Laparoscopic Conversion: VBG to Gastric Bypass

Edward L Felix, MD. Marian Hospital, Santa Maria California.

Vertical banded gastroplasties were common 20 to 30 years ago, but are rarely performed today because of high failure rates and complications. Complications include band erosion, stenosis or obstruction, reflux, and gastro-gastric fistulas or break down of the partitioning staple line as well as weight regain. Patients are still presenting today with one or more of these complications requiring work-up and correction. A complete work-up including UGI and endoscopy are required to define the anatomy and complications before repair is undertaken.

The patient in this video initially presented with weight regain and gerd. She had difficulty tolerating a regular diet and had gained her weight on a high caloric liquid and soft diet. An UGI revealed an obvious gastro-gastric fistula. On upper endoscopy there was a high gastro-gastric fistula, hiatal hernia and moderate obstruction at the level of the band.

She was laparoscoped, the adhesions taken down, a vertical pouch created, a partial gastrectomy performed, and the new roux-en-y gastric bypass created. The techniques and tricks utilized to safely perform the laparoscopic conversion are demonstrated including leak test and repair of the staple line leak.

Failed vertical banded gastroplasties are becoming less common, but being ready to correct the complications still represents an important part of every bariatric surgeon’s expertise. 

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