Laparoscopic conversion of vertical banded gastroplasty with an antireflux wrap into Roux-en-Y gastric bypass.
BACKGROUND
Vertical banded gastroplasty (VBG) is associated with a significant rate of revision because of regain of weight due to staple-line disruption, gastric pouch and stoma dilation, change to sweet eating, outlet stenosis with vomiting and reflux. To avoid reflux, some surgeons added an antireflux wrap.


METHODS
We report laparoscopic revision of VBG with antireflux wrap to Roux-en-Y gastric bypass (RYGBP) in 4 patients. The indication for revision was insufficient weight loss in all 4 patients, with stenosis of the stoma resistant to endoscopic balloon dilation in one and reflux esophagitis in one, who shifted to high-calorie liquids. Revision was performed 73.5 months (range 57-84) after the primary procedure, at mean BMI 39.5 (range 37-41).


RESULTS
Mean operative time was 193.7 min (165-220). There was no conversion to open surgery. There was no mortality. One patient developed a stenosis at the gastrojejunostomy that was managed successfully with endoscopic balloon dilation. Mean length of stay was 6.8 days (range 4-9). At mean follow-up of 11.2 months (range 11-18), mean BMI is 28.5 (range 27-30), and all patients were free of co-morbidities.


CONCLUSIONS
Laparoscopic revision of VBG with an antireflux wrap into an LRYGBP is feasible and effective in achieving weight loss, but the safety requires assessment by a larger series.
Iannelli
Antonio
A
Université de Nice-Sohpia-Antipolis, Faculté de Médecine, Nice, F-06107, France. antonio_iannelli@hotmail.com
Addeo
Pietro
P
Dahman
Moucef
M
Buratti
Massimo Senni
MS
Ben Amor
Imed
I
Piche
Thierry
T
Gugenheim
Jean
J
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000517:prevention & control*; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation; D016896:Treatment Outcome