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Vertical Banded Gastroplasty Operation
Decline of VBG Stomach Banding
Decline of Vertical Banded Gastroplasty Operation
A marked decrease has occurred in use of Vertical Banded Gastroplasty since 1995. Several reasons can account for this decrease. One, surgeon failure to adhere to simple but important guidelines and then reporting such failures as innate features of VBG has discouraged its use. Two, market pressures dictate surgeon choice and there has not been an attractive laparoscopic version of VBG adapted in the United States.
Wei-Jei Lee MD performs a laparoscopic Vertical Banded Gastroplasty which I observed in Taiwan, March of 2001. The stomach was not divided. It followed the recommended guidelines except that the pouch was not measured. The operation was completed in one hour. Lee has performed over 400 LVBGs. I can recommend this technique.
Advantage of Restrictive Bariatric Surgery
The advantage of a well designed pure restriction operation like VBG over bypass operations is that it avoids iron deficiency anemia, osteoporosis, osteomalacia, secondary hyperparathyroidism, stomal ulcer, duodenal ulcer, closed segment obstruction of the excluded upper gastrointestinal tract and dumping symptoms. Most patients with Vertical Banded Gastroplasty are able to drink milk and absorb the calcium and vitamin D to help avoid metabolic bone disease as they increase in age and risk for osteoporosis.
Some surgeons are concerned about the stapled window and use of Marlex mesh for stabilization of the outlet. Silastic ring gastroplasty is acceptable as long as the basic principles of vertical gastroplasty are followed. Longs gastroplasty provides an outlet anatomically close to that of VBG without the window or Marlex mesh. In 1980 Michael Long presented vertical stapling with two Ethibond sutures placed adjacent to the lower end of the staple line and tied around the lesser curvature. It was after hearing this paper, and with thoughts about the reported experience of Wilkinson, Tretbar, Laws and Fabito with vertical pouches, that I began using VBG. In 1980, Jamieson added a third suture to Longs gastroplasty. The three ties were placed over a distance of 22mm, which he found produced better weight control than Longs two sutures. To date, no one has presented a laparaoscopic way of performing Longs gastroplasty. For any surgeon looking for an alternative to VBG and willing to perform an open operation, I would suggest Longs gastroplasty.
VBG has risks. If Marlex mesh becomes infected it will migrate into the lumen. This is one reason for not dividing the stomach and for keeping the technique as simple as possible. Stomach cancer has been reported in two patients after VBG.
Gastric bypass does cure diabetes by rapid transit of undigested food to the distal ileum and GLP-1 release. Failure of weight control with bypass operations has led to use of longer alimentary limbs and biliopancreatic diversion, with or without duodenal switch. The more intestine that is bypassed, the greater the need for long-term special medical care.
Surgery With Least Complications
The well-informed patient is supposed to decide what is best for them. It is the surgeons obligation to educate and recommend to the patient the surgery with the least possible lifetime complications. There is still a need for more complete information about what patients can expect over a lifetime after each of the different operations that are available.
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Laparoscopic or open bariatric surgery, such as gastric banding or bypass is not an easy solution to morbid obesity and weight loss. It is a serious surgical procedure, involving health risks. To produce lasting weight loss it requires a long-term patient commitment to eating a healthy diet and following a regular program of physical exercise. Life-long use of nutritional supplements may also be necessary. So, before deciding, discuss your options fully with your doctor. © 2003-2017 Bariatric-Surgery.Info - Terms - Contact - Information - Resources