Gastroplasty procedures, particularly vertical banded gastroplasty

Vertical banded gastroplasty (VBG), the most frequently performed restricti ve procedure to control severe obesity, was developed by Mason in 1982. The procedure evolved from experiential trials of earlier concepts and the tim ely 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 we ight 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 ty pes of gastroplasty have yet to prove reliable over time. Laparoscopic band ed gastroplasty is reversible, adjustable and attractive to patients. Lapar oscopic VBG must prove equivalent technical precision to that of open proce dures before it can be useful. Deterrents to success such as staple-line fa ilure, band erosion, behavioural backsliding, lack of teeth, large pouch sy ndrome and a super-obese candidate underscore the tenacity of severe obesit y, the disease, as an adversary. Control, not cure, is possible. (C) 1999 L ippincott Williams & Wilkins.