CONVERTING VERTICAL BANDED GASTROPLASTY TO A LESSER CURVATURE GASTRICBYPASS - TECHNICAL CONSIDERATIONS

Background: Vertical banded gastroplasty (VBG) is occasionally followe d by poor weight loss or complications requiring reoperation. Several studies have analyzed the morbidity and mortality associated with conv ersions of VBG to gastric bypass, but few have described the actual te chnique. The most frequent complications related to this type of reope ration are gastrointestinal leaks. Materials and Methods: The authors analyzed 60 consecutive conversions from VBG to lesser curvature gastr ic bypass, performed on 60 patients. The cases were analyzed for surgi cal technique, complications and weight loss. In all the cases the ope ration was limited to the lesser curvature of the stomach, and certain technical maneuvers were done to facilitate the creation of the pouch and anastomosis. Results: There were three major complications, and t wo patients required reoperation. There were no gastrointestinal leaks or mortality. Percentage weight loss at 5 years was similar to primar y gastric bypasses. Conclusion: Converting failed or complicated VBGs to lesser curvature gastric bypasses are safe and effective weight los s operations. By performing several specific technical maneuvers and l imiting the operation to the highly vascular lesser curvature, complic ations can be reduced to a minimum. (C) 1998 Lippincott-Raven Publishe rs.