Conversion surgery for morbid obesity: complications and long-term weight control

Some operations for morbid obesity fail--for a variety of reasons. To better understand the risk and efficacy of converting, during a single operation, a failed procedure to a second type of operation for morbid obesity, a review was made of all 120 patients who underwent this type of conversion surgery at one university hospital during a 10-year period. The initial operations of 62 patients were converted to a gastric bypass with a Roux-en-Y gastrojejunostomy, 11 to an unbanded gastrogastrostomy, and 47 to a vertical banded gastroplasty. Four patients are dead (three of unrelated causes), 11 have undergone a third operation for morbid obesity, and five (4.2%) are lost to follow-up. For 69 of 86 patients, 3- to 5-year follow-up data are available. Serious early complications occurred in 5.8% of the patients. Almost 80% of the patients who received an unbanded gastrogastroplasty did not control their weight, whereas most of those who received a Roux-en-Y gastrojejunostomy or a vertical banded gastroplasty had satisfactory long-term weight control 3 to 5 years later, maintaining an average weight loss of 30% of their original weight or 55% of their excess weight. Conversion surgery is safe and effective.