Conversion of failed vertical banded gastroplasty to biliopancreatic diversion, a wise option

Reoperations due to failures constitute an essential but challenging part of bariatric surgery practice today. The aim of this study was to evaluate the perioperative safety, efficacy, and postoperative quality of life in patients with biliopancreatic diversion (BPD), after failed vertical banded gastroplasty (VBG).

Twelve patients after failed or complicated VBG, eight females and four males, median age 45 years (range 39-52), median body mass index (BMI) 46.39 kg/m2 (range 25.89-69.37), who underwent conversion to BPD, were studied.

Ten patients due to weight regain and two patients because of severe stenosis of the gastric pouch outlet were submitted in conversion to BPD. In eight (66.6%) patients the primary VBG had been followed by at least one revisional operation due to inadequate weight loss. The 10 patients after failed VBG, reached the lowest BMI recorded after VBG in just a year after BPD (p=0.721 for the comparison between the two time points). The two patients with stomal stenosis regained weight in the first six postoperative months and remain stable since then. Regarding safety, one major perioperative complication (gastrojejunostomy stenosis) occurred. At a median follow-up of 21 months (range 12-30) six complications have been documented, including a case of incisional hernia, four cases of pouch gastritis and a case of intractable iron-deficiency anemia.

Our early results indicate that conversion of failed VBG to BPD is highly effective with acceptable morbidity. Our data show that the effect on weight is strongly dependent on the indication for the conversion. Conversion to BPD, in such a group of patients, is a wise alternative, since it may reduce operative risks.