Revisional Surgery After Failed Vertical Banded Gastroplasty: Restoration of Vertical Banded Gastroplasty or Conversion to Gastric Bypass

Gemert, Wim G. van; Wersch, M M van; Greve, Jan; Soeters, P.B.

doi:10.1381/096089298765555006

Cited by 163 publications

(102 citation statements)

References 22 publications

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“…17,18 Three years after VBG, 56% of patients need revisional surgery. 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.…”

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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“…However, the long-term results of VBG have been questioned by authors (4,5). Several late complications have been described, including the need for revisional surgery in up to 56% of patients (6). Band erosion has been recognized as a potential late complication.…”

Section: Discussionmentioning

confidence: 99%

Migration of mesh into gastric lumen: A rare complication of vertical banded gastroplasty

Ece

Yılmaz

Şahi̇n

2016

UCD

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Migration of mesh into gastric lumen: A rare complication of vertical banded gastroplastyThe problem of revision of failed vertical banded gastroplasty (VBG) has become a common situation in bariatric surgery. Sleeve gastrectomy (SG) has been recently used to revise failed restrictive procedures. This study presents a patient that is treated with Roux-n-Y gastric bypass because of mesh migration after SG for revision of failed VBG.Keywords: Vertical banded gastroplasty, revisional surgery, mesh migration INTRODUCTIONVertical banded gastroplasty (VBG) is a purely restrictive procedure in which the upper part of the stomach is partitioned by a vertical staple line with a tight outlet wrapped by a prosthetic mesh or silastic band (1). Weight regain following VBG may be related to staple-line dehiscence and stomal pouch dilation (2). Sleeve gastrectomy (SG) is a good alternative for revisional surgery. In this study, we present current treatment for the complication of an old method. CASE PRESENTATIONA 32-year-old woman underwent open VBG for management of morbid obesity 11 years ago. Sleeve gastrectomy was performed for revisional surgery 3 years ago due to weight regain. The patient visited our outpatient clinic for epigastric pain that had persisted for the past 3 months. The physical examination was unremarkable except for mild tenderness in the epigastric region. Esophagogastroduodenoscopy demonstrated the gastroplasty mesh eroding into the stomach (Figure 1). Case was considered incomplete migration of VBG mesh (Figure 2, 3). Therefore, after taking the informed consent of patient, laparotomy was performed to confirm the mesh erosion. The mesh was removed, and Roux-en-Y gastric bypass was performed. Postoperative course was not eventful, and the patient was discharged on postoperative day 7. DISCUSSIONVertical banded gastroplasty a primarily restrictive bariatric surgical procedure, was first described by Mason (1). Weight loss occurs because of decreased caloric intake of solid food. Vertical banded gastroplasty has been documented as an effective operation for morbid obesity (3). However, the long-term results of VBG have been questioned by authors (4, 5). Several late complications have been described, including the need for revisional surgery in up to 56% of patients (6). Band erosion has been recognized as a potential late complication. The incidence of mesh or silastic ring erosion has been estimated at 0.4% to 3% (7). The average interval to mesh erosion has been reported at 3 to 4 years (7). Vertical banded gastroplasty has been replaced largely by other procedures and is rarely performed due to lack of sustained weight loss, as well as the high incidence of complications requiring revision (8). The most common cause of weight regain in VBG is staple-line disruption and pouch dilatation. Sleeve gastrectomy or Roux-n-Y gastric bypass could be selected according to the surgeon's experience, and patient's weight status for revisional surgery. In this study, we performed a sleeve gastrectomy 8 years after ...

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“…dence of revision as 56% after VBG as the primary operation. 8 The incidence of revision has been reported between 3.5% and 60% after LAGB. 9,10 In our study, all patients who underwent revision had previous restrictive procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Several technical options are offered as an alternative to failed VBG: Revision VBG, conversion to Roux-en-Y gastric bypass, to gastric banding and recently to SG. 8,14,[19][20][21][22][23] Studies have shown that SG is safe and effective in achieving adequate weight loss in most patients. 24,25 We performed Roux-en-Y gastric bypass in one and SG in two patients with failed VBG.…”

Section: Discussionmentioning

confidence: 99%

Revision Surgery in Bariatric Surgery: Initial Experience

Alptekın¹,

Yılmaz²,

Kafali³

et al. 2012

Turkiye Klinikleri J Med Sci

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A AB BS ST TR RA AC CT T OOb bj je ec ct ti iv ve e: : Revision surgery in bariatric surgery is becoming an important issue. It has been associated with higher complication rates, and there is no consensus on the standardized surgical approach to revision surgery. The aim of this study was to review the revision procedures performed in our institute. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : A retrospective review of a prospectively maintained database was performed. One hundred thirty three operations were performed for morbid obesity. Primary procedures were laparoscopic adjustable gastric banding (LAGB) in 61 patients, vertical band gastroplasty (VBG) in 24 patients, Roux-en-Y gastric bypass in 21 patients, sleeve gastrectomy in 10 patients and biliopancreatic diversion with duodenal switch in six patients. Eleven patients were reoperated due to mechanical complications or inadequate weight loss. Data including age, gender, preoperative weight, body mass index (BMI) and postoperative complications were reviewed for all patients undergoing a revision procedure. R Re es su ul lt ts s: In patients with previous VBG, failure of weight loss (3/4) and outlet stenosis (1/4) were the indications. In patients with previous LAGB, mechanical side effects were the indications of surgery. The gastrocolic fistula was the indication of surgery in patient who had been revised from VBG to sleeve gastrectomy. At the mean follow-up of 13 months, the mean BMI and percentage of excess BMI were 32.3 kg/m 2 and 37.4%, respectively. There was one stapler-line leakage. C Co on nc cl lu us si io on n: : Our study suggests that revision bariatric surgery can be performed with satisfactory short-term weight loss. The knowledge of the potential complications associated with revision surgery and their management is crucial for patients' safety. K Ke ey y W Wo or rd ds s: : Obesity; bariatric surgery; reoperation; body mass index Ö ÖZ ZE ET T A Am ma aç ç: : Bariatrik cerrahide revizyonel cerrahi önemli bir konu haline gelmektedir. Yüksek komplikasyon oranları ile ilişkili bulunmuştur ve revizyonel cerrahide standart cerrahi yaklaşımla ilgili fikir birliği yoktur. Bu çalışmanın amacı bizim merkezimizde yapılan revizyonel cerrahilerin göz-den geçirilmesidir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : İleri dönük olarak sürdürülen veri tabanı geriye dönük olarak gözden geçirildi. Morbid obezite nedeniyle 133 ameliyat yapıldı. Birincil ameliyat 61 hastada laparoskopik ayarlanabilir gastrik bantlama (LAGB), 24 hastada vertikal bantlı gastroplasti (VBG), 21 hastada Roux-en-Y gastrik baypas, 10 hastada sleeve gastrektomi ve altı hastada duodenal switch ile biliopankreatik diversiyondu. Onbir hasta mekanik komplikasyonlar veya yetersiz kilo kaybı nedeniyle tekrar ameliyat edildi. Yaş, cinsiyet, ameliyat öncesi ağırlık, beden kitle indeksi (BKİ) (bariatrik ve revizyonel cerrahiden önce) ve postoperatif komplikasyonları içeren veriler revizyon işlemi yapılan tüm hastalarda gözden geçirildi. B Bu ul lg gu ul la ar r: : D...

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Revisional Surgery After Failed Vertical Banded Gastroplasty: Restoration of Vertical Banded Gastroplasty or Conversion to Gastric Bypass

Abstract: Conversion of a failed VBG to a RYGB is more effective than a reVBG, because conversion to RYGB provides satisfactory weight loss without requiring further revisional surgery.

Cited by 163 publications

References 22 publications

A comparison of revisional and primary bariatric surgery

A comparison of revisional and primary bariatric surgery

Migration of mesh into gastric lumen: A rare complication of vertical banded gastroplasty

Revision Surgery in Bariatric Surgery: Initial Experience

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