How I Do It: a Staged Approach to Reverse Vertical Banded Gastroplasty Utilizing Endoscopy

Excerpt

Vertical banded gastroplasty (VBG) was first proposed in 1982 by Dr. Edward Mason as a weight loss procedure that involved vertically stapling the fundus and banding the outlet with a silicone ring or mesh to create a small pouch along the lesser curvature of the stomach. VBG fell out of favor due to more efficacious procedures and long-term problems such as reflux after pouch dilation, nausea, vomiting, malnutrition, obstruction, band erosion, gastro-gastric fistulas, poor emptying of the pouch, and inadequate weight loss. With 45–50% of patients developing symptoms from this procedure, 21–79% of patients with a gastric band, adjustable or non-adjustable, often undergo revisional surgery.^1,2 Nonadjustable gastric bands (NAGB) causing these complications require the removal of the band and possibly revision of their bariatric operation. Extensive scarring and adhesions surrounding the NAGB, stomach, and left lobe of the liver can make removing these NAGB difficult. This paper aims to share our treatment algorithm (Fig. 1) by successfully removing the non-eroded band and then potentially taking down the gastric septum using a re-operative technique that avoids the area of significant adhesive disease.

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