Vertical Banded Gastroplasty Operation
Decline of VBG Stomach Banding
| Bariatric Surgery information Vertical Banded Gastroplasty Operation |
Decline of VBG Stomach Banding |
Guide to Weight Loss Surgery - Research Into Gastric Reduction Surgery |
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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. Laparoscope-Assisted Method 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. Procedure Concerns 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. Long’s 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 Long’s gastroplasty. The three ties were placed over a distance of 22mm, which he found produced better weight control than Long’s two sutures. To date, no one has presented a laparaoscopic way of performing Long’s gastroplasty. For any surgeon looking for an alternative to VBG and willing to perform an open operation, I would suggest Long’s 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. Stomach Bypass 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 surgeon’s 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. References Source: Author: Stomach Bypass Surgery Information |