Stomach stapling: What does it involve?

Stomach stapling is a surgical procedure that is used if you are severely or morbidly obese and you cannot lose weight using diet and exercise. As the name suggests, stomach stapling literally involves stapling the stomach to create a small pouch that fills much quicker. After the operation, eating even tiny amounts of food makes you feel full, so the amount you eat each day is much less than before surgery and weight loss is rapid.

Stomach stapling is a highly invasive procedure carrying significant risks, including tearing around the staples and the staples giving way, resulting in leakage. What’s more, the pouch that is created cannot by adjusted without further surgery. This is why stomach stapling has been superceded in recent years by the relatively safer and more flexible gastric band, which uses an adjustable, inflatable band that does not penetrate the stomach wall.

This article on stomach stapling is written by Kathryn Senior, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites. 

Why have stomach stapling?

Stomach stapling is often the last resort treatment for severely or morbidly obese people who fail to respond to other weight loss regimes and techniques. Over 80% of people who undergo stomach stapling achieve some degree of weight loss and around 30% achieve a normal, healthy size following the operation. It is usual for around half of the excess weight to be lost in the first two years.

It is important to realise that stomach stapling is not a simple solution. The ultimate success of the operation will depend on how well you are able to stick to the accompanying diet regime. Because you are only able to eat small amounts of food, many patients are tempted by high calorie foods or highly processed foods, which are easier to digest than healthier, high fibre options. Modifying what you eat in this way can result in weight gain; studies show that as few as 10% of people who have stomach stapling maintain their initial weight loss after ten years.

The stomach stapling procedure

Stomach stapling can be done as either an open procedure, involving an incision several inches long, or laparoscopically, involving a series of small incisions. Open stomach stapling takes around two hours, while the more complex laparoscopic stomach stapling can take up to four hours.

During the operation, the surgeon will divide the stomach to create a small pouch, and insert staples along this divide, leaving a small opening for food to pass on into the rest of the stomach and beyond. The stapled part of the stomach is supported by a polypropylene band that is stitched into place.

Life after stomach stapling

You will usually need to stay in hospital for around four or five days following the stomach stapling operation. You will only be allowed to drink clear fluids during this time. You can then move on to pureed food for the next two weeks, before gradually introducing solid foods over the next few months.

After the surgery, you will have to make significant, lifelong changes to your diet, as the pouch will only admit small amounts of well-chewed food. As discussed earlier, it is vitally important that you stick to your new diet regime and avoid the temptation of high fat and high calorie processed foods just because they are give you a ‘quick fix’ in small amounts.

You should be aware that because of the invasive nature of the stomach stapling procedure, reversal is much more complicated than the original operation. As a result, you should look at stomach stapling as a permanent change. Modern gastric banding techniques are much more flexible in this respect, and as many as 25% of patients eventually have their bands removed.

The risks of stomach stapling 

As with any invasive surgery, there are many associated risks, and these risks increase greatly in obese patients, the very people who need the operation. Since the incision is deeper and the stitching is under greater strain in obese patients, the risk of wound infections is also greatly increased, rising from around 2% in normal patients to around 10% in the most obese.

Other risks include incisional hernias, damage to the spleen during the operation, splitting open of the pouch if the staples fail and leakage of stomach acid onto nearby organs. In the long term, around 20% of people who have had their stomach stapled experience digestive problems such as heartburn, nausea and vomiting.

Problems with circulation and blood clots during surgery are much more common if you are very overweight and the chance of dying as a result of the surgery is as high as 5% in the worst cases.

The surgeon carrying out the stomach stapling operation will assess the risk in each case and compare this with the patient’s risk of dying from conditions related to obesity.

Alternatives to stomach stapling 

Stomach stapling is just one of many surgical procedures to help severely or morbidly obese people. In addition to gastric band surgery, other options include gastric by-pass procedures in which food is directed around parts of the digestive tract to avoid the absorption of nutrients and calories. However, these procedures do involve even more complex post-operative diets to avoid the risk of vitamin deficiencies or malnutrition.

Is stomach stapling for you? 

Despite the low long-term success rate and the inherent risks of the procedure, stomach stapling could still be a viable option for you if your excess weight is posing a significant risk to your health. Your GP or consultant will advise you on the options available and help you to weigh the risks and benefits to come to the right decision.

Profile of the author

Dr Kathryn Senior is an acclaimed medical journalist who has written over 500 feature articles for leading international journals within The Lancet group. As Senior Writer at Freelance Copy she produces high quality scientific and medical content for websites and printed publications for companies and organisations in the health, medical and pharmaceutical sectors.

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