Vertical banded gastroplasty surgery
Encyclopedia
Vertical banded gastroplasty (VBG), also known as stomach stapling, is a restrictive operation for weight control. Both a band and staples are used to create a small stomach pouch. In the bottom of the pouch is an approximate one-centimeter hole through which the pouch contents can flow into the remainder of the stomach and thence onto the remainder of the gastrointestinal tract
.
Stomach stapling is a restrictive technique for managing obesity. The pouch limits the amount of food a patient can eat at one time and slows passage of the food. Stomach stapling is more effective when combined with a malabsorptive technique
, in which part of the digestive tract is bypassed, reducing the absorption of calories and nutrients. Combined restrictive and malabsorptive techniques are called gastric bypass techniques, of which Roux-en-Y gastric bypass surgery (RGB) is the most common. In this technique, staples are used to form a pouch that is connected to the small intestine
, bypassing the lower stomach, the duodenum
, and the first portion of the jejunum
.
This type of weight loss surgery is losing favor as more doctors begin using the adjustable gastric band
. The newer adjustable band does not require cutting into the stomach
and does not use any staple lines, thus making it a much safer alternative.
VBG is known in the medical community as a very serious and dangerous procedure. It has been classified by the AMA as a "severely dangerous" operation.
that aired on October 24, 2006, 30% of people who undergo weight loss surgery such as VBG or gastric bypass suffer from addiction transference, which is transferring the previous addiction to food with a new addiction to alcoholism. The show stressed the importance of examining the root causes of addiction in order to avoid the phenomenon.
Vertical banded gastroplasty was developed in 1980 by Dr. Edward E. Mason at the University of Iowa. Dr. Mason also developed the original gastric bypass for weight reduction in 1966 and is known for his pioneering work as the "father of obesity surgery".
Gastrointestinal tract
The human gastrointestinal tract refers to the stomach and intestine, and sometimes to all the structures from the mouth to the anus. ....
.
Stomach stapling is a restrictive technique for managing obesity. The pouch limits the amount of food a patient can eat at one time and slows passage of the food. Stomach stapling is more effective when combined with a malabsorptive technique
Malabsorption
Malabsorption is a state arising from abnormality in absorption of food nutrients across the gastrointestinal tract.Impairment can be of single or multiple nutrients depending on the abnormality...
, in which part of the digestive tract is bypassed, reducing the absorption of calories and nutrients. Combined restrictive and malabsorptive techniques are called gastric bypass techniques, of which Roux-en-Y gastric bypass surgery (RGB) is the most common. In this technique, staples are used to form a pouch that is connected to the small intestine
Small intestine
The small intestine is the part of the gastrointestinal tract following the stomach and followed by the large intestine, and is where much of the digestion and absorption of food takes place. In invertebrates such as worms, the terms "gastrointestinal tract" and "large intestine" are often used to...
, bypassing the lower stomach, the duodenum
Duodenum
The duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms anterior intestine or proximal intestine may be used instead of duodenum...
, and the first portion of the jejunum
Jejunum
The jejunum is the middle section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms middle intestine or mid-gut may be used instead of jejunum.The jejunum lies between the duodenum...
.
This type of weight loss surgery is losing favor as more doctors begin using the adjustable gastric band
Adjustable gastric band
A laparoscopic adjustable gastric band, commonly referred to as a lap band, is an inflatable silicone device that is placed around the top portion of the stomach, via laparoscopic surgery, in order to treat obesity...
. The newer adjustable band does not require cutting into the stomach
Stomach
The stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...
and does not use any staple lines, thus making it a much safer alternative.
VBG is known in the medical community as a very serious and dangerous procedure. It has been classified by the AMA as a "severely dangerous" operation.
VBG advantages
- No dumping syndromeGastric dumping syndromeGastric dumping syndrome, or rapid gastric emptying is a condition where ingested foods bypass the stomach too rapidly and enter the small intestine largely undigested. It happens when the upper end of the small intestine, the duodenum, expands too quickly due to the presence of hyperosmolar food...
. - No nutritional deficiencies/malabsorption.
VBG disadvantages
- Needs strict patient compliance to diet.
- High fibre foods and foods with a more dense, natural consistency can become very difficult to eat, while highly refined foods cause little discomfort. Most people who regain any weight lost after surgery do so because choosing "healthier" foods are harder to digest, while "junk" food pass easily.
- VBG is in no way a magic bullet or pill. It must be emphasized that lifestyle changes, i.e. diet and exercise, are absolutely imperative for weight loss to occur and be maintained. Realistic expectations are imperative.
- Reversal of a VBG requires a much more complex and intensive surgical process than getting the VBG. When removal of a polyurethanePolyurethaneA polyurethane is any polymer composed of a chain of organic units joined by carbamate links. Polyurethane polymers are formed through step-growth polymerization, by reacting a monomer with another monomer in the presence of a catalyst.Polyurethanes are...
band is involved (polyurethane was predominantly used in the 1980s and 90s), it likely has built substantial scar tissue that must also be removed, depending on how long ago the VBG took place. Removal of the staples involves stitching the previously separated parts of the stomach back together. For these reasons, a reversal should only be considered if there are serious medical complications. - Vomiting and severe discomfort if food is not properly chewed or if food is eaten too quickly.
- Not adjustable (as with the adjustable gastric bandAdjustable gastric bandA laparoscopic adjustable gastric band, commonly referred to as a lap band, is an inflatable silicone device that is placed around the top portion of the stomach, via laparoscopic surgery, in order to treat obesity...
(aka "lap band")).
VBG alternatives
- Duodenal Switch surgery
- Vertical Sleeve Gastrectomy
- Roux-en-Y Gastric Bypass
- Selective vagotomyVagotomyA vagotomy is a surgical procedure that involves resection of the vagus nerve.-Applications:Truncal vagotomy is a treatment option for chronic duodenal ulcers...
(snipping the vagus nerve, effectively stopping hunger sensations).
Long term
Although restrictive operations lead to weight loss in almost all patients, they are less successful than malabsorptive operations in achieving substantial, long-term weight loss. About 30 percent of those who undergo VBG achieve normal weight, and about 80 percent achieve some degree of weight loss. Most studies have suggested that 10 years after surgery, only 10% of patients maintain a minimum weight loss of at least 50% of their total excess weight at the time of their initial surgery. Some patients regain weight. Others are unable to adjust their eating habits and fail to lose the desired weight. Successful results depend on the patient’s willingness to adopt a long-term plan of healthy eating and regular physical activity. According to an episode of Oprah WinfreyOprah Winfrey
Oprah Winfrey is an American media proprietor, talk show host, actress, producer and philanthropist. Winfrey is best known for her self-titled, multi-award-winning talk show, which has become the highest-rated program of its kind in history and was nationally syndicated from 1986 to 2011...
that aired on October 24, 2006, 30% of people who undergo weight loss surgery such as VBG or gastric bypass suffer from addiction transference, which is transferring the previous addiction to food with a new addiction to alcoholism. The show stressed the importance of examining the root causes of addiction in order to avoid the phenomenon.
History
Vertical banded gastroplasty was developed in 1980 by Dr. Edward E. Mason at the University of Iowa. Dr. Mason also developed the original gastric bypass for weight reduction in 1966 and is known for his pioneering work as the "father of obesity surgery".