Lesser curvature Roux-en-Y gastric bypass as an alternative procedure to failed vertical banded gastroplasty: Surgical technique and short term results

Purpose : The incidence of revisional surgery for failed vertical banded ga stroplasty has increased markedly over the last years. Conversion to gastri c bypass is considered as a good alternative with satisfactory long term we ight loss without further revisional surgery. Nevertheless, significant mor bidity and mortality is still associated with this procedure. New technical aspects make it safer and more effective. The aim of the work is to expose a surgical bypass technique to attempt to reduce morbidity. Patients and methods : Thirty patients have undergone conversions from fail ed vertical banded gastroplasty to a lesser curvature Roux-en-Y Gastric Byp ass. Surgical technique is described in detail and early complications and initial weight loss were analyzed (mean follow-up: 12 months). Results : The key points of the operation were the small vertical pouch, th e complete transection of the distal bypassed stomach, the interposition of a jejunal limb between the two gastric shares and the latero-lateral gastr ojejunal anastomosis without proximal ring interposition. For the entire series, we noticed one major complication, an acute pancreat itis causing anastomotic fistula and four mild complications, one bleeding on the excluded stomach, one bronchopneumonia, one pleural effusion and one wound dehiscence. The percentage of excess weight loss attained 56.1% at o ne year follow-up. Conclusions : There have been tremendous improvements in the safety of gast ric bypass over the years. One year follow-up indicates that our surgical b ypass procedure is secure with a low complication rate.