Bariatric surgery is associated with a significant reduction of weight and associated comorbid conditions resulting in improved quality and prolongation of life. Even though the mortality and morbidity associated with bariatric operations has decreased over time, more complex bariatric operations are associated with increased incidence of complications compared to simpler operations. Therefore, surgical innovators have been in constant search of operations that will improve the health and well-being of the patients without an increase in surgery related complications. In the post jejunoileal bypass era, various forms of gastroplasties and gastric bypasses were designed. One such operation was called the vertical banded gastroplasty (VBG) and was described by Mason in 1982 [1]. In this operation, a vertical pouch was created along the lesser curvature of the stomach using a non-cutting stapler. This resulted in a stomach that was partitioned without actually dividing it and had a capacity of 50 ml. No bowel was bypassed and the stomach was not transected. Thus, it was thought to be a simpler bariatric operation that was also fast and technically easier to perform and with fewer associated operative complications than the Roux-en-Y gastric bypass (RYGB). Postoperative malabsorption, dumping, and marginal ulceration were also avoided.

The original procedure consisted of creating a non-transected 50 ml pouch around a 32 French Ewald tube. A band of Marlex mesh was also placed around the pouch outlet with the hope of providing long-lasting weight loss from a fixed stoma. At the time, one of the prevailing beliefs regarding weight regain after gastroplasty or RYGB was stoma dilation, and the hope was that the Marlex mesh would not allow the gastric outlet in a VBG to dilate with time. However, the Mason VBG had an undivided stomach, which was prone to staple line breakdown resulting in a gastro-gastric fistula and weight regain. It was also performed by laparotomy with the associated wound-related complications such as ventral hernia. In 1993, MacLean et al. [2] described division of the stomach to overcome the problem of staple line breakdown and in 1994 Hess et al. [3] reported a laparoscopic approach. With the advent of the laparoscopic adjustable gastric band (LAGB), the frequency of this once very popular purely restrictive procedure declined considerably and currently very few VBGs are performed.

However, in a relatively recent study, Scozzari et al. [4] reported favorable results of the laparoscopic MacLean type VBG and found that the excess weight loss (EWL) percentages at 3, 5, and 10 years were 65.0 %, 59.9 %, and 59.8 %, respectively. The resolution and/or improvement rate for comorbidities were 47.5 % for hypertension, 55.6 % for diabetes, 75 % for sleep apnea, and 47.4 % for arthritis. Mean Moorehead-Ardelt Quality of Life Questionnaire and BAROS values were 1.4 and 3.8, respectively. Intraoperative complication rate and conversion rate were each 0.9 %. Early postoperative complication rate was 4.2 % and early reoperation rate was 0.5 %. They had no mortality. Late complications occurred in 14.7 % of patients, and 10.0 % of the patients underwent revisional surgery. Most reoperations were for weight regain, though other causes included severe dysphagia , outlet stricture unresponsive to endoscopic dilation, severe reflux, and gastro-gastric fistula. The rate of revision surgery increased during the follow-up period to 10 % at 10 years. Of note, their patients were highly selected as sweet-eaters and patients with a hiatal hernia over 3 cm were excluded [4].

Bekheit et al. [5] have also reported excellent weight loss results in a cohort of 150 patients with a mean preoperative BMI of 47 ± 8.4 kg/m², as 60 % of patients achieved >50 % EWL with a low rate of revision to other operations (<5 %). Their late complications such as staple line dehiscence , stomal stenosis , and mesh erosion rates were also low. However, other authors have described significantly lower weight loss after VBG compared to RYGB.

In a prospective randomized trial comparing VBG to RYGB, Sugerman et al. [6] enrolled 20 patients in each treatment arm and found that at 3 years post surgery, VBG patients had 37 ± 20 % EWL compared to 64 ± 19 % EWL for patients who had RYGB. The difference was even greater for sweet eaters who underwent a VBG compared to those who underwent a RYGB. The study was closed at 9 months because weight loss strongly favored the RYGB.

In another study by Marsk et al. [7], 21 % of patients who underwent VBG required reoperation. Reasons included: staple line disruption, vomiting or food intolerance , inadequate weight loss, band erosion , and an enlarged opening. They also described early complications including leak , bleeding , and pulmonary embolism , but VBG operations are rarely practiced these days and therefore most surgeons are unlikely to encounter these early postoperative complications. Nonetheless, because of the popularity of the VBG in the 1980s and 1990s, there are many surviving patients with a previous VBG and surgeons will still encounter patients suffering from one or more of the long-term complications. Several other authors have reported poor weight loss and high long-term complication rates after VBG [8, 9].