Vertical-banded gastroplasty advantages

• No dumping syndrome
• No nutritional deficiencies/malabsorption

Vertical-banded gastroplasty disadvantages

• Needs strict patient compliance to diet
• High fiber foods and foods with a more dense, natural consistency can become very difficult to eat, while highly refined foods cause little discomfort. Most people who regain any weight lost after surgery do so because choosing "healthier" foods are harder to digest, while "junk" food pass easily.
• VBG is in no way a magic bullet or pill. It must be emphasized that lifestyle changes, i.e. diet Vertical-banded Gastroplasty and exercise, are absolutely imperative for weight loss to occur and be maintained. Realistic expectations are imperative.
• Reversal of a VBG requires a much more complex and intensive surgical process than getting the VBG. When removal of a polyurethane band is involved (polyurethane was predominantly used in the 1980s and 90s), it likely has built substantial scar tissue that must also be removed, depending on how long ago the VBG took place. Removal of the staples involves stitching the previously separated parts of the stomach back together. For these reasons, a reversal should only be considered if there are serious medical complications.
• Vomiting and severe discomfort if food is not properly chewed or if food is eaten too quickly.
• As with any surgical procedure, there are risks of complications. It has been observed that approximately one in every hundred patients undergoing VBG die within a year. There may also be other medical complications down the road, but the risk is relatively low
• Not adjustable

Long term

Although restrictive operations lead to weight loss in almost all patients, they are less successful than malabsorptive operations in achieving substantial, long-term weight loss. About 30 percent of those who undergo VBG achieve normal weight, and about 80 percent achieve some degree of weight loss. Most studies have suggested that 10 years after surgery, only 10% of patients maintain a minimum weight loss of at least 50% of their total excess weight at the time of their initial surgery.

Some patients regain weight. Others are unable to adjust their eating habits and fail to lose the desired weight. Successful results depend on the patient’s willingness to adopt a long-term plan of healthy eating and regular physical activity.

Does vertical-banded gastroplasty result in any vitamin or mineral deficiencies?

In the stomach food comes in contact with gastric acid. Iron found in foods such as spinach, raisins, and red meat requires contact with gastric acid to covert it from the ferrous form, which is not readily absorbed adequately, anemia can result. The stomach also contains something called intrinsic factor, which aids in the absorption of vitamin B12.

Vitamin B12 deficiency can result in a condition called pernicious anemia. Vertical-banded gastroplasty can result in a deficiency of both iron and vitamin B12. Although this is generally not a major problem, supplements of both iron and vitamin B12 are usually necessary. Because of the potential for vitamin and mineral deficiencies following gastric bypass surgery, it is crucial for you to maintain regular follow-up with the nurses, doctors, and dietitians at your gastric bypass
center.

Do people keep their weight off following vertical-banded gastroplasty?

While initial weight loss is quite good with verticalbanded gastroplasty, long-term maintenance is poor. Unlike most other forms of gastric bypass surgery, following vertical-banded gastroplastymost people are not troubled by eating sweets, and as a result they may consume excessive amounts of sweets. This behavior has been linked to poor long-term weight loss. At ten years this procedure has an 80 percent failure rate (meaning much of the initial weight lost is regained). In addition 15 to 20 percent of people who have this procedure require a re-operation due to blockage of the
polypropylene band or reflux of stomach acid into the esophagus. Because of these difficulties, it is unlikely that your doctor will suggest verticalbanded gastroplasty.

How is Roux-en-Y gastric bypass surgery done?

Surgical techniques

Laparoscopic surgery is performed using several small incisions, or ports, one of which conveys a surgical telescope connected to a video camera, and others permit access of specialized operating instruments. The surgeon actually views his operation on a video screen. The method is also called limited access surgery, reflecting both the limitation on handling and feeling tissues, and also the limited resolution and two-dimensionality of the video image. With experience, a skilled laparoscopic surgeon can perform most procedures as expeditiously as with an open incision — with the option of using an incision should the need arise.

The Laparoscopic Gastric Bypass, Roux-en-Y, first performed in 1993, is regarded as one of the most difficult procedures to perform by limited access techniques, but use of this method has greatly popularized the operation, with benefits which include shortened hospital stay, reduced discomfort, shorter recovery time, less scarring, and minimal risk of incisional hernia.

Before gastric bypass, food enters your stomach and passes into the small intestine. After surgery, food is redirected so that it bypasses most of your stomach and the first section of your small intestine (duodenum). Food flows directly into the middle section of your small intestine (jejunum), limiting absorption of calories.

In gastric bypass (Roux-en-Y gastric bypass) the surgeon creates a small pouch at the top of your stomach and adds a bypass around a segment of your stomach and small intestine.

The surgeon staples your stomach across the top, sealing it off from the rest of your stomach. The resulting pouch is about the size of a walnut and can hold only about an ounce of food. The pouch is physically separated from the rest of the stomach. Then, the surgeon cuts the small intestine and sews part of it directly onto the pouch.

This connection redirects the food, bypassing most of your stomach and the first section of your small intestine, the duodenum. Food enters directly into the second section of your small intestine, the jejunum, limiting your ability to absorb calories.

Even though food never enters the lower part of your stomach, the stomach stays healthy and continues to secrete digestive juices to mix with food in your small intestine. Because of its low complication rate and high degree of success, the Roux-en-Y is generally accepted to be the best and safest bariatric procedure.

Some surgeons perform this operation by using a laparoscope — a small, tubular instrument with a camera attached — through short incisions in the abdomen (laparoscopic gastric bypass). The tiny camera on the tip of the scope allows the surgeon to see inside your abdomen.

Recent studies show patients who have had laparoscopic weight loss surgery experience:

• Less pain after surgery
• Easier breathing and lung function
• Fewer wound complications such as infection or hernia
• Quicker return to pre-surgical levels of activity What happens if the operation cannot beperformed or completed by the laparoscopic method?

In some patients the laparoscopic method does not work effectively. Factors that may increase the possibility of choosing or converting to the "open" procedure may include:

Roux-en-Y gastric bypass procedure

A history of prior abdominal surgery causing dense scar tissue

• Inability to visualize organs
• Bleeding problems during the operation

Roux-en-Y gastric bypass procedure If bariatric surgery is performed laparoscopically and complications occur during the operation, your doctor may choose to perform open surgery.

The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. The decision to convert to an open (conventional) procedure is strictly based on patient safety.

Risks And Complications Of the Roux-en-Y Procedure

As with any major surgery, there can be complications. One of the most common in the Roux-en-Y procedure is blood clots in the legs. This occurs in about 0.2 percent of people undergoing the Roux-en-Y procedure. The clots have the potential to travel to the lungs, where they can have serious consequences. In order to prevent this you will be given blood thinners following surgery. You may also be asked to wear compression stockings. These are very tight stockings that have been proven to reduce blood clots in postoperative patients. Your doctor will want you to get up and walk as soon after surgery as possible. Early ambulation has also been proven to reduce the risk of blood clots. Finally,
although the risk of blood clots is highest in the days immediately following surgery, if you notice unexplained swelling in your legs or sudden shortness of breath once you are home from hospital, contact your physician and get yourself evaluated. Another risk is that occasionally food or liquids will leak out of the stomach instead of traveling directly into the jejunum. While this can be a serious complication occurring in about 1 percent of procedures, it can generally be
corrected. If this happens to you, you will need to return to the operating room. In general, one day after your gastric bypass surgery you will go down to the radiology department and drink something called gastrographin (this is a liquid that will show up on an x-ray). After you drink the gastrographin you will have an x-ray to make sure there is no leakage. If there is a problem, it can be addressed immediately.

Complications of Roux-en-Y gastric bypass

Complications of the adjustable gastric band procedure

Complications of the Biliopancreatic diversion with duodenal switch

• Fat malabsorption results in diarrhea and foulsmelling gas in approximately 30% of patients.
• The potential nutritional deficiencies mandate frequent follow-up visits, with close monitoring and supplementation of multivitamins and minerals.
• Malabsorption of fat soluble vitamins (vitamins A, D, E, and K)
• Vitamin A deficiency, which causes night blindness
• Vitamin D deficiency, which causes osteoporosis
• Iron deficiency
• Protein-energy malnutrition (may require a second operation to lengthen the common channel)