Vertical Banded Gastroplasty ("Stomach Stapling") - All You Need to Know

Vertical Banded Gastroplasty, more commonly known as stomach stapling, has been almost entirely replaced by newer and more effective procedures. However, it may be an option for some patients in certain circumstances.

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Is Vertical Banded Gastroplasty Right for You?
Top 3 Resons to Consider VBG
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Is Vertical Banded Gastroplasty Right for You?: Top 3 Resons to Consider VBG

As we’ll discuss further in the next section, it is likely that other types of bariatric surgery will result in a lower risk of complications and more weight loss than vertical banded gastroplasty. However, for some VBG may prove to be the best option for a few reasons…

  1. You may not be able to consider other procedures due to medical problems. For example, vertical banded gastroplasty is effective and safe for patients who have hyperphagia but do not respond well to adjustable gastric banding (lap band surgery) (1).
  2. Certain eating habits may cause your surgeon to recommend VBG over another procedure.
  3. It may cost less than other procedures due to no band adjustments during follow-up visits (compared with lap band surgery) and lower material costs used in performing the procedure (2). 

Vs. Other Types of Weight Loss Surgery
Less Weight Loss, Longer Hospital Stay, More Complications, Restrictive Diet
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Vs. Other Types of Weight Loss Surgery: Less Weight Loss, Longer Hospital Stay, More Complications, Restrictive Diet

While vertical banded gastroplasty has been proven effective, depending on your situation it may not your best bariatric surgery option for a number of reasons, including…

  • Lower excess weight lost over the long term
  • Longer length of stay in the hospital
  • Higher complication rates
  • More restricted diet following recovery (so compliance rates are lower)

Vertical Banded Gastroplasty does have a low mortality rate, has a similar impact on obesity health problems as other surgeries and has similar short-term complication rates. Its weight loss results are also more consistent than lap band surgery, and unlike the gastric bypass and duodenal switch procedures, it does not rearrange the digestive system. The VBG also does not require an inserted device like gastric balloon, vBloc Therapy, and AspireAssist.

Following are studies that directly compared VBG to other types of surgery (click here to skip past the chart)… 

Summary of Study Findings When Comparing Vertical Banded Gastroplasty (VBG) to Other Procedures
Summary of Study Findings When Comparing Vertical Banded Gastroplasty (VBG) to Other Procedures
The patient’s eating habits before surgery play an important role in the choice of the operative technique used. The two operative techniques had the same efficacy in weight reduction. Data were available 2 years after surgery for 101 of the 110 patients (91%). Most comorbid conditions resolved by 1 year after surgery regardless of the type of operation used.
The patient’s eating habits before surgery play an important role in the choice of the operative technique used. The two operative techniques had the same efficacy in weight reduction. Data were available 2 years after surgery for 101 of the 110 patients (91%). Most comorbid conditions resolved by 1 year after surgery regardless of the type of operation used.
Gastric bypass was a time-consuming demanding technique with a higher early complication rate compared with VBG. Although both operations resulted in significant weight reduction and decrease in obesity-related co-morbidities, gastric bypass had a trend of greater weight loss and significantly better gastro-intestinal quality of life index (GIQLI) than VBG at the cost of a significant long-term trace element deficiency state. Each patient should be individualized for the operations according to the patient’s decision.
Gastric bypass was a time-consuming demanding technique with a higher early complication rate compared with VBG. Although both operations resulted in significant weight reduction and decrease in obesity-related co-morbidities, gastric bypass had a trend of greater weight loss and significantly better gastro-intestinal quality of life index (GIQLI) than VBG at the cost of a significant long-term trace element deficiency state. Each patient should be individualized for the operations according to the patient’s decision.
Preoperative eating habits may play a role in choosing the most appropriate bariatric operation for each patient. Although gastric bypass is associated with better mean weight loss outcomes, the percentage of patients who achieved and maintained ≥50% excess weight loss after VBG in this pre-selected patient population was not significantly different. Each type of operation has advantages and disadvantages, and, if properly chosen, a purely restrictive procedure can be successful for some patients. Therefore, it can be said that the decision regarding which bariatric procedure to perform in non-superobese patients must be based on in-depth preoperative evaluation as well as the patients’ own preferences and outcome expectations.
Preoperative eating habits may play a role in choosing the most appropriate bariatric operation for each patient. Although gastric bypass is associated with better mean weight loss outcomes, the percentage of patients who achieved and maintained ≥50% excess weight loss after VBG in this pre-selected patient population was not significantly different. Each type of operation has advantages and disadvantages, and, if properly chosen, a purely restrictive procedure can be successful for some patients. Therefore, it can be said that the decision regarding which bariatric procedure to perform in non-superobese patients must be based on in-depth preoperative evaluation as well as the patients’ own preferences and outcome expectations.
This study demonstrates that in a carefully selected group of patients, VBG is significantly more effective than lap band surgery in terms of late complications, late reoperations, and long-term results on weight loss.
This study demonstrates that in a carefully selected group of patients, VBG is significantly more effective than lap band surgery in terms of late complications, late reoperations, and long-term results on weight loss.
  • Resolution of co-morbidities
    • VBG: 80%
    • Lap Band: 80%
  • Excess weight lost after 12 months
    • VBG: 58%
    • Lap Band: 42%
  • Excess weight lost after a mean of 92 months
    • VBG: 59%
    • Lap Band: 62%
  • Reintervention Rate
    • VBG: 49%
    • Lap Band: 8.6%
  • Reoperation Rate
    • VBG: 39.9%
    • Lap Band: 7.5%
  • Resolution of co-morbidities
    • VBG: 80%
    • Lap Band: 80%
  • Excess weight lost after 12 months
    • VBG: 58%
    • Lap Band: 42%
  • Excess weight lost after a mean of 92 months
    • VBG: 59%
    • Lap Band: 62%
  • Reintervention Rate
    • VBG: 49%
    • Lap Band: 8.6%
  • Reoperation Rate
    • VBG: 39.9%
    • Lap Band: 7.5%
At 1 year after surgery, the costs and Quality of Life of the two treatment modalities were found to be equal. Therefore, the selection of the procedure can be based on the clinical aspects, effectivity and safety at 1 year.
At 1 year after surgery, the costs and Quality of Life of the two treatment modalities were found to be equal. Therefore, the selection of the procedure can be based on the clinical aspects, effectivity and safety at 1 year.
Despite the initial better weight loss in the VBG group, based on complication rates and clinical outcome, lap band surgery is preferred. It had a shorter hospital length of stay and less postoperative morbidity (bariatric surgery complications).G
Despite the initial better weight loss in the VBG group, based on complication rates and clinical outcome, lap band surgery is preferred. It had a shorter hospital length of stay and less postoperative morbidity (bariatric surgery complications).G
Percent excess weight loss at 5 years for VBG patients was 56.4% and for duodenal switch patients 70.6%. 9.4% of VBG patients and 2% of duodenal switch patients required re-operation due to failure of the technique. None of the VBG patients could eat a normal diet, while 80% of the duodenal switch had no restriction in the quality of their intake. At 60 months follow-up, only the duodenal switch patients fulfilled the American Society of Metabolic and Bariatric Surgery requirements of % of excess weight lost >50 in over 75% of the patients.
Percent excess weight loss at 5 years for VBG patients was 56.4% and for duodenal switch patients 70.6%. 9.4% of VBG patients and 2% of duodenal switch patients required re-operation due to failure of the technique. None of the VBG patients could eat a normal diet, while 80% of the duodenal switch had no restriction in the quality of their intake. At 60 months follow-up, only the duodenal switch patients fulfilled the American Society of Metabolic and Bariatric Surgery requirements of % of excess weight lost >50 in over 75% of the patients.
Summary of Study Findings When Comparing Vertical Banded Gastroplasty (VBG) to Other Procedures
Year of Study
The patient’s eating habits before surgery play an important role in the choice of the operative technique used. The two operative techniques had the same efficacy in weight reduction. Data were available 2 years after surgery for 101 of the 110 patients (91%). Most comorbid conditions resolved by 1 year after surgery regardless of the type of operation used.
2007
Gastric bypass was a time-consuming demanding technique with a higher early complication rate compared with VBG. Although both operations resulted in significant weight reduction and decrease in obesity-related co-morbidities, gastric bypass had a trend of greater weight loss and significantly better gastro-intestinal quality of life index (GIQLI) than VBG at the cost of a significant long-term trace element deficiency state. Each patient should be individualized for the operations according to the patient’s decision.
2007
Preoperative eating habits may play a role in choosing the most appropriate bariatric operation for each patient. Although gastric bypass is associated with better mean weight loss outcomes, the percentage of patients who achieved and maintained ≥50% excess weight loss after VBG in this pre-selected patient population was not significantly different. Each type of operation has advantages and disadvantages, and, if properly chosen, a purely restrictive procedure can be successful for some patients. Therefore, it can be said that the decision regarding which bariatric procedure to perform in non-superobese patients must be based on in-depth preoperative evaluation as well as the patients’ own preferences and outcome expectations.
2006
This study demonstrates that in a carefully selected group of patients, VBG is significantly more effective than lap band surgery in terms of late complications, late reoperations, and long-term results on weight loss.
2009
  • Resolution of co-morbidities
    • VBG: 80%
    • Lap Band: 80%
  • Excess weight lost after 12 months
    • VBG: 58%
    • Lap Band: 42%
  • Excess weight lost after a mean of 92 months
    • VBG: 59%
    • Lap Band: 62%
  • Reintervention Rate
    • VBG: 49%
    • Lap Band: 8.6%
  • Reoperation Rate
    • VBG: 39.9%
    • Lap Band: 7.5%
2007
At 1 year after surgery, the costs and Quality of Life of the two treatment modalities were found to be equal. Therefore, the selection of the procedure can be based on the clinical aspects, effectivity and safety at 1 year.
2006
Despite the initial better weight loss in the VBG group, based on complication rates and clinical outcome, lap band surgery is preferred. It had a shorter hospital length of stay and less postoperative morbidity (bariatric surgery complications).G
2005
Percent excess weight loss at 5 years for VBG patients was 56.4% and for duodenal switch patients 70.6%. 9.4% of VBG patients and 2% of duodenal switch patients required re-operation due to failure of the technique. None of the VBG patients could eat a normal diet, while 80% of the duodenal switch had no restriction in the quality of their intake. At 60 months follow-up, only the duodenal switch patients fulfilled the American Society of Metabolic and Bariatric Surgery requirements of % of excess weight lost >50 in over 75% of the patients.
2005

Continue reading below to learn more. For further direct comparison of VBG to other procedures, see our Types of Bariatric Surgery page.

Weight Loss
Half to Two-Thirds of Excess Weight
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Weight Loss: Half to Two-Thirds of Excess Weight

While several studies comparing vertical banded gastroplasty to other procedures suggest that others are more effective, many independent studies have shown VBG to be a good option regarding weight loss and improvement of obesity health issues

Study Topic
Study Topic
VBG: A multicenter prospective study of 200 procedures.I
VBG: A multicenter prospective study of 200 procedures.I
VBG: 6 Years Experience at a Center in Poland.J
VBG: 6 Years Experience at a Center in Poland.J
Study Topic
Summary of Findings
VBG: A multicenter prospective study of 200 procedures.I
Laparoscopic vertical banded gastroplasty is an effective procedure for the surgical management of morbid obesity, especially for patients who present hyperphagia but are unable to manage the constraints of lap band surgery. Laparoscopic vertical banded gastroplasty is safe, as demonstrated by an acceptable bariatric surgery complication rate, of which gastric outlet stenosis, staple line leakage, and gastroesophageal reflux predominate.
VBG: 6 Years Experience at a Center in Poland.J
VBG provided significant weight reduction and improved quality of life in the vast majority of morbidly obese patients. Patients with diabetes and hypertension benefited because these co-morbidities were improved or disappeared with the weight loss.
Study Topic
Year
VBG: A multicenter prospective study of 200 procedures.I
2007
VBG: 6 Years Experience at a Center in Poland.J
2007

However, you will find that VBG results in less excess weight loss than many other bariatric procedures.

The following studies show the percent of short-term excess weight lost to be around 56% and long-term excess weight loss to be between 53% and 68%…

Studies
Studies
Study K
Study K
Study L
Study L
Study M
Study M
Study N
Study N
Studies
# of VBG patients in study
Study K
200
Study L
80
Study M
85
Study N
749
Studies
Weight Loss (% of Excess Weight Lost at…)
Study K
1 year – 56.7%
2 years – 68.3%
3 years – 65.1%
Study L
1 year – 55.4%
2 years – 53.1%
Study M
5 years – 56.4%
Study N
68.2% average (studies ranged from 61.5% – 74.8%)
Studies
Year
Study K
2007
Study L
2007
Study M
2005
Study N
2004

Downsides
Risk of Complications & Side Effects
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Downsides: Risk of Complications & Side Effects

While VBG has a low mortality rate, complications tend to be higher than with other procedures. Early complications occur in up to 5% of patients and late complications are seen in as many as 21%. 

The most common complications include the following (3) (4) (see our Bariatric Surgery Complications page for definitions and treatments of each)…

However, one 5 year study showed that complications classified as “major” only occurred in 1.14% of patients.

Here are the high level statistics from four separate studies (click here to skip past the chart)…

Studies
Studies
Study O
Study O
Study P
Study P
Study Q
Study Q
Study R
Study R
Studies
# of patients in study
Study O
80
Study P
101
Study Q
200
Study R
612
Studies
Mortality/Complication Rate
Study O
Mortality – 0%
Early complication rate – 2.5%
Late complication rate – 5%
Study P
Mortality – 0%
Early complication rate – 4.65%
Late complication rate – 20.9%
Study Q
Mortality – 0.5%
Complication – 24%
Study R
Mortality – 0.16%
Major complications – 1.14%
Minor complications – 4.58%
Studies
Year
Study O
2007
Study P
2007
Study Q
2007
Study R
2005

Complications are often the result of patients not following their doctors’ advice or not thoroughly educating themselves about the pre- and post-bariatric surgery requirements.

Our Bariatric Surgery Complications page covers much of what you need to know to improve your chances for a successful outcome.

When deciding whether the risks of complications and mortality are “worth it”, it is a good idea to evaluate the risks associated with not having surgery. See our Life After Weight Loss Surgery, Obesity Health Problems and Cause and Effect of Obesity pages for more on this.

Procedure
Size of Stomach Reduced by Stapling Portion Closed
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Procedure: Size of Stomach Reduced by Stapling Portion Closed

At around 3 1/2 hours, VBG typically has a longer operation time than other procedures, but your number of days in the hospital can be shorter than the more complicated duodenal switch or laparoscopic gastric bypass surgery. Two to three days in the hospital for laparoscopic vertical banded gastroplasty surgery and 4 to 5 days for open surgery is a good estimate.

The procedure is performed by creating a “hole” in the upper-middle part of the stomach and stapling from the hole to the top of the stomach so no food can pass through. The surgeon then places a band around the opening between the hole and the side of the stomach.

Take a look at the following two videos for a better understanding (first a computer animation, then a video of the actual procedure being performed)…

Computer Animation of Vertical Banded Gastroplasty

(click here to skip past video of actual surgery)

Video of Actual VBG Procedure Being Performed

Recovery
2+ Weeks back to Work, 3 – 5 Weeks for Full Recovery
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Recovery: 2+ Weeks back to Work, 3 – 5 Weeks for Full Recovery

As with all other types of bariatric surgery, it will take some time to get back to normal following surgery. Ideally you should give yourself 3 to 5 weeks recovery time, but plan on not returning to work for at least 2 weeks after surgery.

Before you leave the hospital, your doctor will check for leaks in the staple line. If all is well, you’ll start a liquid diet. If leaks are found (which is relatively common), you’ll be fed through an IV until the leaks have been repaired.

Our Life After Weight Loss Surgery page will tell you all you need to know about recovering as quickly as possible while minimizing your risk of complications.

Diet & Life After
Restricated Diet, Vitamin Regine, Regular Exercise
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Diet & Life After: Restricated Diet, Vitamin Regine, Regular Exercise

As with all types of bariatric surgery, your life will be dramatically changed forever following surgery.

Some of your obesity health problems will slowly fade away while others may be gone immediately. The weight will come off fast in the first year and slowly start to level off in years 2 and 3. As is the case with all procedures, after reaching the low point it is common for patients to experience at least some weight gain after bariatric surgery.

Your bariatric diet will be completely different after surgery. The more you adhere to your dietitian’s eating plan, the better off you’ll be in terms of weight loss and long-term complications.

Your diet will also dictate your bowel movements. If you eat something that your new, smaller stomach doesn’t agree with, you may get constipated. Eating too quickly or not chewing your food well enough could cause food to back up in the esophagus, which can be very uncomfortable.

Chewing food thoroughly, eating slowly, eating specific measured amounts, drinking enough water and taking the right bariatric vitamins will usually keep you in good shape.

See our Bariatric Diet section for more about your eating habits following surgery and how to stay on track.  See our Bariatric Eating page to learn about proper eating techniques (how you eat vs what you eat) that will help you avoid problems.

Our Life After Weight Loss Surgery page gets into the rest of the changes patients experience after vertical banded gastroplasty surgery.

Cost
$15,000 – $25,000 Before Insurance, Financing & Discounts
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Cost: $15,000 – $25,000 Before Insurance, Financing & Discounts

VBG surgery costs can range anywhere from $15,000 to $25,000 (about $5k less than gastric banding on average) or more assuming there are no complications. As with all types of bariatric surgery, actual costs are specific to each surgeon. 

See one of the following pages for more information…

Help & Support
Patient Experiences, Ask the Expert

Help & Support*

Ask the Expert & Patient Experiences*

We would love to hear your experiences with the VBG procedure. Your insights are invaluable to making sure other people have the tools to meet their goals.

We would also be happy to answer any questions you may have about the VBG procedure.

Please use the form below to share your experience or ask a question.

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Questions From Other Visitors*

Click below to see contributions from other visitors to this page…

Curing Side Effects 27 Years After Vertical Banded Gastroplasty (VBG)*

I am a 60 year old female, 27 years post vertical banded gastroplasty. I regained my weight many years ago and my BMI is now 40. I've had acid reflux…


X-Ray Shows Free-Floating Staples in Abdomen 27 Years After Bariatric Surgery*

I had VBG (Vertical Banded Gastroplasty) 27 years ago, and a recent x-ray showed free floating staples in my abdomen. My doctor does not seem concerned. Should I be?


Bariatric Doctors Specializing in Vertical Banded Gastroplasty

Our Bariatric Doctors page will provide you with all of the information you need to find a good surgeon. Since other bariatric surgery procedures are recommended more often over vertical banded gastroplasty, we recommend not working with a surgeon if they are only familiar with VBG.

There are a couple of reasons that you would choose VBG over gastric banding, but many of these reasons are very specific and relatively uncommon. If you are curious about VBG, find a bariatric surgeon who also has experience with other procedures. They can walk you through advantages and disadvantages specific to your situation.

In addition to the methods we recommend on our Bariatric Doctors page, you can also search for surgeons in your area using our directory of bariatric surgeons (includes all surgeons designated as Centers of Excellence as well as recommedations from other visitors):

Ask A Top Bariatric Surgeon About Vertical Banded Gastroplasty (VBG)

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References

  1. Nocca D, et al. Laparoscopic vertical banded gastroplasty : A multicenter prospective study of 200 procedures. Surg Endoscopy 2007, vol. 21, no.6, pp. 870-874.
  2. Ojo P, Valin E. Cost-Effective Restrictive Bariatric Surgery: Laparoscopic Vertical Banded Gastroplasty Versus Laparoscopic Adjustable Gastric Band. Obesity Surgery Volume 19, Number 11 / November, 2009 pgs 1536-1541.
  3. Pasnik K, Krupa J, Stanowski E. Vertical Banded Gastroplasty: 6 Years Experience at a Center in Poland. Obesity Surgery Volume 15, Number 2 / February, 2005 pgs 223-7.

[ Last editorial review/modification of this page : 12/31/2016]

* Disclaimer: The information contained in this website is provided for general information purposes and your specific results may vary depending on a variety of circumstances. It is not intended as nor should be relied upon as medical advice. Rather, it is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician(s). Before you use any of the information provided in the site, you should seek the advice of a qualified medical, dietary, fitness or other appropriate professional. Read More