REVISIONAL SURGERY AFTER FAILED VERTICAL BANDED GASTROPLASTY - RESTORATION OF VERTICAL BANDED GASTROPLASTY OR CONVERSION TO GASTRIC BYPASS

Background: An increasing number of patients with a failed primary bar iatric procedure present themselves for secondary treatment. Only a fe w studies have investigated critically the success of revisional surge ry. In the present study, the effectiveness of revisional surgery for failed vertical banded gastroplasty (VBG) is analyzed: restoration of the VBG (reVBG) is compared to conversion to a Roux-en-Y gastric bypas s (RYGB). Patients and Methods: From 1980 to 1996, 136 consecutive mor bidly obese patients underwent primary RYGB (n = 20) or VBG (n = 16). Weight loss, indications and complications after revisional surgery we re registered. The rate of revisional surgery after primary and second ary bariatric procedures was estimated by means of a Kaplan-Meier anal ysis. Results: Kaplan-Meier analysis revealed that 56% of the patients will eventually require revisional surgery after initial VBG over a 1 2-year period compared to 12% after initial RYGB (P < 0.01). After reV BG 68% will need revisional surgery over a 5-year period, while no fur ther revisional surgery was required after conversion to a RYGB (P < 0 .05). Body mass index dropped significantly after reVBG or conversion to RYGB for insufficient weight loss (P < 0.05), however, more revisio nal surgery was necessary after reVBG to achieve this result. The comp lication rate was comparable between reVBG and conversion to RYGB (33% ). Conclusion: 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. (C) 1998 Rapid Scie nce Ltd.