Laparoscopic Revision of Vertical Banded Gastroplasty to Sleeve Gastrectomy for Gastric Outlet Obstruction: Early Experience in 18 patients

Richdeep S Gill, MD, PhD, Shahzeer Karmali, MD, John A Primomo, MD, Lee Morris, MD, Xinzhe Shi, MPH, Vadim Sherman, MD, FACS. (1) Department of Surgery, University of Alberta, Edmonton, Alberta, Canada. (2) Center for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandria Hospital, Edmonton, Alberta, Canada. (3) The Methodist Hospital, Houston, Texas, USA.

The long-term effectiveness of Vertical Banded Gastroplasty (VBG) is limited due to development of complications related to gastric outlet obstruction at the band site. Surgical reversal or conversion to Roux-en-Y gastric bypass has been the mainstay of treatment for complications. The purpose of this study was to assess outcomes of revising VBG to laparoscopic sleeve gastrectomy (LSG) in patients presenting with gastric outlet obstruction.

We retrospectively reviewed 18 consecutive patients that underwent revision of VBG to LSG for gastric outlet obstruction, from 2008 to 2012, in an academic institution.

The mean age of the patients was 47 ± 11 years (89% females), with mean preoperative BMI of 36 ± 8 kg/m2. Comorbidities included diabetes (n=1) and hypertension (n=5). The mean length of time from the original VBG was 10 ± 7 years. Gastric outlet obstruction, diagnosed by EGD and UGI, was present in 100% (n=18). Intolerance to solid food was present in 40%, while 45% had reflux symptoms. The mean operative time was 187±50 min. There was one conversion to open sleeve gastrectomy secondary to dense adhesions. There were two staple-line leaks (11%) requiring reoperation. There were no perioperative bleeds and no deaths. Symptom resolution was observed in 95% of patients. Postoperative BMI was 33 ± 6 kg/m2 at 15-month follow-up.

Revision of VBG to LSG is a safe and feasible option for patients presenting with gastric outlet obstruction with low BMI. This procedure alleviates gastric outlet obstruction, while maintaining gastric restriction.

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