Revisional surgery for failed vertical-banded gastroplasty

Area of Science:

• Bariatric surgery
• Surgical revision
• Obesity management

Background:

• Vertical-banded gastroplasty (VBG) was a common bariatric procedure but is now less favored due to complications.
• Late complications of VBG include band erosion and stenosis, necessitating revisional surgery.
• Revision options include Roux-en-Y gastric bypass (RYGB) conversion or VBG reversal.

Purpose of the Study:

• To evaluate perioperative outcomes and long-term weight loss after VBG revision.
• To compare outcomes between VBG reversal and RYGB conversion.
• To assess the efficacy of laparoscopic approaches in VBG revision.

Main Methods:

• Retrospective review of 34 patients undergoing VBG revision (January 2003-September 2010).
• Procedures included VBG reversal (n=9) and RYGB conversion (n=25), performed via laparotomy or laparoscopy.
• Outcomes analyzed: operative time, length of stay, complication rates, and long-term weight changes.

Main Results:

• VBG reversal patients were more likely male and less likely to be morbidly obese at revision.
• Laparoscopic procedures had shorter operative times and hospital stays.
• Complication rates were similar between reversal and conversion groups.
• VBG reversal was associated with weight regain and recurrence of morbid obesity.
• RYGB conversion resulted in significant weight loss and resolution of morbid obesity for most patients.

Conclusions:

• Patients with prior VBG may require revision surgery years later due to complications or persistent obesity.
• Laparoscopic RYGB conversion appears to offer superior long-term weight management compared to VBG reversal.
• VBG reversal is often ineffective for long-term weight control and may lead to weight regain.