Gastroplasty (Stomach Stapling)

Gastroplasty (Stomach Stapling) for Surgical Weight Loss

The science of "stapling" surgeries originated in World War II. To provide a rapid method of dealing with injuries sustained on the battlefield, the Russians developed surgical instruments which could staple body tissue together. Later, these instruments were refined into what's used today.

Gastroplasty, or "stomach stapling," represented the next wave of weight loss surgery in the early 1980s. Surgeons could now reduce the volume of the stomach without removing any portion of it. Instead, a staple line would hold the stomach tissue together to create a new wall. Three staples would be removed from the center of the line, however, to allow for a narrow passageway into the lower stomach. The pouch fills quickly and empties slowly with solid food, producing a feeling of fullness. Overeating results in pain or vomiting.

As a result, patients became full after eating only small amounts of food, due to the reduced stomach size and slower passage of food through the new, narrow stomach outlet, or stoma as a result of stomach stapling surgery. Those who had early gastroplasty-called horizontal gastroplasty-lost weight over the first few months, but at a certain point, doctors observed that they stopped losing weight or even regained weight. Doctors quickly determined that the stoma was stretching out over time in many patients.

To address this problem, Dr. Edward Mason at the University of Iowa developed a modification known as vertical banded gastroplasy (VBG) and published the first results in 1982. Mason decided to make the stapling line vertical instead of horizontal to capitalize on the thickest areas of the stomach wall-those least likely to stretch. In addition, he imposed strict measurements for the stomach pouch and placed a polypropylene band around the stoma to reinforce it. As a result, the rate of stoma enlargement decreased.

Compared to its predecessor, the VBG produced better results and fewer complications. Within a matter of time, it became the preferred method of gastroplasty. Because there is no malabsorptive component, patients do not generally encounter serious metabolic side effects or nutritional deficiencies. Weight loss-which can exceed 50% of excess body weight-occurs solely due to the restriction of food intake.

Unfortunately, despite the many improvements over the years, VBG still comes with a risk of weight regain as a late complication. Staple line disruption and shifting of the band can allow the stoma to expand years after surgery. Although not nearly as popular as it once was, the VBG remains in use today.

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