Stomach Stapling vs. Implantable Gastric Stimulation
Stomach Stapling (Vertical Banded Gastrectomy)
Vertical banded gastrectomy is one of the oldest forms of surgery for weight loss. It is used to limit the amount of food that can be eaten. It does not alter any part of the digestive process, and none of the stomach is removed. During this procedure, the upper part of the stomach near the esophagus is stapled vertically. This creates a small pouch. The rest of the stomach is then banded, leaving a small opening at the bottom of the small pouch, which opens into the larger portion of the stomach. A mesh or plastic tissue is placed around the small opening to prevent stretching. This process is known as a restrictive surgery because it limits the amount of food that can be consumed at one time, which causes patients to feel fuller faster. After surgery, most meals must be limited to approximately one ounce. This surgery does not typically cause malnutrition or dumping syndrome. The entire procedure typically lasts between 3 and 4 hours. Vertical banded gastrectomy surgery is reversible, but the procedure to do so is quite complex.
In general, candidates for this procedure will either have a BMI over 40 or a BMI between 35 and 40 plus weight-related health problems. Women who are 80 pounds over their goal weight and men who are 100 pounds over their goal weight are also good candidates for this surgery.
Average Weight Loss Results
On average, most patients are able to lose approximately 50 to 60 percent of their excess body weight after one year. Weight gain can happen easily if the patient does not adhere to consuming very small portions of food and drinks.
If the surgery is performed laparoscopically, the patient will need to remain in the hospital for 2 or 3 days. If it is performed in an open surgery, then the hospital stay is longer, usually 4 or 5 days. Patients will initially need to follow a liquid diet and gradually move onto thicker liquids and soft foods. After about one month, most patients are able to eat solid foods and return to normal activities.
Common Side Effects
Patients may experience side effects such as reflux, stomal stenosis, incisional hernia, staple-line disruption, intolerance to the band, gastric leak, bleeding, fistulas, pulmonary embolus, and peritonitis. More commonly, side effects such as vomiting can occur if a strict diet is not followed, if food is not chewed properly, or if food is eaten too quickly.
The average cost of this procedure is $20,000 to $25,000. Insurance may cover a portion of the cost.\
Implantable Gastric Stimulation Device
Implantable gastric stimulation is a relatively new way to treat obesity. It does not change a patient’s anatomy or rely on malabsorption issues for weight loss, and it takes less than an hour to complete. It is also reversible. Using a laparoscopic approach, a device that is an electrical pulse generator, similar to a pacemaker, is implanted along the front part of the abdomen. Electrode leads are then placed in the gastric muscular wall. Once the surgery is complete and the patient has recovered, the device will be turned on, and the gastric stimulation will begin. The purpose of the device is to make patients feel fuller faster, which may help with overeating and binge eating. It is believed that when the device stimulates the stomach, a message is sent to the brain telling it that it is full.
The ideal candidate for this procedure has a BMI over 40 or a BMI between 35 and 40 plus serious weight-related health problems.
Average Weight Loss Results
Since this is a relatively new procedure, there is not a large amount of data available regarding weight loss results. In general, it appears that patients typically lose between 5 and 17 percent of excess body weight from implantable gastric stimulation. It has been reported that some patients did not lose any weight and others actually gained weight after this procedure. Approximately 80 percent of patients have reported some weight loss, and 60 percent lost more than 10 percent of their body weight within 2 ½ years. In general, it appears that diet and lifestyle changes are necessary for weight loss to occur.
Most patients are given approximately 4 weeks to recover from the procedure. Once the recovery is complete, the stimulation will begin.
Common Side Effects
Possible side effects from this procedure include abdominal pain, generalized pain, fever, and flatulence. Nausea, constipation, and hypoglycemia may also occur, but they are relatively rare.
The cost of this procedure varies, but it is likely to fall somewhere around $15,000 in the US. Insurance may or may not pay for a portion of this procedure.