title: Laparoscopic revision of vertical banded gastroplasty to Roux-en-Y gastric bypass: outcomes of 105 patients.
abstract: BACKGROUND
  Although vertical banded gastroplasty (VBG) was endorsed by the 1991 National Institutes of Health Consensus Conference for the treatment of morbid obesity, it has largely been abandoned owing to the poor long-term weight loss and band-related complications. The objective of the present study was to review the outcomes of patients who had undergone laparoscopic conversion of VBG to Roux-en-Y gastric bypass (RYGB) for weight loss or dysphagia and gastroesophageal reflux.
  
  
  METHODS
  A retrospective review of prospectively collected data from all patients who had undergone revision of VBG to RYGB was performed. The data on the symptoms, weight loss, co-morbidities, and complications were collected.
  
  
  RESULTS
  From July 1999 to April 2010, 2397 bariatric procedures were performed. Of these, 105 (4.4%) were laparoscopic revisions of previous VBG to RYGB. Of the 105 patients, 103 had undergone open VBG and 2 laparoscopic VBG. Of the 105 patients, 97 were women and 8 were men. The average patient age was 49 years (range 23-71). The median preoperative body mass index was 42 kg/m(2) (range 20-72). Short- and long-term complications occurred in 40 patients (38%). No patients died. The median length of stay was 2 days. At an average follow-up of 31 months (range 1-96), the median percentage of excess weight loss was 47% (range -24% to 138%). The median decrease in body mass index was 8 kg/m(2) (range -6 to 30). Dysphagia had improved or resolved in 100%. Gastroesophageal reflux disease had improved or resolved in 95%. Diabetes had improved or went into remission in 90%. Hypertension had improved or resolved in 62%. Obstructive sleep apnea had improved or resolved in 96%.
  
  
  CONCLUSIONS
  The results of our study have shown that laparoscopic revision of VBG to RYGB is a feasible procedure that can provide acceptable weight loss and reversal of weight-related co-morbidities. Complications were common after revisional bariatric surgery.
authors.affiliation: Western Pennsylvania Hospital, Temple University Medical School, Clinical Campus, Pittsburgh, Pennsylvania, USA. dgagne@wpahs.org
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Gagné
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dovec
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Urbandt
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss