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Vertical Banded Gastroplasty or simply VBG is one of the oldest weight loss surgeries. Firstly, a stomach stapling procedure was developed in the 1970s and later the vertical banding was introduced in order to make it more effective. So, while the correct name is vertical banded gastroplasty, it is also often called stomach stapling surgery. Although very popular in its time, VBG is not so often performed these days, having been replaced by the newer bariatric procedures of gastric bypass or gastric sleeve, which tend to have a better success rate.
As with all types of weight loss procedures, a bariatric surgeon will only perform this type of operation on those people who are morbidly obese – this usually means a BMI of over 40 or, in some cases, where the patient has additional chronic and/or potentially fatal underlying conditions, a BMI of over 35.
So, what is VBG or the stomach stapling procedure?
A gastroplasty is an operation or surgical procedure where the size of the stomach is reduced. In vertical banded gastroplasty this reduction is created in two steps. Firstly, surgical staples are used to divide the stomach into two parts with the upper part much smaller than the lower part. Then, a small opening (about 1cm in diameter) is created to allow only a small amount of food to move into the lower larger portion of the stomach and through the small intestine as usual. This opening is kept in place by a plastic band.
The original VBG surgery was done as open surgery under general anaesthetic. With the later advent of laparoscopic surgery, it became possible for surgeons to perform a laparoscopic vertical banded gastroplasty – again under general anaesthetic. Laparoscopic surgery is performed using a laparoscope. This is a long rod with a camera and a light at the end of it. It allows surgeons to perform, what is colloquially known as keyhole surgery. This means that rather than cutting a large hole in the skin, the procedure can be performed with just a few small incisions. The skin healing process is much quicker and potentially less problematic.
Depending on the type of surgery used, the whole stomach stapling procedure takes between 2 to 3.5 hours and normally requires a stay in hospital of about 5 days after the operation.
During the VBG surgery, the doctor reduces the size of the stomach to just a small pouch which can hold about one ounce of soft food
This stomach stapling procedure effectively reduces the size of the stomach to just a small pouch which can hold about one ounce of soft food. The patient, therefore, can only eat very small portions of food and follow the after surgery diet essentially, this is why the weight loss occurs. Unlike some other weight loss surgery VGB does not interfere with the actual absorption process but simply limits the portion size and generates a feeling of fullness much quicker.
After the VGB surgery, the patient can eat 4-6 small meals per day – each meal must be no more than 1 – 2 ounces and should be chewed very slowly. For the first 4-6 weeks, all food will be puréed. Eating too much or too quickly may result in vomiting and sometimes intense pain. The patient will learn quite quickly how much food can be tolerated at any one time.
The first six months after the procedure is when the most rapid weight loss happens. For most patients, it will take 18-24 months to lose 50% of their excess body fat.
After the VBG surgery, there is no need to take additional vitamin supplements. Also, it does not cause nausea and diarrhoea when sweet or fatty foods are eaten and the procedure can be reversed
What are stomach stapling pros and cons? These days there are not so many advantages to having this stomach stapling procedure, mainly because it has now been overtaken by newer and more effective procedures like gastric bypass or gastric sleeve. However, the fact that it does not affect the absorption process means that recipients of this surgery do not have to worry about malabsorption and therefore potential malnutrition. There is no need to take additional vitamin supplements. Furthermore, VBG does not cause nausea and diarrhea when sweet or fatty foods are eaten, although this, in itself, may be a double-edged sword! Moreover, the procedure can be reversed, albeit with a second operation, by removing the staples and the band.
The disadvantages of vertical banded gastroplasty are a little more numerous.
The fact that sweet and fatty foods produce no adverse reactions means that it is very easy for patients to continue to consume these high-calorie foods and thus not reduce their weight.
It is fairly easy for the small pouch to become stretched, thus allowing extra food to be consumed and again meaning that the patient does not reduce their weight.
The long-term weight-loss effects of this surgery are poor, compared to other procedures – a 10-year follow-up study of 70 patients after vertical banded gastroplasty surgery showed that only 20% (14) of the patients had lost 50% of their excess body weight and, additionally, maintained this loss
Over a 10-year period after the initial surgery 29%-39% of VBG patients will require revision surgery. Research with patients in Stockholm (High revision rates after laparoscopic vertical banded gastroplasty – Marsk et al.) showed that, in a follow-up period of between 0-11 years, 21% of patients required gastric revision surgery with almost half of these patients converting to a gastric bypass.
The vertical banded gastroplasty is a fairly major operation and so, firstly, carries all the normal risks associated with any medical surgery, like blood clots, bleeding and wound infections and, of course, the fact that the patient is obese will always slightly raise the risks involved. Generally, however, VBG surgery is considered a low-risk operation.
Side-effects of VBG include:
More serious stomach stapling risks and complications may also occur. Here are some of the most common vertical banded gastroplasty complications:
Complications of stomach stapling
What does it mean
Damage to the spleen
In research with 260 morbidly obese patients, over 33% had complications connected to the gastrointestinal tract after VBG surgery. (Gastrointestinal complications after vertical banded gastroplasty – Papakonstantinou) These included severe gastritis and oesophagitis, gastric perforation, frequent and prolonged vomiting and the formation of gallstones among others.
Gastric revision surgery may have to take place due to general problems with the band including enlargement or when it sometimes becomes engulfed by the surrounding tissue. The body can react in different ways to a ‘foreign object’ (the plastic band) being placed inside it. Sometimes the revision procedure is due to problems with the staples or purely because the patient is no longer losing weight or may even be gaining weight.
Currently the NHS only usually offers different weight loss surgeries like gastric band, gastric bypass and sleeve gastrectomy as standard bariatric procedures. The VBG procedure is therefore not available on the NHS. Furthermore, it may be difficult to track down a surgeon who can still offer this type of surgery. A typical UK cost in the private medical sector would be somewhere in the region of £10,000. As with most weight loss surgery, considerable savings can be made when the procedure is carried out privately overseas.
Vertical banded gastroplasty is a weight-loss procedure that was very popular some years ago. It has now been replaced by more modern procedures such as the gastric bypass and gastric sleeve. These more up-to-date procedures are more effective at helping to reduce weight and maintain it at the required level. If after reading this article you feel that VBG is something you would like to explore further, please contact our consultants who can either advise you if and where there is a possibility of this procedure or can provide current information about the most up-to-date weight loss procedures now available.
High revision rates after laparoscopic vertical banded gastroplasty: https://www.sciencedirect.com/science/article/abs/pii/S1550728908005297
Gastrointestinal complications after vertical banded gastroplasty – https://pubmed.ncbi.nlm.nih.gov/9730397/
In the UK Anne was a professionally qualified trainer with many years of experience in the training industry. She mainly worked in the travel, tourism and leisure industries (including Thomas Cook and British Airways) as well as in other sectors.
Since moving to Poland twelve years ago, Anne has become involved in other business sectors – teaching English as a foreign language and translating documents from Polish into English. She specialises particularly, in medical translations and works closely with dentists, cardiologists and neurologists in translating and preparing articles for publication. She has also trained as a practitioner in the field of neuro-linguistic programming and is a qualified hypnotherapist.
Any spare time is spent renovating the house in Poland which Anne bought some years ago.
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