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Conversion of Failed Vertical Banded Gastroplasty to Biliopancreatic Diversion, a Wise Option
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Clinical Research
Conversion of Failed Vertical Banded Gastroplasty to Biliopancreatic Diversion, a Wise Option
Markos Daskalakis1, Oliver Scheffel1, Sophia Theodoridou1 and Rudolf A. Weiner1 
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Center for Minimal-Invasive Surgery, Department of General and Bariatric Surgery, Krankenhaus Sachsenhausen, Schulstr. 31, 60594, Frankfurt am Main, Germany |
Received: 14 April 2009 Accepted: 28 July 2009 Published online: 29 August 2009
Abstract
Background Reoperations due to failures constitute an essential but challenging part of bariatric surgery practice today. The aim of
this study was to evaluate the perioperative safety, efficacy, and postoperative quality of life in patients with biliopancreatic
diversion (BPD), after failed vertical banded gastroplasty (VBG).
Methods Twelve patients after failed or complicated VBG, eight females and four males, median age 45 years (range 39–52), median body
mass index (BMI) 46.39 kg/m 2 (range 25.89–69.37), who underwent conversion to BPD, were studied.
Results Ten patients due to weight regain and two patients because of severe stenosis of the gastric pouch outlet were submitted in
conversion to BPD. In eight (66.6%) patients the primary VBG had been followed by at least one revisional operation due to
inadequate weight loss. The 10 patients after failed VBG, reached the lowest BMI recorded after VBG in just a year after BPD
( p = 0.721 for the comparison between the two time points). The two patients with stomal stenosis regained weight in the first
six postoperative months and remain stable since then. Regarding safety, one major perioperative complication (gastrojejunostomy
stenosis) occurred. At a median follow-up of 21 months (range 12–30) six complications have been documented, including a case
of incisional hernia, four cases of pouch gastritis and a case of intractable iron-deficiency anemia.
Conclusion Our early results indicate that conversion of failed VBG to BPD is highly effective with acceptable morbidity. Our data show
that the effect on weight is strongly dependent on the indication for the conversion. Conversion to BPD, in such a group of
patients, is a wise alternative, since it may reduce operative risks.
Keywords Bariatric surgery - Vertical banded gastroplasty - Conversion - Revision - Biliopancreatic diversion
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