Remedial surgery following failed gastroplasty for morbid obesity

Gastroplasty (GP) or gastric bypass with exclusion of 90% of the distal stomach (GBP) have largely replaced small bowel bypass in the surgical management of morbid obesity. Despite the theoretical advantages of GP over GBP, revision rates of up to 20% are reported with GP because of unsatisfactory weight loss resulting from staple line disruption, pouch dilatation, and/or stomal enlargement. This report describes four alternative surgical approaches to failed GP. "Complete" partitioning of the stomach accompanied by gastrogastrostomy or conversion to Roux-en-Y GBP is recommended. Because of intangible advantages associated with exclusion of the stomach and duodenum, conversion to GBP is favored over GP revision in such cases.