Morbid obesity has been on the rise in the United States. A decade ago, open vertical gastroplasty was a popular restrictive gastric surgery for weight reduction with a high failure rate. We report our experience in a single institution in converting vertical band gastroplasty (VBG) to roux en y gastric bypass (RYGB) laparoscopically.
A prospective database of all laparoscopic conversions of (VBG) to (RYG) by the senior author (PRR) has been maintained since 1992. Clinical data required included; Body Mass index (BMI) prior to the (VBG), (BMI) before the (LRYGB), operative time (OT), Estimated Blood Loss (EBL), Length of Stay (LOS), intraoperative and postoperative complications. All operations were completed laparoscopically; all patients were given low molecular weight heparin on induction, lower extremities compression devices, and urinary catheter. The abdomen was entered utilizing a 2mm port to insufflate the abdomen, and then a total of six ports were used; two 12mm ports, and four 5mm ports. The anastomosis of the Roux limb with the gastric pouch was created using a double layer of absorbable sutures, and the Roux limb was sutured to the distal end of the biliopancreatic in a side-to-side fashion using a 60 mm endo Gia stapler, and the opening to create the anastomosis was over sewn with a running absorbable suture. The roux limb gastric pouch anastamosis was tested intraoperatively for a leak by placing it under saline irrigation and injecting air via nasogastric tube in to the gastric pouch. A 15 French Blake drain was left next to the proximal anastamosis in all cases.
All twenty-two conversions were completed laparoscopically. There was one male and twenty-one females. One patient (4.3%) had a postoperative leak at the gastrojejunostomy that was detected on an UGI and treated non-operatively. BMI prior to VBG was 45 ± 10.1; BMI before LRYGB was 47.5 ± 6.1; OT was 447 ± 97.4 minutes, EBL 182 ± 175.3 ml, LOS 3.3 ± 4.3 days.
Although converting a VBG to RYGB laparoscopically requires longer operative times, it can be performed with acceptable operative outcomes and length of stay.
Program Number: P071