Your Health

Vertical Banded Gastroplasty -- Open Surgery

Definition

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

The Stomach
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This surgery involves re-shaping the stomach to reduce the amount of food it can hold.
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This is only one type of weight loss surgery. It is currently a less common choice, but still may be suited for some.

Reasons for Procedure

The surgery treats severe obesity. A calculation called body mass index ( BMI ) is used 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 or severe physical limitations that affect employment, movement, 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
  • Improved movement and stamina
  • Enhanced mood, self-esteem, and quality of life

Possible Complications

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

  • 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

Long-term complications include vomiting and gallstones.

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications, such as:

What to Expect

Prior to Procedure

Before the procedure, you may have the following:

  • Thorough physical exam and review of medical history
  • Ongoing consultations with a registered dietitian
  • Mental health evaluation and counseling

Leading up to your procedure:

  • Talk to your doctor about your medications, herbs, and dietary supplements. You may be asked to stop taking some medications up to 1 week before the procedure.
  • Do not start any new medications, 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, an IV will be placed in your arm. You may receive fluids and medications through the IV during the procedure. A breathing tube will be placed 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.

An 8-10 inch incision will be made to open the abdomen. 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.

Immediately After Procedure

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

How Long Will It Take?

About 2 hours

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

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

Postoperative Care

At the Hospital

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

  • Pain medication 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 have1-2 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 daily.
Preventing Infection

During your stay, the hospital staff will take steps to reduce your chance of infection, such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chance of infection, such as:

  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision
At Home

You will need to practice lifelong healthy eating and exercising habits. After your surgery:

  • Do not lift anything heavy for at least 2 weeks.
  • You may have emotional changes after this surgery. Your may be referred to a therapist.

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.
  • When you move to solid foods, food must be well chewed.
  • When making food choices, ensure that you are getting enough 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 high-calorie foods. To promote ongoing weight loss, avoid high-calorie foods.
  • Be sure to follow your doctor’s instructions.

Call Your Doctor

Call your doctor if any of these occur:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Persistent cough , shortness of breath, or chest pain
  • Worsening abdominal pain
  • 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; sudden shortness of breath or chest pain
  • New or worsening symptoms

If you think you have an emergency, call for emergency medical services right away.

Revision Information

  • American Society for Metabolic and Bariatric Surgery

    http://asmbs.org

  • Weight Control Information Network

    http://www.win.niddk.nih.gov

  • Canadian Obesity Network

    http://www.obesitynetwork.ca

  • Weight Loss Surgery

    http://www.weightlosssurgery.ca

  • Bariatric surgery. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 3, 2014. Accessed December 4, 2014.

  • Bariatric surgery for severe obesity. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://win.niddk.nih.gov/publications/gastric.htm. Updated June 2011. Accessed December 4, 2014.

  • Kendrick ML, Dakin GF. Surgical approaches to obesity. Mayo Clin Proc. 2006;81(10 Suppl):S18-24.

  • Maciejewski ML, Livingston EH, et al. Survival among high-risk patients after bariatric surgery. JAMA. 2011;305(23):2419-2426.

  • 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.

  • 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.

  • 9/2/2009 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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 http://www.ebscohost.com/dynamed: 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.