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Disadvantages: Vertical Banded Gastroplasty (VBG)

One of the most recognized types of bariatric surgery is vertical banded gastroplaty (VBG), and although it was one of two procedures recognized by the National Institute of Health, the practice has waned over the last several years.

VBG is a purely restrictive operation and with it comes its own series of disadvantages that may hinder some patients in the long-run.

For instance, stapling of the stomach carries with it the risk of staple-line disruption that can result in leakage and/or serious infection. This may require prolonged hospitalization with antibiotic treatment and/or additional operations. Staple-line disruption may also, in the long-term, lead to weight gain. For these reasons, some surgeons divide the staple-line wall of the pouch from the rest of the stomach to reduce the risk of long-term staple-line disruption.

The band or ring applied may lead to complications of obstruction or perforation, requiring surgical intervention. Characteristically, these procedures, while creating a sense of fullness, do not provide the necessary feeling of satisfaction that one has had "enough" to eat.

Because restrictive procedures rely solely on a small stomach pouch to reduce food intake, there is the risk of the pouch stretching or of the restricting band or ring at the pouch outlet breaking or migrating, thus allowing patients to eat too much. Around 40 percent of patients undergoing these procedures have lost less than half their excess body weight.

As is the case with all weight loss surgeries, readmission to a hospital may be required for fluid replacement or nutritional support if there is excessive vomiting and adequate food intake cannot be maintained.

Even with improvements in VBG, some pitfalls can occur. The laparoscopic approach (operation via camera) to bariatric surgery has made procedures easier for physicians and patients alike. But with the procedure comes a new set of possible risks.

The disadvantage of Laparoscopic Vertical Banding - VBG is it usually results in less weight loss than laparoscopic roux-en-y. It does not restrict intake of high calorie liquids (sweets) and the pouch can stretch with overeating. As a result 20% of people do not lose weight and only half of people lose at least 50% of their excess weight with a Vertical Banding Gastroplasty. This procedure can usually be performed as a 23 hour procedure with return to full activity in 7-10 days. A soft diet, with 6 small meals is suggested for 3 weeks after surgery.

VBG is still considered one of the better procedures for people suffering from morbid obesity but purely restrictive practices are becoming less and less used. 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. 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.

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