Distal Roux-en-Y Gastric Bypass Conversion Operation for Failed Vertical Banded Gastroplasty

Forty-five cases of failed vertical banded gastroplasty were converted to gastric bypass with distal Roux-en-Y constructed with a 250 cm alimentary limb and a 150 cm common channel. The gastroenterostomy is side-to-side, unrestricted and is at least 3 cm wide. We believe that this wide anastomosis is responsible for the zero incidence of stomal ulcers in this group. A nasogastric tube is not used and the patient is placed on ranitidine 150 mg one b.i.d. for the first 4 weeks. The weight loss is excellent and sustained, and the resulting life-style is very close to that of a normal person. All varieties of foods are tolerated in adequate amounts, and diarrhea occurs only if the patient indulges in fatty foods. Hypoproteinemia is generally mild and transient except in five early cases where TPN was needed, and four of these required elongation of the intestinal segments. Wound infection was 4.5%, and there was no mortality.