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Vertical Banded Gastroplasty

AMBULATORY CARE:

Vertical banded gastroplasty (VBG),

or stomach stapling, is surgery to make your stomach smaller. This surgery is done to help with weight loss.

Digestive Tract

What you need to know before you have VBG:

  • You will work closely with a dietitian before and after surgery. Your dietitian will talk to you about nutrition and what you should eat and drink before and after surgery. You may need to follow a very low-calorie diet for several weeks before surgery. This will help you lose some weight before surgery. Weight loss will help your liver handle anesthesia better. It will also help you create healthy nutrition and activity habits.
  • Your surgeon will talk to you about self-care and follow-up activities you will need after surgery. You will need to come in often to have your progress checked. Your band may need to be tightened or loosened during each visit.
  • If you are a woman of childbearing age, your surgeon will talk to you about pregnancy. He or she may recommend that you do not get pregnant for 12 to 18 months after surgery. Then your pregnancy will be monitored for your safety and the safety of your baby. Your provider will tell you how much weight is safe for you to gain. He or she will help you create healthy meal plans so you get the right nutrition without gaining too much weight. If you want to prevent pregnancy, healthcare providers will help you choose the right kind of birth control. You may not be able to use birth control pills because you will not be able to absorb them fully after surgery.

How to prepare for surgery:

  • Your surgeon will talk to you about how to prepare for surgery. He or she may tell you not to eat or drink anything after midnight on the day of your surgery. Arrange to have someone drive you home after surgery and stay with you.
  • Tell your surgeon about all medicines you currently take. He or she will tell you if you need to stop any medicine for surgery, and when to stop. He or she will tell you which medicines to take or not take on the day of your surgery.
  • Tell your surgeon about all your allergies, including to anesthesia or antibiotics. You may be given an antibiotic to help prevent a bacterial infection.
  • You may need a fasting blood test to check your lipid (fat) levels, or other blood tests. Your heart may be checked to make sure it is healthy enough for surgery. You may also need tests to check your digestive system.
  • If you have diabetes, healthcare providers will help you schedule meals and medicines before surgery. Your A1c level may also be checked.
  • If you currently use tobacco products, you will need to quit before you have surgery. It is best to quit at least 1 year before surgery. You must quit at least 6 weeks before surgery. Talk to your surgeon or other healthcare providers if you need help quitting.

What will happen during surgery:

  • You will be given general anesthesia to keep you asleep and free from pain during surgery. Your surgeon will make small incisions in your abdomen. A scope and other medical tools will be put through the incisions.
  • Your surgeon will use a soft band and staples to make a small stomach pouch. The band is located at the lower part of the pouch and creates a small opening. The opening will allow food to pass into the rest of the stomach.
  • Your surgeon will close your incisions with stitches or staples.

What to expect after surgery:

  • You will be helped to walk around after surgery to help prevent blood clots.
  • Medicines may be given to prevent or treat pain, nausea, or a bacterial infection.
  • You will sip water or chew on ice chips after surgery when your healthcare provider says it is okay. The next step is to drink clear liquids. Examples of clear liquids are broth, gelatin, and clear juice. You may only be able to eat a few teaspoons of food at the beginning. Stop eating when you feel full, even if you have food left on your plate.

Risks of VBG surgery:

You may bleed more than expected or get an infection. Your esophagus or other organs may be damaged during surgery. You may develop a life-threatening blood clot. The gastric band may break, cause a scar, or erode the stomach tissue. The internal staples could break down. Stomach liquid may leak into your abdomen. You may develop gallstones. You may lose weight and then gain it back.

Call your local emergency number (911 in the US) if:

  • You feel lightheaded or short of breath, or you have chest pain.
  • You cough up blood.

Seek care immediately if:

  • Your arm or leg feels warm, tender, and painful. It may look swollen and red.
  • You have a fast heartbeat that will not slow down.
  • Your incision area is red, swollen, or draining pus.
  • You cannot stop vomiting.

Call your doctor or surgeon if:

  • You have a fever or chills.
  • You have nausea or are vomiting.
  • You have pain or pressure in your abdomen or back.
  • You have pain in your abdomen or on the right side of your body under your ribs.
  • You have acid reflux or any burning in your stomach, esophagus, or throat.
  • You have hiccups and you feel restless.
  • You have questions or concerns about your condition or care.

Medicines:

You may need any of the following:

  • Medicine may be given to lower the amount of stomach acid, or to relieve heartburn.
  • Nausea medicine may be needed to help decrease nausea and prevent vomiting.
  • A multivitamin may be recommended by your healthcare provider or dietitian. This will help replace vitamins and minerals you may lose from eating less food.
  • Acetaminophen decreases pain and fever. It is available without a doctor's order. Ask how much to take and how often to take it. Follow directions. Read the labels of all other medicines you are using to see if they also contain acetaminophen, or ask your doctor or pharmacist. Acetaminophen can cause liver damage if not taken correctly. Do not use more than 4 grams (4,000 milligrams) total of acetaminophen in one day.
  • Prescription pain medicine may be given. Ask your healthcare provider how to take this medicine safely. Some prescription pain medicines contain acetaminophen. Do not take other medicines that contain acetaminophen without talking to your healthcare provider. Too much acetaminophen may cause liver damage. Prescription pain medicine may cause constipation. Ask your healthcare provider how to prevent or treat constipation.
  • Blood thinners help prevent blood clots. Clots can cause strokes, heart attacks, and death. The following are general safety guidelines to follow while you are taking a blood thinner:
    • Watch for bleeding and bruising while you take blood thinners. Watch for bleeding from your gums or nose. Watch for blood in your urine and bowel movements. Use a soft washcloth on your skin, and a soft toothbrush to brush your teeth. This can keep your skin and gums from bleeding. If you shave, use an electric shaver. Do not play contact sports.
    • Tell your dentist and other healthcare providers that you take a blood thinner. Wear a bracelet or necklace that says you take this medicine.
    • Do not start or stop any other medicines unless your healthcare provider tells you to. Many medicines cannot be used with blood thinners.
    • Take your blood thinner exactly as prescribed by your healthcare provider. Do not skip does or take less than prescribed. Tell your provider right away if you forget to take your blood thinner, or if you take too much.
    • Warfarin is a blood thinner that you may need to take. The following are things you should be aware of if you take warfarin:
      • Foods and medicines can affect the amount of warfarin in your blood. Do not make major changes to your diet while you take warfarin. Warfarin works best when you eat about the same amount of vitamin K every day. Vitamin K is found in green leafy vegetables and certain other foods. Ask for more information about what to eat when you are taking warfarin.
      • You will need to see your healthcare provider for follow-up visits when you are on warfarin. You will need regular blood tests. These tests are used to decide how much medicine you need.
  • Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Make changes to your eating habits:

You may need to puree your food in a blender or food processor at first. You may feel full after only a few teaspoons of food. In time, your stomach pouch will expand a little bit. Then you should be able to eat about ½ to ¾ cup of food during each meal. You should also be able to eat regular foods. The following will help prevent nausea, heartburn, and a stomach ache:

  • Prevent dumping syndrome. Dumping syndrome happens when high-sugar or high-fat foods and drinks go into your intestine too quickly after a meal. Dumping syndrome may also occur if you drink liquids during a meal. Dumping syndrome may cause you to sweat, or feel faint, weak, and dizzy. You may have stomach cramps, an upset stomach, and diarrhea.
  • Eat slowly. Chew your food well before you swallow. Large bits of food may cause choking or may block your stomach. You may vomit or have abdominal pain or heartburn if you eat too quickly. You may also develop a stomach ulcer. Food that is not chewed well enough may get stuck in the opening between the small and large stomach pouches.
  • Eat 3 small meals each day. Do not eat snacks between meals unless your healthcare provider says it is okay. Stop eating when you feel full, even if you have not eaten all of your meal.
  • Drink liquids between meals. Wait at least 1 to 2 hours after you eat to drink liquids. Good liquids include water, tea, diet drinks, or skim milk.
  • Eat a variety of healthy foods. You may have trouble eating foods, such as red meat, bread, or rice after surgery. Start with softer meats, such as fish and chicken. Make sure you eat enough protein. Foods higher in protein include poultry, fish, eggs, nuts, and beans. Dairy products, such as yogurt and cottage cheese, are also good sources of protein. A dietitian will work with you to find the right foods to eat.

Self-care:

  • Care for your wound as directed. When you are allowed to bathe, carefully wash the wound with soap and water. Dry the area and put on new, clean bandages as directed. Change your bandages when they get wet or dirty. If you have small pieces of medical tape on your incision, they will start to peel and fall of on their own.
  • Be active as directed. Your healthcare provider will tell you when it is okay to start being active after surgery. Then aim to get at least 150 minutes of physical activity each week. This is 30 minutes of activity on most days. You can break the 30 minutes into shorter periods throughout the day. Ask your healthcare provider about the best exercise plan for you.
    Walking for Exercise
  • Go to therapy. Therapy may include working with a counselor to understand your reasons for overeating. You may want to join a support group to talk with others who have had vertical banded gastroplasty surgery.

Follow up with your doctor or surgeon as directed:

You will need to return to have your incision area checked. Your weight loss and health will be checked regularly over time. Your healthcare provider may need to adjust your band depending on how you are doing. He or she may also check your vitamin levels. You may need to take more of certain vitamin supplements, such as vitamin A. Write down your questions so you remember to ask them during your visits.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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