title: Revisional surgery after failed vertical banded gastroplasty: restoration of vertical banded gastroplasty or conversion to gastric bypass.
abstract: BACKGROUND
  An increasing number of patients with a failed primary bariatric procedure present themselves for secondary treatment. Only a few studies have investigated critically the success of revisional surgery. In the present study, the effectiveness of revisional surgery for failed vertical banded gastroplasty (VBG) is analyzed: restoration of the VBG (reVBG) is compared to conversion to a Roux-en-Y gastric bypass (RYGB).
  
  
  METHODS
  From 1980 to 1996, 136 consecutive morbidly obese patients underwent primary RYGB (n = 20) or VBG (n = 16). Weight loss, indications and complications after revisional surgery were registered. The rate of revisional surgery after primary and secondary bariatric procedures was estimated by means of a Kaplan-Meier analysis.
  
  
  RESULTS
  Kaplan-Meier analysis revealed that 56% of the patients will eventually require revisional surgery after initial VBG over a 12-year period compared to 12% after initial RYGB (P<0.01). After reVBG 68% will need revisional surgery over a 5-year period, while no further revisional surgery was required after conversion to a RYGB (P<0.05). Body mass index dropped significantly after reVBG or conversion to RYGB for insufficient weight loss (P<0.05), however, more revisional surgery was necessary after reVBG to achieve this result. The complication rate was comparable between reVBG and conversion to RYGB (33%).
  
  
  CONCLUSIONS
  Conversion of a failed VBG to a RYGB is more effective than a reVBG, because conversion to RYGB provides satisfactory weight loss without requiring further revisional surgery.
authors.affiliation: Department of Surgery, University Hospital Maastricht, The Netherlands.
authors.forename: W G
authors.initials: WG
authors.lastname: van Gemert
authors.forename: M M
authors.initials: MM
authors.lastname: van Wersch
authors.forename: J W
authors.initials: JW
authors.lastname: Greve
authors.forename: P B
authors.initials: PB
authors.lastname: Soeters
mesh_terms: D000328:Adult; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D015391:Gastroplasty / Q000009:adverse effects; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation; D017211:Treatment Failure; D015431:Weight Loss