Central surgical associationUnsatisfactory weight loss after vertical banded gastroplasty: Is conversion to Roux-en-Y gastric bypass successful?
Section snippets
Methods
We retrospectively reviewed our prospectively collected data on patients who underwent conversion from a VBG to a RYGB from November 1986 to June 2003 at the Mayo Clinic, Rochester, Minn, after approval by our Institutional Review Board. The medical records of 83 patients who underwent conversion from VBG to RYGB were reviewed; we then selected the 54 patients who had a body mass index (BMI) ≥35 kg/m2 at the time of conversion of VBG to RYGB who did not have a satisfactory weight loss after
Patient group
All patients had the diagnosis of medically complicated obesity at the time of the conversion to RYGB. Fifteen patients had a BMI between 35 and 40 kg/m2 with at least 1 medical comorbidity attributed to obesity; 39 patients had BMI >40 kg/m2. In addition to inadequate weight loss after VBG, which was an indication for operation in all 54 patients, some element of gastroesophageal reflux disorder (GERD) was present as well in 30 (56%) patients. Other concomitant indications included
Discussion
Isolated gastric restrictive procedures, such as the nonbanded19., 20. or banded gastroplasties5., 6. have been very commonly performed bariatric operations, especially after the NIH Consensus Conference4 on bariatric surgery condoned the VBG as an effective treatment for morbid obesity. These operations are attractive in principle, because they do not involve formal gastrointestinal anastomoses nor do they establish a selected or global malabsorptive anatomy. Unfortunately, our long-term (≥10
Conclusion
Our study shows that conversion from an unsuccessful VBG to RYGB is safe and, at a mean follow-up of 6.1 years, provides a good outcome with weight loss, reversal of weight-related comorbidities, and high patient satisfaction. Revisionary bariatric surgery is thus both indicated for ongoing weight-related morbidity and is validated by good outcomes.
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Cited by (29)
Revisional metabolic/bariatric surgery: A moral obligation
2014, Surgery for Obesity and Related DiseasesSystematic review on reoperative bariatric surgery American Society for Metabolic and Bariatric Surgery Revision Task Force
2014, Surgery for Obesity and Related DiseasesCitation Excerpt :Conversions to RYGB have been reported in up to 25–65% of patients after VBG [67,73], though others report lower conversion rates ranging from 4.4–8.0% [74,75]. The perioperative complication and mortality rates among patients who underwent conversion of VBG to RYGB ranged from 8.9–21.0% [69,75–77], and 0–2% [69,75–78], respectively. EWL at 31 months after conversion to RYGB has been reported to be 47% [74].
Twelve-year results for revisional gastric bypass after failed restrictive surgery in 131 patients
2014, Surgery for Obesity and Related DiseasesCitation Excerpt :Considering this, the fact that 74% were satisfied at follow-up is an indication of major improvement. Patient satisfaction has been higher (90%–93%) in other studies with shorter follow-up [6,14] but is difficult to compare because the result depends on how the questionnaire is designed and possibly also on the length of follow-up. When compared by the same methods, the degree of satisfaction after rRYGB was similar to our results after primary RYGB [9].
Laparoscopic revision of vertical banded gastroplasty to Roux-en-Y gastric bypass: Outcomes of 105 patients
2011, Surgery for Obesity and Related DiseasesA two-decade spectrum of revisional bariatric surgery at a tertiary referral center
2007, Surgery for Obesity and Related DiseasesCitation Excerpt :Substantiative symptoms and mechanical complications were the predominant indications for revision in 44% of our patients, with VBG the most common previous procedure. The frequent, debilitating symptoms in patients after VBG necessitating revision or conversion to another bariatric procedure has been previously described [4,13,14] and led to our abandoning this procedure as a primary or revisional procedure in 1989. The most frequent symptom complex prompting revision in our study was GERD (53%).
Is Roux-en-Y gastric bypass safe after previous antireflux surgery? Technical feasibility and postoperative symptom assessment
2005, Surgery for Obesity and Related Diseases
Presented at the 61st Annual Meeting of the Central Surgical Association, Chicago, Illinois, March 4-6, 2004.