Technical Strategies for Converting the Failed Vertical Banded Gastroplasty to the Roux-en-Y Gastric Bypass

Conversion of the failed vertical banded gastroplasty (VBG) to a Roux-en-Y gastric bypass (RYGB) is one of the most challenging revisionary operations in bariatric surgery. It is also one of the least reported remedial operations performed. This study describes the technical details necessary for a successful conversion in a variety of anatomical presentations ranging from near-total staple-line dehiscence to an intact VBG with or without stomal stenosis. Each step is analyzed along with the strategic options available should an intraoperative technical complication occur. The report is based on 20 conversion procedures in patients referred to us since 1983. Indications for conversion include: morbid obesity, intractable vomiting, and gastroesophageal reflux disease. Using the step-by-step method we have developed over the last 9 years, expeditious conversion from a failed VBG to an RYGB can be achieved safely and without the need for blood transfusions or multiple reoperations.