The use of staples to section off part of the stomach and create a smaller stomach to facilitate weight loss was born out of the experience of the Russians who developed a number of instruments to staple various parts of the body as a quick method of dealing with casualties during the Second World War.
American surgical instrument manufacturers then adapted and refined the instruments used by the Russians to create many of the surgical stapling instruments that are used today.
One of the earliest forms of stomach stapling was referred to as a horizontal gastroplasty and involved the use of a straight stapler fired horizontally across the top of the stomach.
In this case a number of staples were removed from the instrument before firing to create a gap in the line of staples and thus a small whole between the newly formed small top section of the stomach and the main stomach cavity, which restricted the passage of food through the digestive system.
This unfortunately proved unsuccessful as over time the stomach wall stretched and the small hole quickly became a large hole through which food could pass with ease.
A number of attempts were made to find a way of solving this problem but none were successful until 1982 when Dr Mason, who was then the Professor of Surgery at the University of Iowa, noted that one section of the stomach wall along the line of least curvature was thicker than other parts of the wall and was less likely to stretch.
He therefore created a very small stomach pouch by placing a vertical line of staples along this section of the stomach wall to create a vertical sleeve. He then placed a polypropylene band around the base of the sleeve to provide a permanent and fixed opening (stoma) between the newly created stomach pouch and the remaining bulk of the stomach.
Dr Mason’s vertical banded gastroplasty is still commonly used today, although many surgeons have now replaced the polypropylene band with a silicone ring to control the opening between the stomach sections.
As a purely restrictive form of weight loss surgery it remains popular because it avoids many of the nutritional problems which are so often associated with malabsorption techniques or combined surgery such as the Roux-en-Y gastric bypass which, incidentally, was a procedure also developed by Dr Mason working with a colleague (Dr Ito) in 1967.
Vertical banded gastroplasty is essentially an open form of surgery although a small but growing number of surgeons with experience of minimally invasive surgery are now undertaking this procedure laparoscopically.