title: Laparoscopic conversion of failed silastic ring vertical gastroplasty (SRVG) and vertical banded gastroplasty (VBG) into biliopancreatic diversion (BPD).
abstract: BACKGROUND
  The Silastic ring vertical gastroplasty (SRVG), a newer modification of Mason's vertical banded gastroplasty (VBG), was the restrictive procedure of choice for many bariatric surgeons before the advent of the laparoscopic adjustable gastric banding. However, a high rate of reoperations for failure and severe complications was reported in long-term studies. Around 50% of the patients underwent conversion to other bariatric procedures.
  
  
  OBJECTIVE
  The aim of this study is to report our experience in laparoscopic conversion of failed VBG and SRVG to biliopancreatic diversion (BPD).
  
  
  METHODS
  The setting of the study was at the University hospital.
  
  
  METHODS
  Between March 2010 and July 2013, 12 patients underwent laparoscopic conversion of VBG and SRVG to BPD. Using a prospectively collected database, we analyzed their data and outcomes.
  
  
  RESULTS
  Eighty-six percent of the conversions were successfully completed laparoscopically. The mean operative time was 220 min. There was no mortality. Perioperative complications occurred in four patients (33%). One (9%) late complication, an adhesional small bowel obstruction, was encountered later than 30 days postoperatively. The follow-up rate was 100%, but only three patients reached 3 years at the time of this writing. At a mean follow-up of 19 (3-40) months, the mean body mass index (BMI) decreased from 45.3 to 27.8 kg/m2. Percent excess weight loss (EWL) was 65.7, and 86.3% at 1 and 3 years, respectively.
  
  
  CONCLUSIONS
  Laparoscopic conversion of failed VBG to BPD is feasible and effective in further reducing weight in morbidly obese patients. Weight loss continues beyond the first postoperative year. However, the complication rate is much higher than in the primary procedure.
authors.affiliation: The Department of Surgery, Hadassah Hebrew University Medical Center, PO Box 12000, Ein Kerem, Jerusalem, 91120, Israel, samirski11@yahoo.com.
authors.forename: Samir
authors.initials: S
authors.lastname: Abu-Gazala
authors.forename: Eran
authors.initials: E
authors.lastname: Sadot
authors.forename: Ilanit
authors.initials: I
authors.lastname: Maler
authors.forename: Inbal
authors.initials: I
authors.lastname: Golomb
authors.forename: Idan
authors.initials: I
authors.lastname: Carmeli
authors.forename: Andrei
authors.initials: A
authors.lastname: Keidar
mesh_terms: D000328:Adult; D000368:Aged; D015904:Biliopancreatic Diversion; D015992:Body Mass Index; D004129:Dimethylpolysiloxanes; D005260:Female; D015391:Gastroplasty; D006785:Hospitals, University; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D012086:Reoperation; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D004129:Dimethylpolysiloxanes; C013830:baysilon