Gastroplasty procedures, particularly vertical banded gastroplasty

Vertical banded gastroplasty (VBG), the most frequently performed restrictive procedure to control severe obesity, was developed by Mason in 1982. The procedure evolved from experiential trials of earlier concepts and the timely availability of instrumentation to allow stapled vertical partition of the stomach. Success requires precise technical mastery and optimal patient compliance to provide permanent governance of satiety. The objective of weight control - to reverse co-morbidities of obesity, while causing minimal metabolic deficiencies - has been achieved in a wide selection of patients. The super-obese may be a group whose needs fall beyond the control of the VBG. Vertical ringed gastroplasty (VRG) performs similarly to VBG. Other types of gastroplasty have yet to prove reliable over time. Laparoscopic banded gastroplasty is reversible, adjustable and attractive to patients. Laparoscopic VBG must prove equivalent technical precision to that of open procedures before it can be useful. Deterrents to success such as staple-line failure, band erosion, behavioural backsliding, lack of teeth, large pouch syndrome and a super-obese candidate underscore the tenacity of severe obesity, the disease, as an adversary. Control, not cure, is possible. (C) 1999 Lippincott Williams & Wilkins.