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Vertical Banded Gastroplasty—Laparoscopic Surgery by Karen Kassel, MS, RD, MEd

Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

Definition

Vertical banded gastroplasty is surgery to treat obesity . It causes weight loss by decreasing the amount of food you can eat.

The Stomach

Reasons for Procedure

The surgery treats severe obesity. Doctors use a calculation called body mass index ( BMI ) to determine how overweight or obese you are. A normal BMI is 18.5-25.

This surgery is a weight loss option for people with:

BMI greater than 40
BMI 35-39.9 and a life-threatening condition, such as heart disease or diabetes
BMI 35-39.9 and severe physical limitations that affect employment, mobility, and family life

The success of vertical banded gastroplasty depends on your commitment. If lifestyle changes are made and maintained, the benefits of bariatric surgery include:

Weight reduction
Improvement in many obesity-related conditions, such as glucose intolerance, diabetes, sleep apnea , high blood pressure , and high cholesterol
Improved mobility and stamina
Enhanced mood, self-esteem, and quality of life
Reduced risk of dying from cardiovascular disease (eg, heart attack , stroke ) and other causes

Possible Complications

If you are planning to have gastroplasty, your doctor will review a list of possible complications, which may include:

Vitamin deficiencies—You will take a multivitamin daily for the rest of your life.
Bleeding
Infection
Blood clots
Vomiting
Breakdown of the staples, allowing stomach juices to leak into the abdomen
Slipping or wearing away of the band
Enlargement of the pouch
Irritation of the throat due to acid reflux
Hernia formation
Complications of general anesthesia
Death, occurs in less than 1% of patients

Factors that may increase the risk of complications include:

Smoking
Recent or chronic illness (eg, kidney disease)
Diabetes
Old age
Heart or lung disease
Bleeding or clotting disorders

What to Expect

Prior to Procedure

Each bariatric surgery program has specific requirements. Your program will likely include the following:

Thorough physical exam and review of medical history
Attempts to lose weight (about 10%) through medically approved dietary means
Ongoing consultations with a registered dietitian
Mental health evaluation and counseling

Leading up to your procedure:

Talk to your doctor about your medicines, herbs, and dietary supplements. You may be asked to stop taking some medicines up to one week before the procedure, like:
- Aspirin or other anti-inflammatory drugs
- Blood thinners, such as warfarin (Coumadin)
- Clopidogrel (Plavix)
Do not start any new medicines, herbs, or supplements without talking to your doctor.
Arrange for a ride to and from the hospital.
Arrange for help at home as you recover.
You may be given antibiotics.
You may be given laxatives and/or an enema to clear your intestines.
The night before, eat a light meal. Do not eat or drink anything after midnight unless told otherwise by your doctor.
Shower or bathe the morning of your surgery.

Anesthesia

General anesthesia will be used. You will be asleep for the surgery.

Description of the Procedure

To prepare you for surgery, a nurse will place an IV line in your arm. You may receive fluids and medicines through this line during the procedure. The doctor will place a breathing tube through your mouth and into your throat. This will help you breathe during surgery. You will also have a catheter placed in your bladder to drain urine.

The laparoscopic method begins with the doctor making several small cuts in the abdomen. Gas will be pumped in to inflate your abdomen. This will make it easier for the doctor to see. A laparoscope and surgical tools will be inserted through the incisions. A laparoscope is a thin, lighted tool with a tiny camera. It sends images of your abdominal cavity to a monitor in the operating room. Your doctor will operate while viewing the area on this monitor.

Surgical staples will be used to divide your stomach into two unequal portions. The upper portion will be a small pouch. It will empty through a tiny opening into the lower portion. The small pouch can hold only ½ to 1 cup of soft, moist, and well-chewed food. A normal stomach can hold 4-6 cups.

Next, a plastic band will be wrapped around the tiny opening. This will prevent it from stretching. This band can be adjusted after surgery. The incisions will then be closed with staples or stitches.

Vertical Banded Gastroplasty

Immediately After Procedure

The breathing tube will be removed. You will be taken to the recovery area.

How Long Will It Take?

About two hours

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. You may have pain and/or soreness at the incision sites. Your doctor can give you pain medicine to relieve the discomfort.

Average Hospital Stay

You will be in the hospital for 2-5 days. Your doctor may choose to keep you longer, however, if complications arise.

Postoperative Care

At the Hospital

While you are recovering at the hospital, you may receive the following care:

Pain medicine will be given as needed.
Your diet:
- Day of surgery—You will not eat or drink anything.
- Day after surgery—You will likely have an x-ray to check for leaks from the stomach pouch. You will drink a special liquid while x-rays are taken.
  - If this x-ray is normal, you will be given 30 milliliters (mL) of liquids every 20 minutes.
  - If leaks are found, you will receive nutrition through an IV until the leaks are fixed.
- On the second day after surgery—You will have 1-2 tablespoons of pureed food or 1-2 ounces of liquids every 20 minutes.
You may be asked to do the following:
- Use an incentive spirometer to take deep breaths every hour to prevent breathing problems.
- Wear elastic surgical stockings or boots to promote blood flow in your legs.
- Get up and walk in the hall daily.

At Home

Be sure to follow your doctor’s instructions. You will need to practice lifelong healthy eating and exercising habits. After your surgery:

Ask your doctor about when it is safe to shower, bathe, or soak in water.
You may be out of work for 2-6 weeks after surgery.
Do not drive or lift anything heavy for at least two weeks.
You should walk as soon as possible, with a goal of exercising daily.
You may have emotional ups and downs after this surgery.
You will meet regularly with your healthcare team for monitoring and support.

Your new stomach is the size of a small egg. It is slow to empty. This will make you feel full quickly. Nutritional steps include:

You need to eat very small amounts and eat very slowly.
You will begin with 4-6 small meals per day. A meal is two ounces of food.
For the first 4-6 weeks after surgery, all food must be pureed.
Once you move to solid foods, food must be well-chewed.
When making food choices, ensure that you are getting adequate protein.
Eating too much or too quickly can cause vomiting or intense pain under your breastbone. Most people quickly learn how much food they can eat.
This procedure does not cause nausea and diarrhea if sweet or fatty foods are eaten. In fact, some people gain back weight because they continue to consume soda, ice cream, or other high-calorie foods. To promote ongoing weight loss, avoid high-calorie foods.
Be sure to follow your doctor’s instructions .

You may need to take medicines, as directed by your doctor, which may include:

Antacids
Pain medicines
Vitamin and mineral supplements

Call Your Doctor

After you leave the hospital, call your doctor if any of the following occurs:

Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision sites
Pain that you cannot control with the medicines you have been given
Blood in the stool
Pain, burning, urgency, or frequency of urination, or persistent bleeding in the urine
Persistent nausea and/or vomiting
Pain and/or swelling in your feet, calves, or legs
Cough, shortness of breath, or chest pain
Any other concerning symptoms

In case of an emergency, call for medical help right away.

RESOURCES:

American Society for Metabolic and Bariatric Surgery https://www.breastsurgeons.org/
National Institutes of Health http://www.nih.gov/
Weight Control Information Network http://www.win.niddk.nih.gov/

CANADIAN RESOURCES:

Canadian Obesity Network http://www.obesitynetwork.ca/
Weight Loss Surgery http://www.weightlosssurgery.ca/

References:

DeMaria E. Bariatric procedures. In: ACS Surgery: Principles & Practice . Medscape website. Available at: http://www.medscape.com/viewarticle/505012_1 . Accessed June 20, 2005.
Gastrointestinal surgery for severe obesity. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://win.niddk.nih.gov/publications/gastric.htm . Published December 2004. Updated March 2008. Accessed July 19, 2008.
Kendrick ML, Dakin GF. Surgical approaches to obesity. Mayo Clin Proc . 2006;81(10 Suppl):S18-24.
Laparoscopic gastric bypass procedure. The Cleveland Clinic website. Available at: http://www.clevelandclinic.org/health/health-info/docs/1900/1993.asp?index=4355 . Accessed June 20, 2005.
Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med . 2005;142:547-559.
Malinowski SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci . 2006;331:219-225.
Obesity surgery. Columbia University Department of Surgery website. Available at: http://www.columbiasurgery.org/divisions/obesity/index_obe.html . Accessed June 20, 2005.
Olbers T, Bjorkman S, Lindroos A, et al. Body composition, dietary intake, and energy expenditure after laparoscopic roux-en-y gastric bypass and laparoscopic vertical banded gastroplasty: a randomized clinical trial. Ann Surg . 2006;244:715-722.
The story of surgery for obesity. American Society for Bariatric Surgery website. Available at: http://www.asbs.org/html/story/chapter4.html . Accessed June 20, 2005.
Surgery for obesity: what is it and is it for you? Mayo Foundation for Medical Education and Research website. Available at: http://www.mayoclinic.com/invoke.cfm?id=HQ01465 . Accessed June 20, 2005.
9/2/2009 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med . 2009;361:445-454.
6/24/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Pontiroli AE, Morabito A. Long-term prevention of mortality in morbid obesity through bariatric surgery. a systematic review and meta-analysis of trials performed with gastric banding and gastric bypass. Ann Surg. 2011;253(3):484-487. Maciejewski ML, Livingston EH, Smith VA, et al. Survival among high-risk patients after bariatric surgery. JAMA. 2011;305(23):2419-2426.

Last reviewed November 2012 by Marcin Chwistek, MD

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