Daniel T McKenna, MD, Samer Mattar, MD, Daniel Mwanza, DO, Michael Burchett, DO, Lori Blythe, APRN, Jennifer Choi, MD, Don Selzer, MD
Indiana University School of Medicine
Introduction: Many patients with a history of failed or complicated bariatric operations seek revision. Reoperative gastric surgery is associated with increased perioperative risk and uncertain benefit.
Methods and Procedures: A retrospective cohort analysis of all patients who underwent conversion of Vertical Banded Gastroplasty (VBG) or Roux en-y Gastric bypass (RNYGB) to RNYGB between January 2005 and January 2011 was conducted.
Results: All patients undergoing revision with weight regain between January 2005 and January 2011:
| VBG | RNYGB | |
| Patients | 53 | 22 |
| Mean Age (years) | 50.2 | 49.4 |
| Mean BMI | 47.9 | 41.9 |
| Mean length of stay (days) | 6.2 | 4.3 |
| Mean operative time (minutes) | 183.3 | 186.3 |
| Mean follow up (months) | 19.2 | 18.1 |
| Mean%EWL | 46.4 | 39 |
| Mean Weight Loss (lbs) | 66.7 | 45.4 |
| Mean Complication Rate | 49% | 31.8% |
There were 22 RYGB patients with a history of weight regain who underwent RNYGB revisional surgery with the following indications: Gastrogastric (G-G) fistula (8), G-G fistula and large pouch (3), G-G fistula and large stoma (1), large pouch (7), gastrojejunal stricture (1), and widened stoma (2). There were 21 females and 1 male. There were 3 open cases, two of which were conversions to open because of uncontrolled hemorrhage, with one splenectomy.
Fifty-three patients underwent a conversion of VBG to a RNYGB. In addition to weight regain, the additional surgical indications included an enlarged pouch (16); band erosion/stricture (5), staple line dehiscence (11), intractable nausea and vomiting (3), and medically recalcitrant GERD with associated hiatal hernia (8). Eighteen procedures were completed open, 31 were completed laparoscopically, and 4 were converted from laparoscopic to open.
Twenty-six patients following VBG-RNY conversion (49%) and 7 patients following RNY revision (31.8%) had major or minor complications. Readmission rates were 17.0% and 22.7% for VBG and RNYGB conversion respectively. VBG to RNYGB patients had 3 anastomotic leaks (11.3%), bleeding (15.1%), stricture (7.5%) and one death (1.9%) due to leak and sepsis. RNY revisions had anastomotic leaks (9.1%), strictures (9.1%), readmission (22.7%), and wound infection (9.1%).
Conclusion: In midterm follow-up, conversion of vertical banded gastroplasty to Roux-en Y gastric bypass and revision of Roux-en Y Gastric Bypass are associated with high complication rate and modest weight loss. Prospective patients should be counseled accordingly.
Session: Poster Presentation
Program Number: P449
