomach, causing leakage into the abdominal cavity.

What to Expect Following Vertical Banded Gastroplasty

The hospital stay following VBG ranges from two to five days. The return to a normal lifestyle is gradual and requires professional guidance along with strict adherence to physical instructions. Some individuals can return to light office work within ten days but should avoid strenuous activity, including bending and lifting, for several months.

Recovery from a VGB also requires time for the new stomach pouch and routing to adjust. Over time, the patient can start re-introducing regular foods into his diet, as long as he complies with guidelines for a healthy diet that will encourage weight loss. The patient begins with liquids for about two weeks, progressing to pureed foods and then gradually to solids. When eating, patients will need to thoroughly chew all foods to avoid discomfort.

Medical and nutritional oversight will continue for several months. To ensure a successful outcome of the surgery, patients will need to exercise regularly, eat healthfully and follow the recommended vitamin and supplement program.

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