The Benefits of Vertical Banded Gastroplasty (VBG)
Vertical banded gastroplasty, or VBG, is an elective weight loss surgery in which the stomach is partitioned off with staples and fitted with a plastic band, in order to limit the amount of food that the stomach can hold at one time. Unlike malabsorptive surgeries, Vertical banded gastroplasty (VBG) controls the amount of food that can be held by the stomach. In malabsorptive surgeries, the food is rerouted within the digestive tract so that food nutrients are not all totally absorbed.
Vertical banded gastroplasty (VGB) is an excellent weight loss option for people who are morbidly obese. In fact, this procedure is one of the first successful types of weight loss surgery for people who fall into this category. When it comes to the management of severe obesity, bariatric surgery is the only procedure that has proved to have long-term success in the majority of patients.
Vertical banded gastroplasty (VBG), like other bariatric surgeries, is reserved for patients who are severely or morbidly obese, which is defined as a BMI (body mass index) of 35 or more.
There are two types of Vertical banded gastroplasty (VBG): the open procedure, which is the older of the two; and laparoscopic VBG, which is done using small incisions through which a small camera is inserted to guide the surgeon through the procedure.
General anesthesia is required for the open Vertical banded gastroplasty (VBG), which is usually completed in about 2 hours. The surgeon makes an incision several inches long in the patient's upper abdomen, and proceeds to create a small pouch at the upper end of the stomach. When finished, the stomach will be only about 10% of the size of a normal stomach, and can hold only a tablespoon or so of solid food.
A laparoscopic vertical banded gastroplasty, or LVBG, is performed with the help of a bariatric laparoscope. A laparoscope is a small (10 mm in diameter) tube that holds a fiberoptic cable. This instrument allows the surgeon to view the inside of the abdominal cavity on a high-resolution video screen and record the operation. In a laparoscopic VBG, the surgeon makes three small incisions on the left side of the abdomen for inserting the laparoscope, and a fourth incision about 2.5 in (14 cm) long on the right side. The formation of the stomach pouch and insertion of the plastic band are done through these small incisions. Because maneuvering these small instruments takes a long time, an LVBG takes about 2-4 hours - longer than an open VBG.
Determining if a patient is eligible to have this type of surgery depends on a number of conditions. The patient must:
- Be at least 100 lb (45 kg) over ideal weight, as defined by life insurance tables; have a BMI of 40 or higher; or have a BMI over 35 along with a weight-related health problem such as severe diabetes or coronary artery disease.
- Be able to demonstrate that he or she has tried other weight loss programs without success.
- Have another cause of their obesity, such as an endocrine disorder
- Be an adult.
Added to this, the patient must be treated by a doctor who has lengthy experience dealing with obese patients and weight loss surgery. The patient also must have entered a comprehensive program that includes preoperative psychological screening and medical examination; nutritional counseling; exercise counseling; and participation in support groups.
VBG patients typically stay in the hospital for 4-5 days after surgery; those who have had a laparoscopic VBG may be released after 2-3 days.
Patients who undergo a VBG are at risk for some of the same complications that may follow any major operation, including death, pulmonary embolism, blood clots, and infection in the surgical incision.
Vertical banded gastroplasty has a number of specific associated risks, including:
- Incisional hernia.
- Dehiscence, which refers to the splitting open of the staples used to seal the incision.
- Nausea and vomiting.
- A narrowing of the plastic band.
- Spleen damage. Due to the proximity of the spleen to the stomach, it can be injured during weight loss surgery.
It is important to note that there may be some long-term risks associated with vertical banded gastroplasty, such as:
- Regaining weight.
- Ongoing vomiting and heartburn.
- Psychological problems due to the difficulty some patients have with adjusting to major changes in lifestyle.