Definition & Overview
Gastroplasty is a surgical procedure to limit food intake primarily performed for weight control and weight loss. It is also known as vertical banded gastroplasty or gastric stapling.
This procedure was developed to address morbid obesity, a condition characterised by a body mass index of 35 or more with patients experiencing several serious medical problems as consequences of being overweight. Individuals who are morbidly obese have a high risk of developing diabetes, hypertension, coronary heart disease, liver disease, and a wide array of syndromes and disorders.
Gastroplasty is considered a restrictive procedure since it controls the amount of food the patient can take in. The creation of a stomach pouch also ensures the slow passage of food through the digestive system. Unlike other bariatric surgery techniques, this procedure does not result in nutritional deficiencies since there is no alteration of gastrointestinal tract anatomy and the passage of nutrients is not interrupted. The stomach is left intact and there is lesser occurrence of dumping syndrome, a condition prevalent among gastric surgery patients characterised by rapid bowel movement after meals, abdominal discomfort, and general weakness.
Who Should Undergo and Expected Results
As mentioned above, gastroplasty is offered to patients who are morbidly obese and are in dire need of reducing their weight. The procedure is often considered by individuals who have tried other alternative, non-surgical weight loss therapies but have not gotten any significant and long-term results. Apart from the physiological effects of being overweight, most of these patients are also suffering from the psychological impacts of their condition.
Gastroplasty is performed on patients aged 18 to 65 years old and who are determined to be physically capable to undergo surgery, with the commitment of following a balanced diet plan meant to maximise the benefits of this procedure. Patients who are offered gastroplasty are typically suffering from conditions that contribute to their weight gain, such as an endocrine disorder. Obese patients who are not suitable for other aggressive bariatric procedures, such as gastric bypass, can also benefit from gastroplasty to reduce their weight.
This procedure is not indicated for pregnant women and those with drug or alcohol problems.
After a brief hospital stay, the patient is placed on a very strict diet several weeks after gastroplasty. Patients are urged to follow the prescribed diet to help the stomach adjust to the changes made. Pain medication is also administered to help ease postoperative discomfort. The procedure also requires patients to avoid strenuous physical activities for several weeks and to start on a physical therapy program when able. Weight loss is usually achieved after several months, with many patients reporting up to 50% weight lost. In the majority of cases, there is also marked improvement and even resolution of associated conditions such diabetes and high blood pressure.
How is the Procedure Performed?
The procedure is performed under general anaesthesia and typically requires 3-5 days of hospitalisation for close monitoring. There are generally two types of gastroplasty. The first technique is called the open vertical banded gastroplasty, in which the surgeon makes a large incision in the abdominal area and the upper part of the stomach, just below the oesophagus. Surgical staples are then placed in the direction of the oesophagus to create a small pouch in the upper stomach. The pouch should be small enough to hold about a tablespoon of solid food. A polypropylene band is then fitted and stitched around the outlet of the pouch. The band restricts the food and allows it to stay in the stomach longer leading to the feeling of satiation, which means that the patient does not feel hungry even when eating only a small amount. The incisions are then closed with sutures.
The second type of gastroplasty is called the laparoscopic vertical banded gastroplasty in which the surgeon uses a laparoscope for visualisation. Small incisions are made on the left part of the abdominal to insert the laparoscope and another incision on the right side to insert specialised surgical tools. The stomach then undergoes stapling and banding, similar to the process employed in the first technique.
From the procedure described, surgeons have developed modified techniques for gastroplasty. An example would be the endoscopic sleeve gastroplasty, in which an endoscope with a suturing device is inserted down the patient’s throat to the oesophagus. The device then sutures the stomach to form a tube-shaped structure.
Possible Risks and Complications
Following the procedure, patients face the risk of bleeding, blood clot formation, and infection of the surgical site.
There are also reports of surgical staples coming loose after gastroplasty, which can lead to dehiscence or opening of the stomach walls.
Those who are unable to follow the strict diet prescribed after the procedure may experience nausea and vomiting, which may not resolve on their own and could lead to heartburn.
Nearby body parts such as the spleen and the intestine could also be injured while the stomach is being sutured.
Some patients, for one reason or another, are unable to maintain their weight loss despite undergoing gastroplasty. Recurring weight gain is not unheard of among patients, which can easily lead to worsening health problems and depression.
Buchwald H. Sleeve gastrectomy. In: Buchwald H. Buchwald’s Atlas of Metabolic and Bariatric Surgical Techniques and Procedures. Philadelphia, PA: Elsevier Saunders; 2012:chap 10.
Richards WO. Morbid obesity. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 15. Thompson CC, Morton JM. Surgical and endoscopic treatment of obesity. In: Feldman M, Friedman LS, Brandt LJ. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 8.