Gastric Stapling Operations - eg. Vertical Banded Gastroplasty
Use of Gastric Staples to Reduce Stomach
and Food Intake
Surgery | Restrictive
Surgery Benefits, Risks | Gastric
Banding | Lap Band Surgical
Procedure | Lap Band Diagram
| Lap Band Follow-Up
The stomach reduction technique known as "gastric stapling" to restrict food intake in morbidly obese patients, evolved from Russian wartime research into surgical instruments capable of stapling together various body tissues to cope with wounds. Nowadays, gastric stomach stapling techniques are used in a number of bariatric procedures like gastric bypass (eg. Roux-en-Y) and vertical banded gastroplasty.
Stomach Restriction Using Gastric Staples
In purely restrictive operations (like gastroplasty), bariatric surgeons use gastric stapling to divide the stomach into two sections: a small upper pouch and a larger lower section. A narrow gap (stoma) between the two sections is left unstapled. The idea behind this type of stomach stapling is that food which the patient eats is held up in the segment of stomach above the staple line causing a sensation of fullness and thus a reduced calorie-intake. The food then empties slowly through the stoma into the stomach below the staple line where digestion takes place normally.
Gastric Stapling in Stomach Bypass
In malabsorptive gastric bypass procedures, like Roux-en-Y bypass, weight loss surgeons also use stapling to reduce stomach capacity and appetite, but the lower (distal) part of the stomach is then bypassed, together with the first portion of the small intestine (duodenum and jejunum) and the food is re-routed directly to the final section of the small intestine.
Gastric Stapling Complications
Using staples to reduce the stomach and restrict food intake has one problem. The muscular stomach wall has a tendency to stretch, thus widening the stoma and permitting greater food and calorie intake. Early gastroplasty patients would therefore stop losing weight and would frequently regain all weight lost.
Improvements in Gastric Stapling
A more secure method of gastroplasty, now known as Vertical Banded Gastroplasty, was devised by Dr. Edward E. Mason, Professor of Surgery at the University of Iowa. He made three improvements. (1) Realizing that the lesser curvature part of the stomach had the thickest wall and was therefore least likely to stretch, Mason used a vertical segment of stomach along the lesser curvature for the pouch. (2) He fixed an optimum stomach pouch-size capacity of only 14 ccs saline at the time of surgery. (3) He placed a polypropylene band around the lower end of the vertical pouch, which acts as the stoma, to fix the size of the outlet of the pouch, preventing it from stretching. Mason performed this gastric band placement using a circular stapling instrument to staple the front and back walls of the stomach together, cutting out a circular window to allow the polypropylene band to be placed around the lower end of the pouch. Correctly performed, Vertical Banded Gastroplasty produces good weight loss results.
BARIATRIC SURGERY INFORMATION