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What is Gastric Restrictive Surgery?

Gastric restrictive surgery is a type of bariatric surgery (weight-loss surgery) performed for the treatment of extreme or morbid obesity and involves surgical modification of the stomach to reduce its size, create early satiety, and limit food intake.

With gastric restrictive procedures, the normal digestive process is kept intact without bypassing any of the gastrointestinal tract. These procedures are of 2 types:

  • In the first type, the stomach is divided into 2 portions, one of which is a small pouch that can hold only about 1 ounce.
  • In the second type, about 80 percent of the stomach is removed with the remaining stomach being much smaller.

As the size of the stomach is decreased drastically, these operations are called “restrictive” procedures.

The 2 types of common gastric restrictive surgeries performed for obesity include laparoscopic adjustable gastric banding (LAGB) and vertical sleeve gastrectomy (VSG). Both procedures serve only to limit the food intake. They do not alter the usual process of digestion as in gastric bypass surgery.

Indications for Gastric Restrictive Surgery

Gastric restrictive surgery is indicated for extremely obese patients who have not been successful in losing weight through conservative measures such as dieting, exercise, and medication.

Obesity is a chronic condition in which there is an excessive accumulation of fat in the body. Obesity is defined as a Body Mass Index (BMI) of 30 to 34.9 and extreme or morbid obesity is a BMI of 40 or more. Obesity is a global problem affecting people of almost all age groups and is associated with increased risk of cardiac problems, diabetes, high blood pressure, breathing difficulties, and other diseases.

Potential candidates for gastric restrictive surgery include:

  • A body mass index (BMI) of 40 (or)
  • A BMI of 30 with one or more obesity-associated complications

Preparation for Gastric Restrictive Surgery

In general, pre-procedure preparation for gastric restrictive surgery may involve the following steps:

  • A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications or supplements that you are taking or any medical conditions you have such as lung or heart disease.
  • You may need to refrain from certain medications such as blood thinners or anti-inflammatories for a week or two prior to the procedure.
  • Refrain from smoking or alcohol for at least a couple of weeks before surgery and several weeks after surgery.
  • You should not consume any solids or liquids at least 8 hours prior to the procedure.
  • You should arrange for someone to drive you home after the surgery.
  • A signed informed consent will be obtained from you after the procedure has been explained in detail.

Procedure for Gastric Restrictive Surgery

The two most commonly employed gastric restrictive surgeries include:

Laparoscopic adjustable gastric banding (LAGB)

Laparoscopic adjustable gastric banding, commonly referred to as Lap-Band surgery, is performed laparoscopically under general anesthesia. Your surgeon makes a few small incisions in the abdominal wall and inserts a laparoscope, a lighted fiber-optic tube with a camera attached to its end, into one incision. Small surgical instruments are inserted through the other incisions. Your surgeon is able to see the internal structures of the abdomen on a monitor with images sent from the camera. A band is placed around the upper part of the stomach to divide it into two sections: a smaller, upper pouch and a larger, lower pouch. The band is then secured and fastened with sutures. The band is inflated with sterile saline until it attains the correct pressure in the stomach. In order to adjust the band, an access port connected to the band is placed under the skin of the abdomen. This enables your surgeon to loosen (deflate) or tighten (inflate) the band by injecting or aspirating saline solution as needed. Finally, the incisions are closed.

Vertical sleeve gastrectomy (VSG)

Vertical sleeve gastrectomy procedure is performed under general anesthesia. The surgeon makes 2 to 5 small incisions on your abdomen.  A laparoscope, a thin instrument with a light and camera attached, is inserted through one incision, allowing your surgeon to clearly view the internal organs on a monitor. Additional surgical instruments are inserted through the other incisions. Your surgeon will remove about 80% of the stomach. A thin sleeve shaped like a banana is created by stapling the remaining part of the stomach. At the end of the procedure, the scope and the surgical instruments are withdrawn, and the incisions are closed with sutures and bandaged. The entire procedure takes about 60 to 90 minutes to complete.

Postoperative Care and Recovery

After the surgery, you are required to stay in the hospital for about 2 to 3 days. You will be given pain medications to keep you comfortable and antacids to reduce the amount of acid produced by your stomach. Your nurse will help you to move at the earliest after the surgery to prevent blood clots, respiratory problems, and bedsores. To check if the lap band is in appropriate position, an X-ray of your stomach may be advised a day after the surgery. You will be kept on a liquid diet for the first 2 weeks. Your surgeon or dietician will give you a specific diet plan and instructions to follow after the surgery. It is important to drink plenty of fluids throughout the day to avoid dehydration. Refrain from smoking and alcohol for a specific period of time as it can hinder the healing process. Refrain from strenuous activities and lifting anything heavier than 5 pounds for a defined period. Refrain from driving until you are fully fit and receive your doctor’s consent. A follow-up appointment will be scheduled to monitor your progress.

Risks and Complications of Gastric Restrictive Surgery

Gastric restrictive surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:

  • Internal bleeding 
  • Infection
  • Nausea and vomiting
  • Band slippage or deflation
  • Esophageal dilation
  • Erosion of the stomach
  • Obstruction of the stomach
  • Blood clots
  • Leakage of gastric content
  • The need for repeat surgery (rarely)

Related Topics

American College of Surgeons American Society for Metabolic and Bariatric Surgery Society of American Gastrointestinal and Endoscopic Surgeons