Revisional Surgery for Failed Gastric Restrictive Procedures for Morbid Obesity

Abstract

As part of the Adelaide Obesity Surgery Study, we have reviewed all patients who have undergone revisional surgery. Of the 31 0 trial patients, 63 (20%) had revisions 1-69 (median 32) months following their original surgery-30% of all 105 gastrogastrostomy (GG) operations, 22% of 106 gastroplasty (GP) procedures, and 9% of 99 gastric bypasses (GB). Failure was due to stomal dilatation, 11% of all trial patients (71% of GG revisions), stomal stenosis, 6% (52% of GP revisions) and staple dehiscence, 4%. There was no mortality and a low hospital morbidity. Long-term success was only 23% (follow-up at least 3 years) and was achieved at considerable expense (3 reversals, 10 further revisions, 44 endoscopic procedures). Revisional surgery was successful in 45% of patients with stomal dilatation or dehiscence but in only 17% with stenosis. Overall, the most successful operation was revision of, or conversion to, gastric bypass (58% success rate), compared with gastroplasty (24%) and gastrogastrostomy (25%). Our long-term results following revisional surgery were disappointing, particularly for stenosis, and most failures followed revision to GG or GP. Roux-en-Y gastric bypass is the procedure of choice when considering revision.

Three-Year Results of Roux-en-Y Gastric Bypass-on-Vertical Banded Gastroplasty: an Effective and Safe Procedure which Enables Endoscopy and X-Ray Study of the Stomach and Biliary Tract

“…Our results are in agreement with the main points of several authors who reported good results with combined procedures [20][21][22][23] or excellent weight loss of RYGBP in spite of gastro-gastric fistula. [24][25][26] In the RYGBP-on-VBG, the nearly total passage of the meal through the non-restricted gastro-jejunal anastomosis, in spite of the open gastro-gastric outlet, can be explained by the concept of Magenstrasse: the gastrojejunostomy represents the preferential way.…”

Indications and Results of Reversal of Vertical Banded Gastroplasty (VBG)

“…In the study by Hunter and colleagues, 80% of revisionary operations were not successful in patients that had failure of a primary operation due to stomal stenosis. 10 In addition, nearly 50% of the patients operated for stomal stenosis required an additional revision and 33% had recurrent stenosis; 16% of the patients ended up with a complete reversal of the original bariatric procedure. Nearly 70% of the patients in this series had multiple endoscopic procedures including balloon dilatation following their revisional surgery.…”

Laparoscopic conversion of vertical banded gastroplasty to a Roux-en-Y gastric bypass

“…Complication rates as high as 62% have been reported with reoperative surgeries in the past. However, more recent reports demonstrate complication rates slightly lower, in the range of 10% to 40%, with the mortality rate typically 2% or less [20][21][22][23][24].…”