Vertical-banded gastroplasty

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Vertical-banded gastroplasty (VBG) is an older, purely restrictive procedure used to treat morbid obesity.

Procedure

It involves creating a small gastric pouch, based on the lesser curvature of the stomach (which is thicker and less resistant to stretching than the greater curvature), by using a staples and band, stapler to vertically partition the stomach by using a circular stapler, the anterior and posterior walls of the stomach are then stapled together and an incision is made through the excluded gastric walls to create a circular window. Lastly, a polypropylene mesh band is wrapped around the stomach and placed through the window to create a small proximal gastric pouch and a small stoma into the remainder of the stomach.

Radiographic features

Fluoroscopy

Initial postoperative imaging is performed with fluoroscopy by using water soluble contrast media to assess for contrast extravasation, staple line competence and to evaluate postoperative fluoroscopic anatomy. CT is not usually indicated for early postoperative evaluation

Complications

VBG has fallen into disfavor among surgeons because of complications and needs strict patients adherence to dietary measures and increasing use of either adjustable or more effective alternative procedures namely laparoscopic adjustable gastric banding, sleeve gastrectomy and Roux-en-Y gastric bypass.

Recognized complications include:

  • early
    • gastric leak
    • abscess formation
    • gastric perforation secondary to ischemia or hyperacidity
    • staple line disruption
  • late
    • stomal stenosis
    • pouch enlargement
    • stomal widening
    • staple line disruption
    • ulceration
    • food impaction

History and etymology

It was originally introduced by Dr. E. Mason in1982.