Conversion of failed or complicated vertical banded gastroplasty to gastric bypass in morbid obesity

Sugerman, Harvey J.; Kellum, John M.; DeMaria, Eric J.; Reines, H. David

doi:10.1016/s0002-9610(97)89565-7

Cited by 139 publications

(78 citation statements)

References 20 publications

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“…19 Studies also suggest a 26%-48% rate of staple line failure within 5 years. 20,21 Therefore, it is not surprising that a large portion of the revision clinic patients comprises those who underwent VBG. Ten-year follow-up of this procedure is uncommon, but 1 study reported only 26% of patients maintained weight loss in the long term.…”

Section: Discussionmentioning

confidence: 99%

A comparison of revisional and primary bariatric surgery

Fulton

Sheppard

Birch

et al. 2017

CJS

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A comparison of revisional and primary bariatric surgeryBackground: Revisional surgery is an important component of addressing weight regain and complications following primary bariatric surgery. Owing to provincial need and the complexity of this patient population, a specialized multidisciplinary revision clinic was developed. We sought to characterize patients who undergo revision surgery and compare their outcomes with primary bariatric surgery clinic data. Methods:We completed a retrospective chart review of bariatric revision clinic patients compared with primary bariatric surgery patients from December 2009 to June 2014. Results:We reviewed the charts of 2769 primary bariatric clinic patients, 886 of whom had bariatric surgery, and 534 revision bariatric clinic patients, 83 of whom had revision surgery. Fewer revision clinic patients underwent surgery than primary clinic patients (22% v. 32%). The mean preoperative body mass index (BMI) was 44.7 ± 9.5 in revision patients compared with 45.7 ± 7.6 in primary bariatric surgery patients. Most revision patients had a prior vertical banded gastroplasty (VBG; 48%) or a laparoscopic adjustable gastric band (LAGB; 24%). Bands were removed in 36% of all LAGB patients presenting to clinic. Of the 134 procedures performed in the revision clinic, 83 were bariatric weight loss surgeries, and 51 were band removals. Revision clinic patients experienced a significant decrease in BMI (from 44.7 ± 9.5 to 33.8 ± 7.5, p < 0.001); their BMI at 12-month follow-up was similar to that of primary clinic patients (34.5 ± 7.0, p = 0.7). Complications were significantly more frequent in revision patients than primary patients (41% v. 15%, p < 0.001). Conclusion:A bariatric revision clinic manages a wide variety of complex patients distinct from those seen in a primary clinic. Operative candidates at the revision clinic are chosen based on favourable medical, anatomic and psychosocial factors, keeping in mind the resource constraints of a public health care system. Contexte : La chirurgie de révision est une intervention importante lors d'une reprise de poids ou lors de complications à la suite d'une chirurgie bariatrique primaire. Compte tenu des besoins provinciaux et de la complexité de cette population de patients, une clinique de révision multidisciplinaire spécialisée a été créée. Nous avons voulu caractériser les patients qui subissent une chirurgie de révision et comparer leurs résultats aux données de la clinique de chirurgie bariatrique primaire.Méthodes : Nous avons procédé à un examen rétrospectif des dossiers des patients de la clinique de révision bariatrique par rapport aux patients ayant subi une chirurgie bariatrique primaire entre décembre 2009 et juin 2014.Résultats : Nous avons examiné les dossiers de 2769 patients de la clinique bariatrique primaire, dont 886 avaient subi une chirurgie bariatrique, et 534 patients de la clinique de révision, dont 83 avaient subi une chirurgie de révision. Un moins grand nombre de patients de la clinique de révision ont subi une c...

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Section: Discussionmentioning

confidence: 99%

A comparison of revisional and primary bariatric surgery

Fulton

Sheppard

Birch

et al. 2017

CJS

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“…Frequent vomiting associated with gastro-oesophageal reflux may, however, occur in some patients, as a result of stomal stenosis; this may prove refractory even to multiple attempts at endoscopic balloon catheter dilation 16 . Late failure in terms of insufficient loss of weight, or even of weight regain, may result either from an excessive ingestion of high-calorie liquids and sweet foods, or from staple disruption.…”

Section: Gastroplastiesmentioning

confidence: 99%

“…If vertical banded gastroplasty is followed by complications, such as intractable vomiting with gastro-oesophageal reflux, staple line disruption or inadequate loss of weight, some authors advocate conversion of complicated or failed gastroplasty to gastric bypass 16 . This opinion is not shared by Mason 18 who considers that, in the case of staple disruption, the simplest revision is to restaple the pouch, and that vertical banded gastroplasty not followed by a stenosis of the outlet, is amongst the best of antireflux operations.…”

Section: Gastroplastiesmentioning

confidence: 99%

“…According to some authors 5 ' 16 , vertical banded gastroplasty is not a suitable intervention in these subjects, and gastric bypass offers them much better postoperative results. Indeed, the gastric bypass procedure is followed by rapid emptying of the gastric pouch into the small bowel with ensuing aversion to sweets, due to the dumping syndrome 3 ' 9 ' 16 .…”

Section: Long-term Benefits Of Gastric Surgerymentioning

confidence: 99%

“…Since vitamin B12, in its protein-bound form, is poorly absorbed in these patients, Rhode 30 has recently suggested daily administration of the crystalline form of vitamin B12 at very high dosage. Indeed, at least 350 ug of crystalline vitamin B12 are necessary to normalize the serum levels of this vitamin, and a dosage as high as 500 ug/day has been recommended 16 . Monthly vitamin B12 injections may be substituted for oral administration.…”

Section: Gastric Surgery -Related Risks and Complicationsmentioning

confidence: 99%

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Surgical treatment for morbid obesity

Kolanowski

1997

British Medical Bulletin

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Since severe obesity is frequently associated with serious metabolic, cardiovascular and psychological co-morbid conditions, and given the usually unsuccessful results of conservative therapeutic approaches, surgical treatment based on gastric restriction procedures is increasingly recognized as a treatment of choice for morbidly obese persons. Among several surgical approaches designed to promote a substantial loss of weight, two gastric restriction procedures, i.e. the vertical banded gastroplasty and the gastric bypass, have been increasingly used during the past years. Both techniques induce an impressive loss of weight, and are surprisingly well tolerated, even by severely obese persons.The usual 50-75% reduction of initial weight excess, is followed by a clear-cut reduction, or even disappearance of, obesity-related co-morbidity, such as hypertension, diabetes mellitus or sleep apnea syndrome.While serious peri-and postoperative risks are very limited, the intractable vomiting occurring after gastroplasty, and potential sequelae related to iron and calcium malabsorption after the gastric bypass, represent much more frequent complications of the surgical treatment of obesity. There is also a tendency towards a late regain of weight, but the benefit in terms of improvement in the obesity-associated co-morbidity is in general maintained despite this partial increase in weight.Gastric procedures are, therefore, an effective treatment of severe obesity and of its co-morbid conditions. However, careful medical and nutritional supervision is necessary during the follow-up after surgery, to prevent potential nutritional or digestive complications.

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