Morbid obesity: use of vertical banded gastroplasty

Vertical banded gastroplasty has evolved from gastric bypass and earlier forms of gastroplasty as a safe and effective gastric reduction procedure for the treatment of morbid obesity. This article provides a step-by-step description of the technique. Spatial orientation by use of landmarks such as an Ewald tube in the esophagus, the angle of His, and a Penrose drain around the esophagus is important in avoiding injury to adjacent structures. Careful measurement of the pouch volume at a pressure of 70 cm H2O is necessary. For patients between 170 and 225 per cent of ideal weight, a 5.0 cm circumference collar is used around the outlet. For heavier patients, a 4.5 cm collar is used. Bypass is not necessary because weight control depends on a small pouch and stoma.