Problems with the vertical banded gastroplasty1

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Problems with the vertical banded gastroplasty(1)

• Requires the band around the outlet to work.
  Unbanded, the outlet will stretch, the gastric
  tube becomes funnel shaped and the intake
  restriction is lost.

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Unbanded gastroplasty Distended gastric
pouch
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Problems with the vertical banded gastroplasty(2)

• Band can induce fibrosis and the outlet stenoses
  leading to high pressure in gastric pouch,
  vomiting and eventually staple line disruption
  (90 by 10 years).

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Banded gastroplasty Staple line
disruption Outlet stenosis
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Problems with the vertical banded gastroplasty(3)

• No protection against high calorie liquids e.g.
  liquidised Mars Bars, milkshakes etc

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Roux-en-Y gastric bypass

• Gastric restriction
• Modest degree of
• malabsorption
• Hypoglycaemic dumping
• in response to refined
• carbohydrates

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Roux-en-Y gastric bypass

• Can be performed open or laparoscopically
• No difference in long term outcome.
• Less visible scarring with laparoscopic but
  higher risk of complications such as anastomotic
  leakage and internal hernias

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Laparoscopic Band (1)

• Laparoscopically inserted balloon catheter to
  encircle upper stomach
• Subsequent inflation of balloon in steps to
  create a small gastric pouch with controlled but
  adjustable outlet
• Works by gastric restriction alone