Bariatric Revisionary Surgery for Failed or Complicated Vertical Banded Gastroplasty (VBG): Comparison of VBG Reoperation (re-VBG) versus Roux-en-Y Gastric Bypass-on-VBG (RYGB-on-VBG)

Background. Revision of failed bariatric procedures is a significant challenge for bariatric surgeons, because of the increasing number of recurring morbid obesity or complications, especially in patients with a previous Vertical Banded Gastroplasty (VBG). Methods. Since November 1998, 109 patients with failed or complicated VBG were followed in a retrospective study. 49 patients underwent re-VBG and, since 2004, 60 underwent Roux-en-Y Gastric Bypass-on-Vertical Banded Gastroplasty (RYGB-on-VBG). Results. At 3 years follow-up, mean BMI decreased from 37.4 to 31.2 Kg/m2 in the first group, and from 35.0 to 28.4 Kg/m2 in the second. Early complications were 7 (14.3%) in the first group and 4 (6.5%) in the second; late complications were 33 (59.1%) and 11 (18.3%), respectively. Conclusion. Although both operations seem to be effective as bariatric revision procedures in terms of BMI, the mid-term outcomes of RYGB-on-VBG demonstrate the lowest rate of complications and better quality of life

Il Bypass Gastrico: evoluzione di una tecnica

Riportiamo l'evoluzione della nostra esperienza in chirurgia bariatrica con l'evoluzione da tecniche tradizionali di Bypass Gastrico su ansa alla Roux a nuove soluzioni per consentire lo studio endoscopico e radiologico dello stomaco esclus

GORD and Barrett’s oesophagus after bariatric procedures: multicentre prospective study

Introduction: Gastroesophageal reflux disease (GORD) after bariatric surgery (BS) is a debated topic. This study investigated the prevalence of GORD and related oesophageal complications after bariatric procedures – namely, adjustable gastric banding (AGB), sleeve gastrectomy (SG), Roux-en- Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB). Methods: This was a prospective multicentre study designed to evaluate long-term effects of BS on GORD. Patients were studied at baseline, at >10 years after AGB, SG, RYGB and at >3 years after OAGB (due to its more recent recognition as a standard bariatric procedure). Patients were assessed by endoscopy and GORD symptom evaluation. Results: A total of 241 patients were enrolled. A minimum follow-up of 10 years was reached by 193 patients after AGB (n=57), SG (n=95), RYGB (n=41) and by 48 subjects >3 years after OAGB. GERD symptoms increased after AGB and SG (from 14.0% to 31.6% and 26.3% to 58.9%; P<0.0001, respectively), improved after RYGB (from 36.6% to 14.6%; P<0.0001) and were unchanged after OAGB. The overall prevalence of erosive oesophagitis was greater after SG (74.7%) than AGB (42.1%), RYGB (22.0%), or OAGB (22.9%), (P<0.0001). Barrett’s oesophagus was found only after SG in 16.8%. More biliary-like gastric stagnation was found in SG and OAGB patients (79.7% and 69.4%, respectively) than other groups (P<0.0001). Biliary-type reflux into the oesophagus was worst after SG (74.7%). Conclusions: Bariatric surgery leads to gastroesophageal consequences of variable extent. Sleeve gastrectomy is particularly troublesome with a large proportion developing Barrett’s oesophagus