Restricting Your Food Intake – Vertical Banded Gastroplasty, Gastric Sleeve and the Toga System

Appetizing dietetic salad of  aubergine

Restrictive methods focus on preventing your stomach from receiving food. A common restrictive method is laparoscopic adjustable banding (LAGB). Yet, while LAGB is popular, it is not the only form of bariatric surgery that works on this premise. Throughout the history of weight loss surgery, several types of restrictive surgery have been employed. Among the better known of these forms of surgical weight loss are: vertical banded gastroplasty (VBG), sleeve gastrectomy (SG), and the transoral bariatric surgical procedure – commonly referred to as TOGA.

Vertical Banded Gastroplasty

VBG consists of the creation of a pouch on the curvature of the stomach. A ring is used to define the selected outlet area of the pouch. As is the case with many forms of bariatric surgery, it becomes safer when the laparoscopic technique is applied in preference to the open method.

Advantages of the VBG method include:

  • Low mortality rate
  • Absence of micronutrient deficiencies
  • Lower risk of infectious complications
  • Completely reversible
  • The anatomy is not affected

Disadvantages of this method of bariatric surgery consist of the following:

  • Unable to eat a normal diet
  • Need to chew your food completely and carefully
  • Must avoid sweets
  • Slower and less overal weight loss than surgeries such as RYGB

Overall, the VGB method is effective for reducing morbid obesity. Exccess weight loss following surgery stood at approximately 50%. A decrease in weight loss was discovered during the 3 to 5 years following surgery. Weight loss than declined to 20%. It is this that has affected the usage. This is likely due to patients learning to “beat the surgery” by eating smaller, more frequent meals or drinking a large amount of calories. Better results are currently achieved with RYGBP and BPDDS ( upt to 70% loss of excess weight).

Once among the most popular bariatric surgical options VBG is being performed with less frequency. Research has provided evidence of weight regain and worsening of severe heartburn. VBG has actually been banned from usage in some countries.

Laparoscopic Sleeve Gastrectomy (LSG)

LSG is a form of restrictive surgery based on biliopancreatic diversion with duodenal switch (BPDDS)1. A variation is vertical sleeve gastrectomy (VSG). Both require the removal of a substantial section of the stomach and the creation of a new route for the entry and exit of food and other forms of nourishment. The reshaped stomach resembles a long, tube.

It does, however, have several advantages over its initial source. Advantages of LSG are numerous. They include:

  • Safe even for older patients
  • Can be an outpatient procedure
  • Requires only an overnight and up to 23 hour stay following the operation2
  • Less complicated than laparoscopic roux-en-y gastric bypass (LRYGB)
  • Fewer risks than LRYGB

Disadvantages consist of the following:

  • Require nutritional supplements
  • Post operative care can be demanding
  • Hypoalbuminemia

Overall LSG proves to be equal to LRYGB for weight reduction and more successful than LAGB.

Transoral Bariatric Surgical Procedure (TOGA)

TOGA is one of the newest forms of bariatric surgery. It is still in the clinical trials stage. A flexible device called an endoscope (a camera) is inserted into the mouth. It then descends into the stomach where the bariatric surgeon uses it to suction in the walls of the proximal stomach before stapling them. The result is a small pouch or tube of approximately 4-inches.

The surgeon slides the flexible stapler into the stomach. The next step is to insert an endoscope. An endoscope is a device with a flexible camera that can be placed into the stomach where the camera then broadcasts to a room television screen. The walls of the stomach are suctioned into the stapler so that a 4 inch tube or pouch is formed.

The result of the surgery is twofold. The food ingested will pass slowly through the pouch into the remainder of the stomach and onwards into and out of the rest of the digestive system. The individual feels full only after ingesting a small amount of food.

To date, clinical studies are being performed on the method. There are several different types of TOGA currently being explored. They include:

  • Using the endoscopic method to place a sleeve (endobarrier) in the intestines
  • Primary Obesity Surgery Endoscopically or POSE

As we have already noted, each system of weight reductive surgery has both advantages and disadvantages. The advantages of TOGA are:

  • It is an efficient way of reducing individuals with morbid obesity
  • The method reduces the amount of incisions to zero – further even than those for laparoscopic surgery
  • Minimal risk due to no incisions
  • Minimal recovery time as a result of no incisions
  • Measurements of quality of life(QOL) are excellent according to the studies3

Disadvantages or risks of the new system include:

  • The staple line can fail and come apart similar to problems facing those of VBG surgery
  • Pain
  • Gastric ulcer
  • Diarrhea
  • Nausea

Unlike other systems, however, TOGA seems to lead to resolution over time. To date, the results of the initial clinical trials and research indicate that TOGA is a promising alternative to the current restrictive and malabsorptive methods of bariatric surgery.


Restrictive surgery is one means through which obese individuals can regain control of their lives. If you are extremely overweight or obese, you may qualify for bariatric surgery. Talk to your medical professional about whether restrictive surgery is the right approach to take to combat your weight issue. If this is the right path to take, make sure you thoroughly research and understand the possible options. The more you know, the easier it will be for you to resolve upon the bariatric surgery best suited for your needs.


1 Gluck, B; Movitz, (Gluck, Movitz and Gluck) B; Jansma, S; Gluck, J; and Laskowski, K  (2011) Laparoscopic Sleeve Gastrectomy is a Safe and Effective Bariatric Procedure for the Lower BMI(35.0–43.0 kg/m2) Population. Obesity Surgery 21 (8): 1168-1171.

2 Sasse, K (2009). Outpatient Weight-Loss Surgery.Reno,Nevada: 360 Publishing. (Sasse)

3 Devière, J; Ojeda Valdes, G; Herrera, CL; Closset, J; and Le Moine, O, et al. (2008). Safety, Feasibility and Weight Loss after Transoral Gastroplasty: First Human Multicenter Study. Surgical Endoscopy 22 (3): 589-598.


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