Revisional Surgery for Failed Vertical-Banded Gastroplasty

Abstract

Vertical-banded gastroplasty (VBG) was once a common bariatric procedure. It has fallen out of favor due to the emergence of the adjustable gastric band and late complications including band erosion and stenosis. Options for revision include conversion to a Roux-en-Y gastric bypass (RYGB) or VBG reversal via gastrogastrostomy. Patients undergoing revision of a previous VBG were identified. VBG reversal was performed laparoscopically. Conversion to RYGB was performed by both laparotomy and laparoscopy. Perioperative outcomes and long-term weight loss were evaluated. A total of 34 patients with a previous open VBG underwent revision over a nearly 8-year period (January 2003 to September 2010). Conversion to RYGB was performed in 25 (four laparoscopically) and VBG reversal in nine patients. Mean age for all patients was 56.3 years (range 36-70), and VBG had been performed 23 years previously (range 16-30). Patients to undergo VBG reversal were more likely to be male and less likely to be morbidly obese at the time of revision. Operative time and length of stay were shorter for laparoscopic procedures. Complication rates did not differ based on technique or procedure. Patients with a previous VBG may present with complications and obesity decades after the primary procedure. Revisional surgery can be accomplished laparoscopically. Following VBG reversal, most patients gain weight and many become morbidly obese again. Conversion to RYGB is associated with weight loss and resolution of morbid obesity in most patients. When feasible, laparoscopic conversion to RYGB may offer the best outcomes.

Revisional bariatric surgery can improve refractory metabolic disease

“…The %EWL after revisional surgery has been shown to be less compared with the initial bariatric operation. For example, in patients who have had a conversion of a VBG to RYGB, the mean %EWL ranges from 35%-60% [23][24][25][26][27][28]. We know from previous studies that after primary RYGB patients lose 470% of their excess weight at 18 months [5].…”

Conversion of Open Vertical Banded Gastroplasty to Roux-en-Y Gastric Bypass: a Single-Center, Single-Surgeon Experience with 6 Years of Follow-up

“…Short-term results were very promising, but long-term sustained weight loss was compromised by complications and so two decades later, initial optimism regarding this technique declined [7,[9][10][11]. In literature, incidence of revisional surgery after VBG is 10-56 % [5,[12][13][14][15][16][17][18][19].…”

Surgical and Endoscopic Options for Benign and Malignant Gastric Outlet Obstruction

“…Two different surgical procedures have been described to relieve the obstruction from a failed VBG, RYGB and VBG reversal via a gastro-gastrostomy. A retrospective review of 34 patients who underwent a VBG that ultimately required revision compared laparoscopic VBG reversal with open [23]. While there was no difference in complication rates, patients who had the RYGB procedure had a significant decrease in BMI 1-2 years postoperatively, while VBG reversal patients had a significant increase.…”