title: Laparoscopic conversion of failed vertical banded gastroplasty to Roux-en-Y gastric bypass or biliopancreatic diversion.
abstract: BACKGROUND
  The Silastic ring vertical gastroplasty (SRVG), a modification of Mason's vertical banded gastroplasty (VBG), was the restrictive procedure of choice for many bariatric surgeons. The reoperation rate for failure/complications reported in long-term studies is approximately 50%.
  
  
  OBJECTIVE
  We report our experience in laparoscopic conversion of failed SRVG to Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD).
  
  
  METHODS
  A single surgeon's experience at a university-affiliated hospital.
  
  
  METHODS
  Between March 2006 and April 2014, 39 patients underwent conversion of SRVG to laparoscopic RYGB (n = 25) or BPD (n = 14). The outcomes were retrieved from a prospectively collected database and analyzed.
  
  
  RESULTS
  Most (89%) of the conversions were completed laparoscopically. The mean operative time was 195 and 200 min for RYGB and BPD, respectively. There was no mortality. Complications occurred in 11 patients (28%), 5 in RYGB (19%) and 6 in BPD (42%). At the 3-year follow-up, the mean body mass index decreased from 47±8 kg/m(2) to 26±4 kg/m(2) for BPD, and from 43 kg/m(2) to 34 kg/m(2) (P = .05) for RYGB. Weight (kg) decreased from 110 to 84 and to 92, and from 123 to 81 and 68, at 1 and 3 years for RYGB and BPD, respectively.
  
  
  CONCLUSIONS
  The weight loss for RYGB and BPD was equal at 1 year but tended to be better for BPD at 3 years postoperatively. Laparoscopic conversion of failed VBG to RYGB or BPD was feasible, but it was followed by prohibitively high complication rates in BPD patients. The risk:benefit ratio of these procedures in this series is questionable.
authors: Department of Surgery Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel.
authors: Matan Ben
authors: MB
authors: David
authors: Department of Surgery, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel.
authors: Samir
authors: S
authors: Abu-Gazala
authors: Department of Surgery Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel.
authors: Eran
authors: E
authors: Sadot
authors: Department of Surgery Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel.
authors: Nir
authors: N
authors: Wasserberg
authors: Department of Surgery Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel.
authors: Hanoch
authors: H
authors: Kashtan
authors: Department of Surgery Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel. Electronic address: keidar66@yahoo.com.
authors: Andrei
authors: A
authors: Keidar
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods; D015904:Biliopancreatic Diversion / Q000379:methods*; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods; D006785:Hospitals, University; D006801:Humans; D007557:Israel; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology
keywords: Failed bariatric procedure; Laparoscopic Roux–en–Y gastric bypass; Laparoscopic biliopancreatic diversion; Silastic ring vertical gastroplasty; Vertical banded gastroplasty