Vertical banded gastroplasty (VBG) is a surgical weight loss procedure used to limit the food intake of severely obese individuals. Prior to determining eligibility, individuals must demonstrate that they meet specific criteria established by the medical community and insurance industry. Candidates for a VBG procedure are subjected to a battery of tests to evaluate their physical and psychological health. There are serious risks associated with this procedure and these should be discussed with a qualified health care provider prior to pursuing this treatment option.
Since vertical banded gastroplasty is considered to be a dangerous procedure, it is generally reserved for patients who are determined to be morbidly obese with a body mass index (BMI) of 35 or higher. A determination must be made regarding the extent of an individual's obesity prior to confirming a diagnosis. The most frequently administered guidelines are those of Milliman and Robertson, a well-known company that sets guidelines for numerous other procedures in the medical community.
According to established guidelines, individuals seeking vertical banded gastroplasty surgery must be at least 100 pounds (46 kg) overweight and possess a BMI of at least 40. Those who have a secondary condition, such as diabetes or heart disease, may qualify for surgery with a BMI of 35 or higher. The obesity must have a physiological reason, such as thyroid disease. Additional guidelines state that the individual must be of adult age and demonstrate an inability to lose weight on his or her own.
After demonstrating his or her ability to meet established guidelines, the individual is then subjected to a battery of tests, including a psychological evaluation, physical examination, and blood tests. Individuals must undergo a psychological screening to establish if there are any underlying factors, such as compulsive eating, which need to be addressed prior to or following surgery. In some cases, individuals with a history of substance abuse, major psychiatric illness, or systemic disease may not qualify for vertical banded gastroplasty.
The VBG procedure, which lasts approximately one hour, may be performed either as an open, or traditional, surgery requiring a single large incision, or as a laparoscopic procedure involving the use of small incisions and equally small instruments. Conducted under general anesthesia, the procedure involves the implantation of staples to reduce the size of the stomach by dividing it into two sections. A small passageway, called a stoma, is left to reduce the rate at which food passes into the stomach. A band is placed around the stoma as a means of reinforcing the restriction.
Required hospitalization for an open surgery is generally two to five days, whereas a laparoscopic procedure may require two to three days. Individuals are encouraged to move around as soon as they are able in order to prevent the development of pneumonia. Pain medications are administered to alleviate discomfort and breathing exercises are encouraged to promote proper lung function.
Following surgery, the individual is placed on a restricted diet, consisting of the strict administration of liquids only. Over time, the individual is able to progress from liquid to semi-solid foods and, finally, to solid foods. Though each stage of progression may last up to one month, dietary progression is dependent on the individual. New life-long nutritional requirements must be adopted, including a healthy diet and eating habits.
As with any major surgery and the administration of general anesthesia, there are general risks with vertical banded gastroplasty, including infection, stroke, excessive bleeding, and blood clots. Complications specific to the VBG procedure include stenosis or narrowing at the site of band placement, nausea and vomiting, and the tearing or breaking of staples, known as dehiscence. Long-term risks may include the development of psychiatric issues and the recurrence of weight gain.
