The surgical methods have changed over the years, but can be divided into gastric (stomach) restrictive procedures and gastrointestinal (intestinal) bypass procedures.

Gastric (stomach) restrictive procedures

Vertical banded gastroplasty (not commonly done any longer)

The gastric restrictive procedures are performed in many medical centers. The vertical banded gastroplasty (VBG) sometimes with additional reinforcement of a small silastic (plastic) ring is one variation.  In VBG, the stomach is "stapled" to reduce its capacity to approximately 15 ml. (1/2 oz.) and a silastic ring is inserted to help prevent the stomach from "stretching" in size. What is formed is essentially a small stomach "pouch" that receives food from the esophagus and a much larger, unstapled stomach that receives small amounts of food from the proximal "pouch". When one eats, only a small amount of food can be consumed without the pouch becoming distended. This generally leads to a feeling of satiety or fullness. If one continues to eat, one will develop nausea, vomiting, or pain, which generally results in the termination of eating. Patients must adapt to their new, restricted stomach size and restrict their food intake to prevent these side-effects. Complications can result from the surgery. When gastroplasty is done by well-trained physicians, the mortality (death rate) from the surgery is under 1 %.

Complications include risk of infection, obstruction (blockage) of the outlet, necessitating surgical revision; development of blood clots in the legs or lungs; bleeding; metabolic or nutritional deficiencies (including protein calorie malnutrition); and recurrent vomiting. Although uncommon, it is possible to slowly develop vitamin (especially vitamin B-12) and mineral deficiencies resulting in anemia or osteoporosis (softening of the bones) after this surgery. Post-operatively, the patient must be followed by physicians who are familiar with the long-term complications and required long-term treatment.

The effectiveness of the surgery is fair, with loss of 40 to 50% of excess body weight with generally 50% of the weight loss being maintained after 5 years. It is common for the body weight to slowly increase after the first or second year.

The surgery requires a modified diet to prevent nausea and vomiting and to help prevent other long-term side effects. Additionally, one can (partially) bypass the "restriction" by eating calorie-dense liquids such as ice cream or regular soda. Long-term changes in eating habits must take place in order for the surgery to be successful. Vertical Banded Gastroplasty, however, is a viable treatment alternative for obese individuals.

Page 1 of 3 | Next page