title: Endoscopic revision (StomaphyX) versus formal surgical revision (gastric bypass) for failed vertical band gastroplasty.
abstract: BACKGROUND
  Weight regain secondary to VBG pouch dilation is a typical referral for Bariatric surgeons. In this study we compare an endoluminal pouch reduction (Stomaphyx) to RYGB for revision.
  
  
  METHODS
  A retrospective review was completed for patients with a previous VBG presenting with weight regain between 2003-2010.
  
  
  RESULTS
  Thirty patients were identified for study 23 RYGB, 14 StomaphyX. Significant post procedure BMI loss was seen in each cohort (RYGB, 47.7 ± 7 kg/m(2) to 35 ± 7 kg/m(2); StomaphyX 43 ± 10 kg/m(2) to 40 ± 9 kg/m(2), P = 0.0007). Whereas nausea and headache were the only complications observed in StomaphyX patients, the RYGB group had a 43.5% complication rate and 1 mortality. Complications following RYGB include: incisional hernia (13%), anastomotic leak (8.7%), respiratory failure (8.7%), fistula (8.7%), and perforation (4.35%). The median length of stay following RYGB was 6 days compared to 1.5 ± 0.5 days following StomaphyX.
  
  
  CONCLUSIONS
  This study suggests that while RYGB revision may achieve greater weight loss, the complication rates and severity is discouraging. StomaphyX may be a safe alternative. Further technical modifications of the device and longer follow-up may clarify the role of this approach.
authors: Department of Surgery, University of Alberta, Edmonton, AB, Canada T6G 2B7.
authors: Johan
authors: J
authors: Bolton
authors: Richdeep S
authors: RS
authors: Gill
authors: Akram
authors: A
authors: Al-Jahdali
authors: Simon
authors: S
authors: Byrns
authors: Xinzhe
authors: X
authors: Shi
authors: Daniel W
authors: DW
authors: Birch
authors: Shahzeer
authors: S
authors: Karmali
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D015391:Gastroplasty; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D017211:Treatment Failure; D015430:Weight Gain; D015431:Weight Loss
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