Vertical Banded Gastroplasty (VBG) is a restrictive procedure. Restriction is accomplished by surgically altering the stomach so it is smaller (1 ounce). A hole is cut into the upper stomach to allow it to receive a band that in conjunction with staples create a pouch to receive food. Malabsorption is not applied so none of the intestinal tract is bypassed or altered.
The Vertical Banded Gastroplasty (VBG) is a pure restrictive operation that simply works by restricting the intake of solid food. Restrictive gastric operations, such as Vertical Banded Gastroplasty (VBG), serve only to restrict and decrease food intake and do not interfere with the normal digestive process. This surgery is rarely done anymore.
There are no alterations to the intestinal tract. The surgeon cuts a hole or "window" into the upper part of the stomach a few inches below the esophagus. The second step involves placing a line of surgical staples from the window in the direction of the esophagus, which creates a small pouch at the upper end of the stomach. The size of this pouch is about 10% of the size of a normal stomach and will hold about a tablespoon of solid food. The outlet from the pouch to the rest of the stomach is restricted by a band made of special material. The band delays the emptying of food from the pouch, causing a feeling of fullness. VBG comes in two forms, the Vertical Banded Gastroplasty and the Vertical Silastic Ring Gastroplasty. These operations are functionally the same but have one minor difference—the material used to reinforce the stoma.
The stomach is surgically altered to act as an hourglass, where the upper stomach holds about one ounce and the food drips into the lower stomach at a rate dependent upon the size of the stoma (or opening between them) and the thickness of the food. Solid food takes longer than puree or mushy types of foods. This stoma is reinforced with a band of material made of either Marlex mesh (VBG) or a silastic ring (VSRG) – the band material (either Marlex or silastic) is the only difference between these operations. The band does not stretch, meaning the stoma cannot be enlarged by constantly challenging it with either more food or larger food particles.
Once food is eaten, it slowly drips into the lower pouch through its stoma (or the opening between the upper and lower pouch). When this small amount of food is in the upper pouch, a feeling of fullness (satiety) is present, creating an enforced "portion control."
As with most weight loss surgeries, the feeling of fullness (satiety) is one reason for the success of this operation. Patients develop a sense of control over food, often for the first time in years. A change within the brain occurs, and I would only be speculating if I told you it was in the thalamus or the cortex, or any other brain parts—suffice it to say that there is more to appetite control than satiety.
It isn't fun to vomit
Overfilling the pouch leads to vomiting, as does putting something into the pouch that cannot go through the stoma (a large piece of meat, some vegetables, some fruits—bananas are a common offender). This reinforces control over the amount of food eaten. However, some discover that certain foods go down easily, especially those that are generally dense in calories, such as milkshakes, mashed potatoes, donuts, potato chips, and other high calorie snacks. This can reinforce negative eating habits, leading to eating foods that "go down" easily, and overriding the procedure.
Some people are more likely to have trouble with the VBG than others
You may have trouble if you:
- have dental problems leading to an inability to chew food thoroughly
- consume a large concentration of calories coming from a liquid source
- eat lots of sweets
- have a history of bulimia (induced vomiting for weight loss)
- demonstrate an unwillingness to change habits
- need to take a lot of pills
A diet history is important in determining if the VBG or lap-band would be an appropriate surgery. If you cannot keep away from "soft," high carbohydrate foods, then this procedure is not likely to benefit you.
Requirements following Vertical Banded Gastroplasty Surgery
- fully chew food before swallowing
- not drink liquids while eating
- have the ability to stop eating when full
- avoid high calorie liquid items
- take a multivitamin daily
Highly suggested changes to maximize VBG benefits
- Exercise at least 45 minutes four times per week
- Take Nutritional classes to maximize meal planning
- Avoid snacks
- Avoid "soft foods"
Advantages of the Vertical Banded Gastroplasty
- No blind segments of the digestive tract
- No dumping
- No calcium deficiency
- No protein malnutrition
- Minimal monitoring of vitamin and minerals
- Allows endoscopic and radiologic evaluation of the GI tract
Disadvantages of the VBG
- Less effective than the RNY for sustained weight loss
- Less effective as a weight loss procedure for control of diabetes
- Requires implantation of a foreign body (marlex or silastic)
- Behavior changes important for long term success
The VBG is a fundamentally sound procedure
Note: Patients who are in the "super" morbid obese category benefit less from this procedure.
While this is a relatively simple operation, it still has all the risks of any bariatric procedure. However, newer stapling instruments have improved some outcomes and decreased the incidence of breakdown of the staple line. This procedure is well suited to a laparoscopic approach. At one time, this was the most popular bariatric procedure, but it has recently decreased in popularity—perhaps because of studies showing better results with the RNY gastric bypass.
An entire industry was built around the VBG surgery, with a hospital group that put together the Life Lite program. This program brought patients from around the country to a few major centers where the silastic ring VBG variant was performed. This program was later dismantled, although it had developed its own stapling device and training program for its surgeons. Surgeons now run their own bariatric programs in individual hospitals. Recently the pendulum has returned to where surgeons join a larger association of physicians or hospitals, ostensibly for marketing purposes.
The adjustable laparoscopic band (ALB) is replacing the VBG. The VBG is now being done laparoscopically, however there is no advantage in this over the newer technique, the Lap-band. The adjustable band is, simply put, adjustable.
The main advantage of the VBG and LAP-BAND is that there is no malabsorption. Both procedures do well for weight loss, but the safety of the LAP-BAND may render the VBG to history.
This procedure can later be revised to another procedure, a distinct advantage. Some believe that VBG can be revised to a RNY much easier than a lap-band to the RNY. However, this may simply be their lack of experience. Most surgeons note that the lap-band is not that difficult to remove.
The VBG is a fundamentally sound procedure and has been performed extensively in the bariatric community. When the jejunal-ileal bypass was abandoned as a weight loss procedure, most patients were converted the VBG. It was determined to be a safe, reliable procedure with minimal long-term complications, and became the staple of bariatric surgeons for a number of years. It continues to evolve in terms of laparoscopic techniques and some believe that the adjustable laparoscopic band may have evolved from it.