CONVERSION OF FAILED OR COMPLICATED VERTICAL BANDED GASTROPLASTY TO GASTRIC BYPASS IN MORBID-OBESITY

BACKGROUND: Previous studies have documented a significantly better we ight loss for gastric bypass (GBP) than for vertical banded gastroplas ty (VBG). Additional problems associated with VBG include intractable vomiting or gastroesophageal (GE) reflux, intragastric migration of th e polypropylene band, staple line disruption, or inadequate weight los s due to excessive ingestion of high-calorie liquid or soft carbohydra tes. PATIENTS AND METHODS: Fifty-eight morbidly obese patients underwe nt conversion from VBG to GBP for either weight-loss failure (15) or c omplications of VBG (43), including 2 who were referred with anastomot ic leaks and peritonitis, 3 with band erosion, 15 with staple line dis ruption, and 23 with stomal stenosis, of whom 6 had severe GE reflux, with a Barrett's esophagus in 1. RESULTS: Percentage of excess weight loss in the 53 patients followed up for at least 1 year after conversi on increased from 36% +/- 24% to 67% +/- 18%, and in the 15 ''sweets e aters'' from 20% +/- 19% to 70% +/- 19% (both P <0.001), was equal to weight loss after primary GBP, and was reasonably constant over 8 year s in those patients who could be contacted for follow-up, although ave rage follow-up after 5 years was only 45%. All patients had resolution of GE reflux symptoms immediately after surgery and for at least 1 ye ar or at last contact. Complications of conversion included 2 anastomo tic leaks with major wound infections (1 in a referred patient requiri ng emergency subtotal gastrectomy following a VBG leak), 3 staple line disruptions (2 subclinical), 3 small-bowel obstructions, and 20 margi nal ulcers or stomal stenoses (all responded to endoscopic balloon dil ation or acid reduction therapy). Hemoglobin, calcium, and Vitamin B-1 2 levels remained within normal levels with prophylactic supplementati on in patients who returned for follow-up evaluation. CONCLUSIONS: The se data support the efficacy of conversion to GBP in morbidly obese pa tients with a failed or complicated VBG.