Surgical Science, 2011, 2, 242-245 doi:10.4236/ss.2011.25053 Published Online July 2011 (http://www.SciRP.org/journal/ss) Copyright © 2011 SciRes. SS Gastric Bezoar after Vertical Banded Gastroplasty: A Case Report and Review of the Literature Abdul S. Bangura, Stelin Johnson, Karen E. Gibbs Division of Minimally Invasive and Bariatric Surgery, Staten Island University Hospital, Staten Island, New York, USA E-mail: kgibbs@siuh.edu Received February 18, 2011; revised April 25, 2011; accepted May 27, 2011 Abstract Gastric bezoars are uncommon in the bariatric surgery population. Though popular in earlier decades, the Vertical Banded Gastroplasty (VBG) is no longer a staple procedure in the United States. It has been sup- planted by the Roux-en-Y gastric bypass (RYGBP) and the laparoscopic adjustable gastric band (LAGB) as the most commonly performed bariatric procedures. However, there are many patients who have previously undergone VBGs, and may present with associated complications. We present a case of a gastric obstruction caused by a bezoar in a patient who had a VBG fifteen years prior to presentation. Keywords: Vertical Banded Gastroplasty, Bariatric Surgery, Bezoar, Obstruction 1. Introduction The VBG pioneered by Mason at the University of Iowa, in the 1970’s was one of the most performed bariatric operations in the 1980’s and early 1990’s [1]. It is a purely restrictive procedure. Currently, it is less com- monly performed in the United States as more effective procedures have replaced it. Even so, the present day bariatric surgeon must be aware of the VBG procedure and the potential complications. The VBG features a pouch based on the lesser curvature of the stomach and a polypropelene mesh or silastic ring around the outlet of the pouch. The combination of a small pouch and its outlet restricted by the band leads to weight loss. How- ever, this restriction may theoretically put the patient at increased risk of bezoar formation and resultant pouch outlet obstruction. Nonetheless, gastric bezoar following VGB is very uncommon, with few reported cases in the literature [3,4]. We present the diagnostic workup and management of a patient who developed a gastric bezoar fifteen years after a VBG. 2. Case Report A 59-year-old female with a history of morbid obesity (315 lbs, BMI 49.3) hypertension and diabetes mellitus, underwent an open VBG in 1995. She reported a total weight loss of approximately 100 lbs after the procedure, but had regained some weight over the years. At the time of presentation she weighed 225 lbs (BMI 35.2). She presented with a five day history of epigastric pain and intermittent, post prandial nausea and vomiting. Physical exam was significant for mild epigastric tenderness, with normal vital signs. Laboratory studies were normal on presentation. An abdominal CT scan suggested a partial gastric outlet obstruction with dilatation of the distal esophagus and proximal stomach with collapse of the distal segment (Figure 1). Endoscopic evaluation dem- onstrated a narrow gastric outlet with mild gastritis and an impacted phytobezoar (Figure 2). The bezoar was successfully removed with a basket. The patient had an uneventful post-procedure course and was subsequently discharged with resolution of her acute symptoms. Of note, the patient did report a history of difficulty with certain foods which, over time, she had learned to avoid. Figure 1. CT showing filling defect at level of pouch outlet.