Restrictive gastric bypass - Gastric Banding and Vertical Banded Gastroplasty

Curbing the Appetite by Surgically Creating a Mini Stomach

These surgeries do not remove any digestive organs. Thus, the digestive process remains intact after the surgery. The basic objective is to alter the size of stomach, so the patient feels full after eating of a small amount of food/liquid. With a notable decrease in food intake, the patient loses weight until the calories eaten can keep up a steady weight. Normally, patients lose up to 40% of the surplus weight 1-2 years following these surgeries.

These surgeries make use of either a band or staples to divide the stomach into two parts. The upper-part (immediately after the esophagus) is a small pouch, with a room for merely about an ounce of food initially and about 2-3 ounce after some time. This small pouch serves as the ‘new’ stomach after the surgery. It opens into the remaining portion of the stomach with an opening that is much smaller than that of normal stomach into the small intestine. Thus, it takes long for the food to empty the new stomach. Following restrictive surgery, you can comfortably eat about 1 cup of food. If you eat more than the capacity of your mini-stomach, you are likely to vomit.

Restrictive surgeries are of two types:

Gastric Banding (GB)

In this procedure, an inflatable band is surgically placed around the top portion of stomach and is tightened like a belt to create a small pouch, which serves a new stomach. The size of this new stomach is much smaller, just about the size of an egg. It is possible to regulate band’s diameter around the stomach (and thus the size of the opening between the new and old stomach) by addition or withdrawal of saline (salt water). This is a plus to this method. In case a patient does not feel full after meals, the surgeon can further tighten the band to impede the passage of food. Since surgery does not permanently change the stomach, it is possible to reverse gastric banding by removing the band. However, doing so would restore the normal size to the stomach, which might make it difficult to maintain the lost weight.

Vertical Banded Gastroplasty (VGB)

This procedure makes use of a band and staples to create a stomach pouch. The upper part of stomach is vertically stapled to form a small pouch; the base of this pouch has a mesh band, which allows a narrow passage into remaining stomach.

With both GB and VGB, a choice of open surgery or laparoscopy is available. The latter is a less invasive, in which several small incisions are made rather than one big incision, as in an open surgery. The surgeon introduces a laparoscope (a small tube with a tiny camera attached) and the necessary surgical instruments via the small incisions to perform the surgery.

Although restrictive surgeries cause weight loss in a most of patients, they fail to confer the weight loss equivalent to that obtained with malabsortive surgeries. Other disadvantages include spillage of band, collapse of the staple line and seepage of gastric juices into the abdomen.