Failed Vertical Banded Gastroplasty Research Articles

Laparoscopic mini-gastric bypass versus laparoscopic Roux-en-Y gastric bypass in redosurgery after failed vertical banded gastroplasty with long gastric pouch

Background Up to 50% of patients who undergo vertical band gastroplasty (VBG) experienced weight regain or complications, like band erosion or slippage, within 5–10 years of the procedure, the aim of the study to evaluate laparoscopic mini-gastric bypass versus laparoscopic Roux-en-Y gastric bypass as a redosurgery after failed VBG. Patients and methods We analyzed the data of 102 patients (38 males and 64 females) underwent revisional surgery after failed VBGs from July 2021 to August 2022, with mean age 45.92 years, follow up for 1 year in Ain Shams University Hospitals. Results The mean hospital stay was 1.8 days (1–4 days), 2.9 days (2–7 days) in Redo laparoscopic mini gastric bypass (R-LMNGB) and Redo laparoscopic roux en Y gastric bypass (R-LRYGB) respectively. Postoperative BMI after 1 year 31.16±27.83 and 31.94±3.69 in R-LMNGB and R-LRYGB, respectively, %EWL show significant difference between two groups after 3 months and 1 year. Postoperative complications rates were 3.92% in R-LRYGB. Conclusions R-LMNGB after failed VBG has almost the same results of R-LRYGB as regard weight loss, improvement of obesity-related comorbidities with less operative time, hospital stay, less anastomosis, and complications.

Short-Term (30-Day) Morbidity of Biliopancreatic Diversion Compared to Roux-en-Y Gastric Bypass as Revisional Procedures for Failed Vertical Banded Gastroplasty.

Silastic ring vertical gastroplasty (SRVG) and vertical banded gastroplasty (VBG) are associated with a high failure rate due to weight regain and complications at long-term follow-up. Consequently, surgical correction for such procedures is warranted. Controversy exists as to which surgical procedure is the ideal choice for such correction. Our aim is to compare short-term outcome of Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) repair for failed VBG/SRVG bariatric procedures. The medical records of patients with failed SRVG who underwent corrective procedures at our institute between 2004 and 2018 were retrospectively reviewed. Patients characteristics, surgical approaches, and intraoperative and post-operative complications were examined and compared. Sixty patients in total underwent a surgical corrective procedure for failed SRVG. Thirty-one patients underwent RYGB, and 29 patients underwent BPD. Major complications were seen more in the RYGB group (35% = 11) compared to the BPD (6.9% = 2). Even though anastomotic leak rates were not statistically significant (p = 0.053), an apparent tendency for such a complication was noted in the RYGB group. RYGB procedure had an increased 30-day complication rate (p = 0.055) compared to RYGB. Laparoscopic approach had statistically fewer complications than open approach. No mortality was observed in either group. Our study showed that BPD is a safe option with less complication rates than RYGB in the short-term period for surgical correction of failed VBG/SRVG procedures.

Laparoscopic Roux-en-Y Gastric Bypass After Failed Vertical Banded Gastroplasty: 2-Year Follow-up of 102 Patients

Vertical banded gastroplasty (VBG) is now discarded from being a restrictive procedure for morbid obesity due to its many drawbacks, doubtful efficacy, and lots of post-operative complications. Roux-en-Y gastric bypass (RYGB) is the most commonly performed procedure for VBG revision. So we aimed at reporting our experience in conversional RYGB for a failed VBG. Analyzing follow-up records of 102 patients who underwent revisional RYGB after failed VBG in the period from April 2014 to January 2018. A total of 102 laparoscopic revisions of failed VBGs to RYGB were performed. The mean operating time was 161.9 min ±29.2 and the mean length of the hospital stay was 1.5 days ±1.2. Fourteen patients (13%) developed early post-operative complications (gastrojejunostomy leak 5; bleeding 9). Four patients (4.7%) developed late complications (Port site hernia 2; internal hernia 1; Stomal ulcer 1). The mean BMI pre-RYGB was 46.6 ± 5.9 kg/m2, and the mean %EBWL (percent excess body weight lost) of the patients at 12 and 24 months post-revision were 56.2% and 64.3%, respectively. Our patients had immediate post-revision resolution of VBG-related complications like dysphagia and vomiting. We also report improvement in all obesity-related health problems with (75.7%) complete remission rate and (24.3%) partial remission or improvement rate of diabetes mellitus. Conversion of VBG to RYGB is a feasible procedure and is associated with acceptable early morbidity rates and reduced lengths of hospitalization also it provides acceptable weight loss and improvement in obesity-related health problems. Graphical Abstract.

Twelve-Year Experience with Roux-en-Y Gastric Bypass as a Conversional Procedure for Vertical Banded Gastroplasty: Are We on the Right Track?

Vertical banded gastroplasty (VBG) has high rates of long-term complications. Conversion to Roux-en-Y gastric bypass (RYGB) is considered optimal; however, there are limited data on the late results of these conversions. We aimed to analyze our single-center long-term outcomes of patients requiring conversional RYGB for a failed VBG. The records of patients who underwent RYGB as a conversional procedure after VBG from November 2004 to December 2016 were reviewed. Follow-up data were obtained by direct telephone calls with patients, electronic files, and general practitioner reports. Characteristics, indications of conversion, long-term (> 30days) morbidities, weight records, obesity-related comorbidities, and overall patient satisfaction were analyzed. Overall, 305 VBG patients (82% female) underwent conversional RYGB during the study period. The mean pre-RYGB body mass index (BMI) was 35.6 (23-66)kg/m2. Conversions were indicated in 61% of patients because of simultaneous VBG complications and weight regain. After a median follow-up of 74.3 (5-151)months, 225 (73.8%) patients agreed to participate. The mean BMI and percentage of total weight loss (%TWL) were 28.6 (18-45)kg/m2 and 17.4%, respectively. Nearly all conversion indications were addressed effectively. Surgical reintervention was mandatory in 28 of 225 patients (12.4%) due to complications. Approximately 85% of patients reported complete remission of obesity-related comorbidities, and four-fifths were fully satisfied. RYGB resolves VBG complications, improves quality of life, and results in prolonged stable weight loss. It has a key role in the management of obesity-related comorbidities and in expert hands is the preferred conversional procedure for patients with failed VBG.

Laparoscopic Roux-en-Y Gastric Bypass for Failed Vertical Banded Gastroplasty

BackgroundAlthough the vertical banded gastroplasty (VBG) is effective in achieving weight loss without metabolic side effects during the first few years, late failures cause weight regain in about 20% of the patients. The laparoscopic Roux-en-Y gastric bypass (LRYGB) is the procedure of choice to convert a failed VBG.Materials and MethodsBetween August 2014 and June 2016, 37 patients (23 females and 14 males) underwent revisional LRYGBs after failed VBGs. Thirty-four patients had open VBGs and two patients had laparoscopic butterfly gastroplasties. These patients completed follow-ups of at least 1 year.ResultsThe median operating time was 164 min (range 132–246), and the mean length of the hospital stay was 2.4 days (range 2–7). The mean body mass index (BMI) of the study group was 42.5 kg/m2, while the mean BMI and the percentage of excess body weight loss (%EBWL) for the patients 6 months after the operation were 31.7 kg/m2 and 52.1%, respectively. The mean BMI and %EBWL for the patients 1 year after the operation were 29.5 kg/m2 and 67.7%, respectively. There were neither intraoperative complications nor postoperative mortalities, but the overall complication rate was 22% (eight patients).ConclusionAn LRYGB following a VBG is technically challenging, but safe, with low morbidity and mortality rates. Moreover, a revisional LRYGB provides excellent weight loss results.

Laparoscopic Conversion of Vertical Banded Gastroplasty into Roux-en-Y Gastric Bypass.

Laparoscopic conversion of vertical banded gastroplasty (VBG) into Roux-en-Y gastric bypass is a technically demanding procedure. This article demonstrates the feasibility of conversion of failed VBG to Roux-en-Y gastric bypass (RYGBP).We have a series of 15 patients who underwent conversion from VBG to RYGBP, and the results were satisfactory regarding the percent excess weight loss and the resolution of the comorbidities, without a significant increase in the complications. In patients with a difficult anatomy below the cardia, dividing the esophagus just above the esophagogastric junction and performing an esophagojejunostomy may be a safe alternative to converting to a Scopinaro-BPD. Laparoscopic conversion of failed VBG to RYGBP is safe and feasible.

A172 - Management Techniques for Failed Vertical Banded Gastroplasty.

A172 - Management Techniques for Failed Vertical Banded Gastroplasty.

Laparoscopic conversion of failed vertical banded gastroplasty to Roux-en-Y gastric bypass or biliopancreatic diversion

BackgroundThe Silastic ring vertical gastroplasty (SRVG), a modification of Mason’s vertical banded gastroplasty (VBG), was the restrictive procedure of choice for many bariatric surgeons. The reoperation rate for failure/complications reported in long-term studies is approximately 50%. ObjectiveWe report our experience in laparoscopic conversion of failed SRVG to Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD). SettingA single surgeon’s experience at a university-affiliated hospital. MethodsBetween March 2006 and April 2014, 39 patients underwent conversion of SRVG to laparoscopic RYGB (n = 25) or BPD (n = 14). The outcomes were retrieved from a prospectively collected database and analyzed. ResultsMost (89%) of the conversions were completed laparoscopically. The mean operative time was 195 and 200 min for RYGB and BPD, respectively. There was no mortality. Complications occurred in 11 patients (28%), 5 in RYGB (19%) and 6 in BPD (42%). At the 3-year follow-up, the mean body mass index decreased from 47±8 kg/m2 to 26±4 kg/m2 for BPD, and from 43 kg/m2 to 34 kg/m2 (P = .05) for RYGB. Weight (kg) decreased from 110 to 84 and to 92, and from 123 to 81 and 68, at 1 and 3 years for RYGB and BPD, respectively. ConclusionsThe weight loss for RYGB and BPD was equal at 1 year but tended to be better for BPD at 3 years postoperatively. Laparoscopic conversion of failed VBG to RYGB or BPD was feasible, but it was followed by prohibitively high complication rates in BPD patients. The risk:benefit ratio of these procedures in this series is questionable.

Laparoscopic Conversion of Failed Silastic Ring Vertical Gastroplasty (SRVG) and Vertical Banded Gastroplasty (VBG) Into Biliopancreatic Diversion (BPD)

BackgroundThe Silastic ring vertical gastroplasty (SRVG), a newer modification of Mason’s vertical banded gastroplasty (VBG), was the restrictive procedure of choice for many bariatric surgeons before the advent of the laparoscopic adjustable gastric banding. However, a high rate of reoperations for failure and severe complications was reported in long-term studies. Around 50 % of the patients underwent conversion to other bariatric procedures. ObjectivesThe aim of this study is to report our experience in laparoscopic conversion of failed VBG and SRVG to biliopancreatic diversion (BPD). SettingsThe setting of the study was at the University hospital. MethodsBetween March 2010 and July 2013, 12 patients underwent laparoscopic conversion of VBG and SRVG to BPD. Using a prospectively collected database, we analyzed their data and outcomes. ResultsEighty-six percent of the conversions were successfully completed laparoscopically. The mean operative time was 220 min. There was no mortality. Perioperative complications occurred in four patients (33 %). One (9 %) late complication, an adhesional small bowel obstruction, was encountered later than 30 days postoperatively. The follow-up rate was 100 %, but only three patients reached 3 years at the time of this writing. At a mean follow-up of 19 (3–40) months, the mean body mass index (BMI) decreased from 45.3 to 27.8 kg/m2. Percent excess weight loss (EWL) was 65.7, and 86.3 % at 1 and 3 years, respectively. ConclusionLaparoscopic conversion of failed VBG to BPD is feasible and effective in further reducing weight in morbidly obese patients. Weight loss continues beyond the first postoperative year. However, the complication rate is much higher than in the primary procedure.

Perioperative outcomes of revisional laparoscopic gastric bypass after failed adjustable gastric banding and after vertical banded gastroplasty: experience with 107 cases and subgroup analysis

A growing number of revision procedures are to be expected in bariatric surgery after failed restrictive procedures such as failed adjustable gastric banding (AGB) or vertical banded gastroplasty (VBG). Conversion to revisional laparoscopic Roux-en-Y gastric bypass (ReLRYGBP) has been advocated as the procedure of choice. The results of ReLRYGBP were reviewed in a retrospective chart review. A subgroup analysis compared perioperative results after VBG and after AGB. A second subgroup analysis compared perioperative results of ReLRYGBP immediately after AGB removal and after a delay as a two-step procedure. Between 2003 and 2009, ReLRYGBP was performed for 107 patients. Of these 107 operations, 21 were performed after failed VBG and 86 after failed AGB. The mean body mass index (BMI) was 42 kg/m(2). The causes of failure were mainly insufficient weight loss or reflux disease-related symptoms. During a median follow-up period of 44 months, there was no mortality, and morbidity was 34 %, including late complications. Major early complications occurred in 11 % of the cases (n = 12). Conversions and major early complications occurred significantly more frequently after VBG than after AGB (p < 0.05). In 59 % of the cases (n = 50), ReLRYGBP was performed as a single-stage procedure immediately after removal of AGB and in 41 % of the cases (n = 36) as a delayed two-step procedure. The outcomes did not differ significantly (p > 0.5). The perioperative outcomes of ReLRYGBP are worse after VBG than after AGB. The ReLRYGBP operation can be performed safely as a one-step procedure after AGB removal.

Laparoscopic Roux-en-Y Gastric Bypass After Failed Vertical Banded Gastroplasty: a Multicenter Experience with 203 Patients

Vertical banded gastroplasty (VBG) has long been the main restrictive procedure for morbid obesity but has many long-term complications for which conversion to Roux-en-Y gastric bypass (RYGBP) is often considered the best option. This series regroups patients operated on by three different surgeons in four different centers. All data were collected prospectively, then pooled and analyzed retrospectively. Out of 2,522 RYGBP performed between 1998 and 2010, 538 were reoperations, including 203 laparoscopic RYGBP after VBG. There were 175 women and 28 men. The mean BMI before VBG was 43.2 ± 6.3, and the mean BMI before reoperation was 37.4 ± 8.3. Most patients had more than one indication for reoperation and/or had regained significant weight. There was no conversion to open surgery. A total of 24 patients (11.8%) developed complications, including nine (4.5%) who required reoperation and one death. With a follow-up of 88.9% after 8years, the mean BMI after 1, 3, 5, 7, and 9years was 29.1, 28.8, 28.7, 29.9, and 28.8, respectively. On the basis of this experience, the largest with laparoscopic reoperative RYGBP after failed VBG, we conclude that this procedure can safely be performed in experienced hands, with weight loss results similar to those observed after primary RYGBP. In patients with too difficult an anatomy below the cardia, dividing the esophagus just above the esophago-gastric junction and performing an esophagojejunostomy may be a safe alternative to converting to a Scopinaro-type BPD, obviating the additional long-term risks associated with malabsorption.

Natural Orifice Surgery: Endoluminal Pouch Reduction Following Failed Vertical Banded Gastroplasty

Following vertical banded gastroplasty (VBG), patients may develop pouch complications such as dilation and staple-line dehiscence. This may contribute to weight regain, and if conservative measures are exhausted, traditionally, open revisional surgery of the pouch or conversion of the VBG to Roux-en-Y gastric bypass (RYGB) would be considered. StomaphyX(TM) is an endoscopic device used with a conventional gastroscope for the approximation of tissue in gastric pouches or across gastroenteric anastomoses to enhance restriction. The objective of this study is to analyze the outcomes of StomaphyX(TM) endoluminal pouch revision following failed VBG. Patients with weight gain following VBG had endoluminal pouch reduction performed using the StomaphyX(TM) device in revisional bariatric surgery clinic, tertiary care hospital, Canada. Pre- and postoperative weights were compared, and a regression model was developed to examine for predictors of weight loss following StomaphyX(TM). Fourteen patients were included in the study. Patients had a mean age of 47.3 ± 7.9years, and 13 of 14 were female. Significant reductions were appreciated between pre- and postoperative weight and BMI (119.5 ± 25.9kg vs. 109.6 ± 24.4kg; 43.4 ± 9.7kg/m(2) vs. 39.8 ± 9.1kg/m(2), respectively). There was no correlation between preoperative pouch status and weight loss. Three patients had two separate StomaphyX(TM) procedures performed. Only minor complications (headache, back pain) were identified. The StomaphyX(TM) device may be safely used for reduction of pouch size in patients following VBG. Further studies are required to determine the role of StomaphyX(TM) endoluminal pouch reduction in comparison to open or laparoscopic revisional surgery.

Bariatric Revisionary Surgery for Failed or Complicated Vertical Banded Gastroplasty (VBG): Comparison of VBG Reoperation (re-VBG) versus Roux-en-Y Gastric Bypass-on-VBG (RYGB-on-VBG)

Background. Revision of failed bariatric procedures is a significant challenge for bariatric surgeons, because of the increasing number of recurring morbid obesity or complications, especially in patients with a previous Vertical Banded Gastroplasty (VBG). Methods. Since November 1998, 109 patients with failed or complicated VBG were followed in a retrospective study. 49 patients underwent re-VBG and, since 2004, 60 underwent Roux-en-Y Gastric Bypass-on-Vertical Banded Gastroplasty (RYGB-on-VBG). Results. At 3 years follow-up, mean BMI decreased from 37.4 to 31.2 Kg/m2 in the first group, and from 35.0 to 28.4 Kg/m2 in the second. Early complications were 7 (14.3%) in the first group and 4 (6.5%) in the second; late complications were 33 (59.1%) and 11 (18.3%), respectively. Conclusion. Although both operations seem to be effective as bariatric revision procedures in terms of BMI, the mid-term outcomes of RYGB-on-VBG demonstrate the lowest rate of complications and better quality of life.

Conversion of Failed Vertical Banded Gastroplasty to Biliopancreatic Diversion, a Wise Option

Reoperations due to failures constitute an essential but challenging part of bariatric surgery practice today. The aim of this study was to evaluate the perioperative safety, efficacy, and postoperative quality of life in patients with biliopancreatic diversion (BPD), after failed vertical banded gastroplasty (VBG). Twelve patients after failed or complicated VBG, eight females and four males, median age 45 years (range 39-52), median body mass index (BMI) 46.39 kg/m2 (range 25.89-69.37), who underwent conversion to BPD, were studied. Ten patients due to weight regain and two patients because of severe stenosis of the gastric pouch outlet were submitted in conversion to BPD. In eight (66.6%) patients the primary VBG had been followed by at least one revisional operation due to inadequate weight loss. The 10 patients after failed VBG, reached the lowest BMI recorded after VBG in just a year after BPD (p=0.721 for the comparison between the two time points). The two patients with stomal stenosis regained weight in the first six postoperative months and remain stable since then. Regarding safety, one major perioperative complication (gastrojejunostomy stenosis) occurred. At a median follow-up of 21 months (range 12-30) six complications have been documented, including a case of incisional hernia, four cases of pouch gastritis and a case of intractable iron-deficiency anemia. Our early results indicate that conversion of failed VBG to BPD is highly effective with acceptable morbidity. Our data show that the effect on weight is strongly dependent on the indication for the conversion. Conversion to BPD, in such a group of patients, is a wise alternative, since it may reduce operative risks.

Laparoscopic Sleeve Gastrectomy as Revisional Procedure for Failed Gastric Banding and Vertical Banded Gastroplasty

The problem of revision of failed gastric banding (GB) and vertical banded gastroplasty (VBG) procedures has become a common situation in bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) has been recently used to revise failed restrictive procedures. The objective of this study is to evaluate the results of LSG as revisional procedure for failed GB and VBG. A prospective held database was questioned regarding patients' demographic, indication for revision, conversion to open surgery, morbidity, percentage of excess weight loss (%EWL), evolution of comorbidities, and need for a second procedure after LSG. Forty-one patients, 34 women and seven men with a mean age of 42 years (range 19 to 63 years) and a mean body mass index at 49.9 kg/m(2) (range 35.9-63 kg/m(2)), underwent laparoscopic conversion of GB (36 patients) and VBG (five patients) into LSG. Indication for revisional surgery was insufficient weight loss in all the cases. All procedures were completed laparoscopically. There was no mortality and five patients (12.2%) developed complications (high leak, one patient; intra-abdominal abscess, three patients; and complicated incisional hernia, one patient). At a mean follow-up of 13.4 months, %EWL is on average 42.7% (range 4-76.1%). Six patients had a second procedure (four had laparoscopic duodenal switch, one had laparoscopic Roux-en-Y gastric bypass, and one had laparoscopic biliopancreatic diversion). Conversion of GB and VBG into LSG is feasible and safe. LSG is effective in the short term with a mean %EWL of 42.7% at 13.4 months. Long-term results of LSG as revisional procedure are awaited to establish its efficacy in the long term.

High revision rates after laparoscopic vertical banded gastroplasty

Background To evaluate, in a surgical department at a university hospital in Stockholm, Sweden, the long-term results after laparoscopic vertical banded gastroplasty (VBG), with special emphasis on revisional surgery. Few studies are available with long-term results after laparoscopic VBG. Some short-term studies have shown results similar to gastric banding. Methods All consecutive patients who underwent attempted laparoscopic VBG between 1995 and 2005 were followed up regarding weight loss and the need for revisional surgery. Follow-up was from the date of surgery to the end of the observational period (December 2006). Results In 486 patients, laparoscopic VBG was attempted. Of the 486 cases, 64 were converted to open surgery. Conversions were common in the first patients, with a conversion rate of 4% during the last 100 patients. The mean body mass index at surgery was 42.4 kg/m 2. The median follow-up was 3 years (range 0–11). All patients lost weight. A total of 104 patients (21%) required revisional surgery 114 times during the follow-up period, with food intolerance/vomiting and insufficient weight loss the most common reasons. Of the 104 patients, 31 underwent repeat VBG, of whom 10 needed a secondary revisional procedure, and 49 required conversion to gastric bypass, of whom none have required additional revisional surgery. Conclusion Laparoscopic VBG is associated with high revisional rates. In the case of failed VBG, repeat VBG seems to be a poor option and conversion to gastric bypass yields better results. We have abandoned VBG as a surgical option in the treatment of obesity.

Reconstruction of the gastric passage by a side-to-side gastrogastrostomy after failed vertical-banded gastroplasty: a case report

IntroductionVertical-banded gastroplasty, a technique that is commonly performed in the treatment of morbid obesity, represents a nonadjustable restrictive procedure which reduces the volume of the upper stomach by a vertical stapler line. In addition, a textile or silicone band restricts food passage through the stomach.Case presentationA 71-year-old woman presented with a severe gastric stenosis 11 years after vertical gastroplasty. We describe a side-to-side gastrogastrostomy as a safe surgical procedure to restore the physiological gastric passage after failed vertical-banded gastroplasty.ConclusionOccasionally, restrictive procedures for morbid obesity cannot be converted into an alternative bariatric procedure to maintain weight control. This report demonstrates that a side-to-side gastrogastrostomy is a feasible and safe procedure.

PL-58: Failed Vertical Banded Gastroplasty (VBG) - adjustable gastric banding or Roux-en-Y gastric bypass: A prospective long-term follow-up study Miller K, MD, FACS, Hell E, MD, Pump A, MD, Hallein Clinic, Austria

Vertcal Banded Gastroplasty (VBG) was the standard restrictive procedure over decades. Conversion to a Roux-en-Y Gastric Bypass (RYGB) has been advocated after the failure of VBG.The aim of this study was to assess the effect of laparoscopic treatment of complications linked to VBG.

Roux-en-Y Gastric Bypass after Failed Vertical Banded Gastroplasty

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). 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. 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. 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.

Revision of Failed Vertical Banded Gastroplasty to Non-resectional Scopinaro Biliopancreatic Diversion: Early Experience

The most commonly performed revision operation following failed vertical banded gastroplasty (VBG) is Roux-en-Y gastric bypass, although revision to biliopancreatic diversion (BPD) with duodenal switch is now another common option. We describe the surgical technique for revision of a failed VBG to a non-resectional Scopinaro BPD in a series of patients, as well as the outcome in terms of complications and mean % excess weight loss (%EWL). A retrospective review was conducted on all patients who underwent revision to BPD at Mercy Bariatrics, Western Australia, between June 2001 and April 2005. This yielded 20 patients who had revision to BPD, 9 of whom had VBG as their initial operation. The mean %EWL was measured at regular intervals postoperatively (3, 6, 12, and 24 months). Mean %EWL at 12 and 24 months was 69.5 and 76.7, respectively. These results are comparable to %EWL after a primary BPD. Nutritional manifestations were found to be the most common of the minor complications. Our technique for revision of a failed restrictive operation to a non-resectional Scopinaro BPD is described. The preliminary results in terms of %EWL and complications are comparable to other revisional malabsorptive operations. Prospective randomized controlled trials are needed to further evaluate effects of revision to a non-resectional Scopinaro BPD and to ensure that the results (in terms of %EWL) are reproducible.