Analysis of Vertical Gastric Reconstruction: Operation and Efficacy Evaluation of Gastric Reconstruction for Weight Loss

Gastroplasty

Mason first used vertical banded gastroplasia (VGB) in 1980 to treat morbidly obese patients. VGB involves suturing the stomach vertically along the lesser curvature to create a narrow, elongated pouch with a capacity of approximately 15 ml, thus restricting food intake and achieving weight loss. This surgery preserves the continuity of the stomach and duodenum, avoiding potential micronutrient deficiencies. Gastroplasty is currently a popular weight-loss surgery abroad.

1. Surgical Procedure: A midline incision is made in the upper abdomen. An Ewald gastric tube is prepared preoperatively and placed along the lesser curvature. A Penrose drainage tube is placed in the lower esophagus, close to the cardia. The hepatogastric ligament is first separated. Using a left finger, the gastric neurovascular bundle is dissected from the stomach wall within the omental bursa. The Penrose drainage tube is then placed around the esophagus and stomach wall tissues, protecting blood vessels and the vagus nerve. At the location adjacent to the Ewald tube, 9 cm from the cardia and 3 cm from the lesser curvature of the stomach, a circular window is formed by penetrating the anterior and posterior walls of the stomach using a 25-gauge end-to-end stapler. The window edge is reinforced with absorbable sutures. Using a TA90 linear stapler, four rows of staples are placed parallel to the lesser curvature of the stomach from the fundus to the body, creating a narrow, elongated gastric pouch with a capacity of 9–25 ml on the lesser curvature side. The volume of the gastric pouch is measured by injecting fluid through the Ewald tube. To limit secondary dilation of the gastric pouch outlet caused by repeated food passage postoperatively, a 7 cm long and 1.5 cm wide polypropylene strip (or silicone strip) is wrapped around the lower outlet of the gastric pouch, with the ends of the strip overlapping and sutured to form a 4.5–5.0 cm circumference ring. Before closing the abdomen, normal saline is instilled into the abdominal cavity, and air is blown into the gastric pouch through the Ewald tube to check for leakage. A polypropylene ring band was applied using the greater omentum. The abdomen was sutured in layers.

Postoperatively, a liquid diet was started, followed by a semi-liquid diet with mineral and vitamin supplementation after 12 weeks. Food intake was controlled at 5 meals per day, approximately 50g per meal, with a protein-rich diet to maintain the reduced weight long-term.

2. Surgical Outcomes: Weight gradually decreased within 12 months postoperatively, stabilizing after 2-3 years. Typically, only about 38% of patients maintained their weight loss after 3 years. However, more than half of the patients experienced weight regain, mainly due to failure to control their intake of high-calorie soft foods and beverages postoperatively. These patients could also achieve good weight loss if they underwent gastric bypass surgery.

Many morbidly obese patients achieved good, lasting weight loss within 3 years after vertical gastrectomy, while also reducing or alleviating complications of morbid obesity, such as diabetes, impaired glucose tolerance, hypertension, left ventricular dysfunction, and hyperlipidemia. This surgery has positive significance in the treatment of morbid obesity and is currently a popular weight-loss surgery.

3. Complications Common short-term complications of vertical gastrectomy include vomiting due to rapid eating. More serious complications include anastomotic leakage and peritonitis, with an incidence of approximately 0.8%. The mortality rate is around 0.3%. Other complications include deep vein thrombosis (0.35%), pulmonary embolism (0.03%), subdiaphragmatic abscess (0.05%), and wound infection (5%). Severe complications are mainly common in older patients and morbidly obese patients with male-pattern fat distribution. Long-term complications include micronutrient deficiencies (such as iron, zinc, vitamin B₁₂, folic acid, etc.), but these are not common.