Background
Vertical banded gastroplasty (VBG) was the restrictive procedure of choice for many years. However, VBG has been associated with a high rate of long-term failure. We reviewed our experience of conversion of failed VBG to Roux-en-Y gastric bypass (RYGBP).
Methods
The data on all patients undergoing conversion of failed VBG to RYGBP were reviewed. Failed VBG was defined as insufficient weight loss (BMI > 35 kg/m2) and/or VBG-related complications.
Results
We performed 24 conversions from VBG to RYGBP. Median age was 40 ± 8 years (range 28 to 61). Preoperative weight was 111 ± 25 kg (range 85 to 181), and median BMI was 41 ± 8 kg/m2 (range 30 to 69 kg/m2). Indication for conversion was: VBG failure in 18 patients and VBG complications in 6 patients. A gastrectomy (total or proximal) had to be performed in 5 cases (21%). The conversion was performed by laparoscopy in 13 cases. Postoperative complications occurred in 4 patients (16.7%). There were no leaks, nor mortality. Postoperative BMI was 31 kg/m2 (range 25 to 42) at a median follow-up of 12 months (range 3 to 36 months). The average percentage of excess weight loss was 62% at 1 year.
Conclusion
VBG has been associated with a significant reoperation rate for failure and/or complications. Conversion to RYGBP is effective in terms of weight loss and treatment of complications after VBG. Gastrectomy and resection of the staple-line could reduce such complications as leaks and mucocele. Although technically challenging, conversion of VBG to RYGBP is feasible, with acceptable morbidity and no mortality. The conversion is feasible laparoscopically.
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References
Miller K, Pump A, Hell E. Vertical banded gastroplasty versus adjustable gastric banding: prospective long-term follow-up study. Surg Obes Relat Dis 2007; 3: 84–90
van Gemert WG, van Wersch MM, Greve JW et al. Revisional surgery after failed vertical banded gastroplasty: restoration of vertical banded gastroplasty or conversion to gastric bypass. Obes Surg 1998; 8:21–8.
Balsiger BM, Poggio JL, Mai J et al. Ten and more years after vertical banded gastroplasty as primary operation for morbid obesity. J Gastrointest Surg 2000; 4: 598–605.
Mognol P, Chosidow D, Marmuse JP. Laparoscopic conversion of laparoscopic gastric banding to Rouxen-Y gastric bypass: a review of 70 patients. Obes Surg 2004; 14: 1349–53.
Wylezol M, Pardela M. Results of revisional operation following vertical banded gastroplasty performed due to morbid obesity- comparison between restoration of vertical banded gastroplasty and conversion of gastric bypass up to three years. J Physiol Pharmacol 2005; 56 (Suppl 6): 135–44.
Sanchez-Pernaute A, Perez-Aguirre E, Talavera P et al. Mucocele of the gastric tube after conversion of vertical banded gastroplasty to duodenal switch: not just a radiological image. Obes Surg 2006; 16: 524–7.
Kalfarentzos F, Skroubis G, Kehagias I et al. A prospective comparison of vertical banded gastroplasty and Roux-en-Y gastric bypass in a non-superobese population. Obes Surg 2006; 16: 151–8.
Fernandez AZ Jr, Demaria EJ, Tichansky DS et al. Multivariate analysis of risk factors for death following gastric bypass for treatment of morbid obesity. Ann Surg 2004; 239: 698–702; discussion 702–3.
Gonzalez R, Gallagher SF, Haines K et al. Operative technique for converting a failed vertical banded gastroplasty to Roux-en-Y gastric bypass. J Am Coll Surg 2005; 201: 366–74.
Balsiger BM, Murr MM, Mai J et al. Gastroesophageal reflux after intact vertical banded gastroplasty: correction by conversion to Roux-en-Y gastric bypass. J Gastrointest Surg 2000; 4: 276–81.
Sugerman HJ, Kellum JM Jr, DeMaria EJ et al. Conversion of failed or complicated vertical banded gastroplasty to gastric bypass in morbid obesity. Am J Surg 1996; 171: 263–9.
Jones KB Jr. Revisional bariatric surgery-safe and effective. Obes Surg 2001; 11: 183–9.
Ortega J, Sala C, Flor B et al. Vertical banded gastroplasty converted to Roux-en-Y gastric bypass: little impact on nutritional status after 5-year follow-up. Obes Surg 2004; 14: 638–43.
Cordera F, Mai JL, Thompson GB et al. Unsatisfactory weight loss after vertical banded gastroplasty: is conversion to Roux-en-Y gastric bypass successful? Surgery 2004; 136: 731–7.
Westling A, Ohrvall M, Gustavsson S. Roux-en-Y gastric bypass after previous unsuccessful gastric restrictive surgery. J Gastrointest Surg 2002; 6: 206–11.
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Mognol, P., Chosidow, D. & Marmuse, J.P. Roux-en-Y Gastric Bypass after Failed Vertical Banded Gastroplasty. OBES SURG 17, 1431–1434 (2007). https://doi.org/10.1007/s11695-008-9419-9
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DOI: https://doi.org/10.1007/s11695-008-9419-9