Elsevier

Surgery

Volume 136, Issue 4, October 2004, Pages 731-737
Surgery

Central surgical association
Unsatisfactory weight loss after vertical banded gastroplasty: Is conversion to Roux-en-Y gastric bypass successful?

https://doi.org/10.1016/j.surg.2004.05.055Get rights and content

Background

In 1991, the National Institutes of Health sanctioned 2 operations for treatment of morbid obesity: vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGB). Long-term results with VBG are disappointing. We wondered whether patients who had “adapted” to the VBG anatomy and had regained weight would lose weight after conversion to RYGB.

Methods

We reviewed data on patients undergoing conversion of VBG to RGYB.

Results

Fifty-four patients (mean body mass index [BMI] of 46 kg/m2 [range, 36-66]) underwent standard (48 patients) or distal (malabsorptive) (6 patients) RYGB. There were no perioperative deaths; postoperative morbidity delaying discharge occurred in 7 patients (13%). Follow-up (complete in 51 patients, x¯= 6.1 years) was obtained by mail questionnaires and patient contact. Mean BMI decreased to 35 kg/m2 (range, 22-47), and 59% of the patients with >1 year follow-up had a BMI <35 kg/m2. The number of patients requiring positive pressure oxygen for sleep apnea decreased by half; most patients discontinued or decreased the number of medications treating weight-related comorbidities. At last follow-up, 90% of patients were satisfied subjectively with the results.

Conclusions

Conversion of VBG to RYGB is safe and provides weight loss, improved quality of life, and reversal of weight related comorbidities.

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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