S4117 Complications of Vertical Banded Gastroplasty: A Case Highlighting Late Sequelae

Introduction: Vertical banded gastroplasty (VBG) is a restrictive bariatric procedure that creates a small proximal gastric pouch using a vertical staple line across the lesser curvature of the stomach and a nonadjustable silastic band at the outlet. Although VBG was once a common weight loss surgery, it has fallen out of favor due to high rates of complications, including mechanical obstruction, ulcers, weight regain, and intractable symptoms. We present a case illustrating the long-term, potentially life-threatening complications of VBG nearly 3 decades after the initial surgery. Case Description: A 67-year-old woman with a history of VBG in 1998 presented with 5 days of nausea, vomiting, and progression to hematemesis. On arrival, she was tachycardic (heart rate 100 bpm) and hypotensive (blood pressure 103/56). Laboratory findings were significant for anemia (Hgb 7.8 g/dL), elevated blood urea nitrogen (31 mg/dL), and serum creatinine (1.4 mg/dL). She was treated with intravenous pantoprazole and underwent esophagogastroduodenoscopy, which revealed VBG anatomy with severe ulceration and active bleeding in the gastric pouch, stenosis at the silastic band site, and a gastro-gastro fistula. Hemostasis was achieved with epinephrine injection and hemostatic powder. Surgical consultation was obtained, but the patient experienced recurrent bleeding requiring additional endoscopic interventions and eventual partial gastrectomy with band removal and gastro-gastrostomy. Her post-operative course was further complicated by gastroparesis, managed conservatively, with eventual recovery and discharge. Discussion: Although VBG has fallen out of favor in bariatric surgery, patients with prior procedures may continue to present with late complications, including gastrointestinal bleeding, fistula formation, obstruction, and ulceration. Our case is notable for the delayed presentation of VBG-associated pathology over 25 years post-procedure, requiring multi-modal management including advanced endoscopic therapy and foregut surgery. Gastroenterologists should remain vigilant of this bariatric procedure and the associated anatomic alterations, as they may present with complex, high-risk pathology requiring prompt recognition and coordinated care. Awareness of such complications is critical in emergency and outpatient settings, particularly with an aging population of patients with historic bariatric surgeries.