Laparoscopic conversion of vertical banded gastroplasty (Mason MacLean) into Roux-en-Y gastric bypass.
BACKGROUND
Revision of bariatric procedures is required in 10 to 25% of patients either for insufficient weight loss or for complications. Patients undergoing vertical banded gastroplasty (VBG; Mason MacLean) may require revision in up to half of the cases in the long term. Roux-en-Y gastric bypass (RYGBP) is considered the procedure of choice for revision of VBG gastroplasty.


METHODS
Eighteen patients, 16 women and 2 men with a mean age of 41.7 years (range 27-72) and a mean BMI at 37.6 kg/m(2) (range 22.5-47), underwent laparoscopic conversion of VBG into RYGBP. Indications for revisional surgery were insufficient weight loss (11 patients), stoma stenosis (4 patients), and acid reflux (3 patients).


RESULTS
Operative time was on average 203 min (range 60-300 min), and conversion was required in one patient (5.5%). There was no early postoperative mortality, and four patients (22.2%) developed immediate postoperative complications (gastrojejunostomy leak 1; stenosis of the gastrojejunal anastomosis 2; liver abscess 1). One patient died 6 months after conversion because of a bleeding anastomotic ulcer (late mortality 5.5%). Two patients (11.5%) developed late complications (incisional hernia 1; internal hernia 1). At a mean follow-up of 23, 4 months BMI is on average 29.8 kg/m(2) (range 22.7-37).


CONCLUSIONS
Although revision of failed VBG into RYGBP gives good functional results, the risk of postoperative serious complications must be carefully evaluated before revision.
Iannelli
Antonio
A
Faculté de Médecine, Université de Nice-Sophia-Antipolis, Nice, 06107, France. antonio_iannelli@hotmail.com
Amato
Daniela
D
Addeo
Pietro
P
Buratti
Massimo Senni
MS
Damhan
Moucef
M
Ben Amor
Imed
I
Sejor
Eric
E
Facchiano
Enrico
E
Gugenheim
Jean
J
D000328:Adult; D000368:Aged; D005260:Female; D015390:Gastric Bypass; D015391:Gastroplasty; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000009:adverse effects*