Vertical banded gastroplasty.

VBG and vertical Silastic ring gastroplasty are simple gastric restriction procedures that have defined technical standards. Two recent improvements in the operation have been the development of the six-row endolinear cutting-stapling instrument that divides the vertical partition without an increase in GI leakage and the application of minimally invasive laparoscopic techniques that have reduced the incidence of incisional hernia to less than 1%. VBG and vertical Silastic ring gastroplasty are procedures that can effectively help select patients to manage their morbid obesity. However, these procedures are critically dependent on patient compliance. It is not possible to know preoperatively whether a candidate will make the lifelong behavior modifications necessary for sustained weight loss. Experience has demonstrated that bariatric surgeons have limited control over a patient's level of motivation for compliance.