Restrictive operations -stomach stapling (vertical banded gastroplasty) or gastric banding

Surgery Overview

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Restrictive operations make the stomach smaller. With a smaller stomach, you will feel full a lot quicker than you are used to. This means that you will need to make big lifelong changes in how you eat—including smaller portion sizes and different foods—in order to lose weight. The most common restrictive surgery is adjustable gastric banding.

Stomach stapling (vertical banded gastroplasty)

In stomach stapling (vertical banded gastroplasty), an incision is made in the abdomen. Surgical staples and a plastic band are used to create a small pouch at the top of the stomach. This pouch is not completely closed off from the rest of the stomach. A small opening, about across, allows the partially digested food to move into the rest of the stomach and then into the intestines. The size of the pouch is small enough that you can eat only to of food before feeling uncomfortable.

See a picture of stomach stapling .

Gastric banding

Gastric banding was approved by the U.S. Food and Drug Administration (FDA) in 2001.

In this operation, a small band is placed around the upper part of the stomach, creating a small pouch. As with stomach stapling, the small size of the pouch means that you feel full sooner. But the band can be adjusted in size by inflating or deflating the band. This allows the health professional to adjust the size of the opening between the pouch and the stomach.

See a picture of gastric banding .

These procedures can be done by making a large incision in the abdomen (an open procedure) or by making several small incisions and using small instruments and a camera to guide the surgery (laparoscopic approach).

What To Expect After Surgery

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Open surgery for stomach stapling usually involves a 2- to 4-day hospital stay. Most people can return to their normal activities within 3 to 5 weeks.

Preliminary studies note that gastric banding is associated with a short hospital stay, rapid recovery, and little risk of complications.¹ However, follow-up studies are needed.

After these operations, you will be able to eat only or less of food at a time. You must be careful to chew food well and to stop eating when you feel full. This can take some adjustment, because you will feel full after eating much less food than you are used to eating. If you do not chew your food well or do not stop eating soon enough, you may feel discomfort or nausea and may sometimes vomit. If you drink a lot of high calorie liquid such as soda or fruit juice, you may not lose weight. If you continually overeat, the pouch may stretch. If the pouch stretches, you will not benefit from your surgery.

You may develop nutritional problems and need to take vitamins.

Why It Is Done

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Although guidelines vary, surgery is generally considered when your body mass index is 40 or higher. Surgery may also be performed when your BMI is 35 or higher and you have a life-threatening or disabling condition that is related to your weight.

Your doctor may only consider doing surgery if you have not been able to lose weight with other treatments.

The following conditions may also be required or at least considered:

• You have been obese for at least 5 years.
• You have no history of alcohol abuse.
• You do not have untreated depression or another major emotional disorder.
• You are between 18 and 65 years of age.

All surgeries have risk, and it is important for you and your health professional to discuss your treatment options to decide what is best for your situation.

How Well It Works

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After a restrictive operation—stomach stapling (vertical banded gastroplasty) or adjustable gastric banding—you will generally lose about half of your excess body weight in the first year. After stomach stapling (vertical banded gastroplasty), you may regain some of the weight you lost in the first 3 to 5 years. After 10 years, only 1 out of 5 people have kept the weight off.^{2, 3} A review of studies on stomach stapling (vertical banded gastroplasty) notes that 60% of excess weight (the weight above what is considered healthy) was lost, although a large portion of people regained the lost weight after 3 to 5 years.²

Research in Europe on laparoscopic stomach stapling (vertical banded gastroplasty) notes that up to 63% to 75% of excess weight was lost during periods of time ranging from 1 year to 3 years.¹

Research in Europe on adjustable gastric banding notes that 40% to 60% of excess weight was lost during a 3-year period of time.¹

Risks

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Risks common to all surgeries for weight loss include an infection in the incision, a leak from the stomach into the abdominal cavity (resulting in an infection called peritonitis), and a blood clot in the lung (pulmonary embolism). About one-third of all people having surgery for obesity develop gallstones or a nutritional deficiency condition such as anemia or osteoporosis.^{4, 3}

Fewer than 3 in 200 people (1.5%) die after surgery for weight loss.⁴

Stomach stapling (vertical banded gastroplasty)

After stomach stapling (vertical banded gastroplasty):⁴

• About 1 out of 5 people may need a second operation because the connection between the stomach and the intestines narrows (stomal stenosis), leading to nausea and vomiting, or because of an increase of gastroesophageal reflux after eating.²
• The staples pull loose in about 1 out of 3 cases.
• The plastic band may slip or wear away.

Laparoscopic surgeries

Laparoscopic surgery for obesity reduces recovery time and postsurgery complications.¹

Research in Europe notes that:¹

• Complications of laparoscopic stomach stapling include abscess, leaks, and fistulas.
• Complications of laparoscopic gastric banding include inability to eat (food intolerance), wound infections, band slippage, and pouch enlargement. Second operations may be necessary.

What To Think About

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Liquids and foods that contain little or no fiber (highly refined foods) are able to move through the pouch more quickly than meats, fruits, and vegetables—this can defeat the purpose of the surgery. People who continue to drink high-calorie liquids (such as soda pop or milk shakes) often regain weight.⁵ Gastric bypass surgery may be more helpful for these people than restrictive stapling. Gastric bypass surgery results in food bypassing the lower stomach and upper small intestine, which means fewer calories are absorbed.

People who have had this surgery may need to talk with a registered dietitian to be certain that what they eat provides proper nutrition and supports the maximum benefit from the surgery.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

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Citations

1. Schauer PR, Ikramuddin S (2001). Laparoscopic surgery for morbid obesity. Surgical Clinics of North America, 81(5): 1145–1179.

2. Brolin RE (2002). Bariatric surgery and long-term control of morbid obesity. JAMA, 288(22): 2793–2796.

3. National Institute of Diabetes and Digestive and Kidney Diseases (2004). Gastrointestinal Surgery for Severe Obesity (NIH Publication No. 04-4006). Available online: http://www.win.niddk.nih.gov/publications/gastric.htm.

4. American Gastroenterological Association (2002). AGA technical review on obesity. Gastroenterology, 123(3): 882–932. [Erratum in Gastroenterology, 123(5): 1752.

5. Balsiger BM, et al. (2000). Bariatric surgery. Medical Clinics of America, 84(2): 477–489.

Credits

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Associate Editor	Tracy Landauer
Specialist Medical Reviewer	W. Stewart Agras, MD - Psychiatry
Last Updated	October 3, 2005