Voranaddha Vacharathit, MD, Essa M Aleassa, MD, Matthew Kroh, MD, Stacy A Brethauer, MD, Philip R Schauer, MD, Ali Aminian, MD. Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland
Vertical banded gastroplasties (VBGs) were a common bariatric procedure in the 1980s but have largely fallen out of favor due to unsatisfactory weight loss and a relatively high incidence of long-term complications such as dysphagia and severe gastroesophageal reflux disease (GERD). One of the ways to address these undesirable effects is to convert to a Roux-en-Y gastric bypass (RYGB). The aim of this study was to assess the safety and efficacy of VBG-to-RYGB conversion.
Outcomes of VBG revisions performed at an academic center between 2008 and 2017 were reviewed.
Of the 54 VBG revisions, gastrogastrostomies were created in two patients, two underwent a planned 2-stage conversion, and 50 VBGs were converted to RYGBs. Patients were operated on an average of 24 years after their initial VBG. Presenting symptoms were weight regain (n=30, 55.6%), dysphagia (n=29, 53.7%), or severe GERD (n=23, 42.6%). Fourteen patients (26%) had a gastric staple line dehiscence. Of the 50 VBG to RYGB conversions, 39 were laparoscopic, 5 were converted to open, 4 were open, and 2 were robotic-assisted. Average operative time and length of hospital stay were 305.4 minutes and 9.2 days, respectively. Within the first 3 months post-operatively, twelve (24%) patients required readmission directly related to surgery, while eight (16%) visited the emergency department. Eight patients (16%) required at least one unplanned operation due to complication(s) during the entire follow-up: small bowel obstruction (n=3, at 1-week, 12-months, and 14-months), necrosis/leak of remnant stomach requiring remnant gastrectomy (n=3), tracheostomy for prolonged respiratory failure (n=2), bleeding (n=1), anastomotic leak (n=1), and hemothorax requiring VATS (n=1). Four patients (8%) had a contained perforation that was medically managed and five (10%) developed a gastrojejunal anastomosis stricture requiring endoscopic intervention. One patient (1.8%) developed pulmonary embolism. There was no mortality directly related to surgery. Complete resolution or improvement of GERD/dysphagia was appreciated in all patients in the short term follow-up. Patients who presented with weight regain had a mean BMI loss of 13.2±8.2 points in the median follow-up time of 8.5 months up to a year after conversion to RYGB.
In summary, reoperative bariatric surgeries after VBGs are complex, requiring longer operative times and length of stay. Our study found 16% risk of severe complications requiring reoperations, compared to the previously cited 38% in short and long-term complications. Conversion of VBG to RYGB provides excellent relief of severe GERD and dysphagia and is a viable option for significant weight reduction.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88570
Program Number: P557
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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