Gastric Banding

Abstract

The surgical management of morbid obesity now has over five decades of history. In the early 1960s, malabsorption through intestinal bypass was recognized to result in significant weight loss for obese patients. Paired with the restriction of a gastric pouch, the RYGB (Roux-en-Y gastric bypass) grew to become the procedure of choice for surgical weight loss. Malabsorption was the main focus of the first generation of bariatric procedures; however, in 1982 the vertical banded gastroplasty (VBG) was introduced after it became clear that gastric restriction also led to weight loss. Importantly, restrictive operations avoid the sequelae of malabsorption. The surgery was described by Mason in 1982 and modified in the years to follow. First, a 32F tube passed through the mouth defined the width of the gastric pouch. A gastrotomy was made through the anterior and posterior walls of the stomach approximately 2 cm from the gastroesophageal junction (GEJ) with a circular stapler. A linear stapler through this gastrotomy was aimed toward the angle of His and fired to create a small pouch and exclude the fundus. Finally, a band or mesh was fixed at the base of the pouch to restrict its expansion and provide a consistent-sized gastric outlet. While successful in producing weight loss, the VBG was often complicated by staple line dehiscence, migrated bands, or mesh erosion.