Conversion of Vertical Banded Gastroplasty to Roux-en-Y Gastric Bypass Results in Restoration of the Positive Effect on Weight Loss and Co-morbidities: Evaluation of 101 Patients

BACKGROUND: Vertical banded gastroplasty (VBG) is a widely used restrictive procedure in bariatric surgery. However, the re-operation rate after this operation is high. In the case of VBG failure, a conversion to Roux-en-Y gastric bypass (RYGBP) is an option. A study was undertaken to evaluate the results of the conversion from VBG to RYGBP. METHODS: 101 patients had conversion from VBG to RYGBP. Patients were separated into 3 groups, based on the indication for conversion: weight regain (group 1), excessive weight loss (group 2) and severe eating difficulties (group 3). Data for the study were collected by retrospective analysis of prospectively recorded data. RESULTS: Weight regain (group 1) was the reason for conversion in 73.3% of patients. Staple-line disruption was the most important cause for the weight regain (74.3%). Excessive weight loss (group 2) affected 14% of patients and was caused by outlet stenosis in 78.6% of patients. The remaining 13% had severe eating difficulties as a result of outlet stenosis (46.1%), pouch dilatation (30.8%) and pouch diverticula (23.1%). Mean BMI before conversion to RYGBP was 40.5, 22.3 and 29.8 kg/m2 in group 1, 2 and 3, respectively. Minor or major direct postoperative complications were observed in 2.0% to 7.0%. Long-term complications were more frequent, and consisted mainly of anastomotic stenosis (22.7%) and incisional hernia (16.8%). Follow-up after conversion was achieved in all patients (100%), with a mean period of 38 +/- 29 months. BMI decreased from 40.5 to 30.1 kg/m2, increased from 22.3 to 25.3 kg/m2. and decreased slightly from 29.8 to 29.0 kg/m2 in group 1, 2 and 3, respectively. All patients in group 3 noticed an improvement in eating difficulties. CONCLUSION: Complications after conversion from failed VBG to RYGBP are substantial and need to be considered. However, the conversion itself is a successful operation in terms of effect on body weight and treating eating difficulties after VBG

Laparoscopic placement of non-adjustable silicone ring for weight regain after roux-en-Y gastric bypass

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Estudo da gastrinemia pré e pós-operatória em pacientes submetidos à gastroplastia vertical com banda e reconstrução em Y de Roux por obesidade mórbida

OBJETIVO: Avaliar as concentrações pré e pós-operatória da gastrina sérica, hormônio fundamental na produção do ácido clorídrico gástrico, correlacionando-as com as complicações cloridropépticas pós-cirúrgicas, em pacientes submetidos à gastroplastia vertical com banda e reconstrução em Y de Roux (GVBYR). MÉTODO: Foram incluídos neste estudo, 20 pacientes com Índice de Massa Corpórea (IMC) superior a 40 Kg/m² selecionados após rigorosa avaliação psicológica. A dosagem da gastrina foi realizada no pré e no pós-operatório. Neste mesmo período todos os pacientes forma também submetidos a exame endoscópico com biópsia para estudo histopatológico. RESULTADOS: As quantidades de gastrina produzidas antes e após o tratamento cirúrgico não diferiram significativamente (p= 0,4281). Nenhum paciente apresentou alteração endoscópica ou histológica até o 2º mês de pós-operatório. CONCLUSÃO: Após a realização da GVBYR ocorre uma adaptação do tubo digestivo, de modo a manter a sua fisiologia, conduzindo-nos à convicção da segurança dessa técnica no tratamento da obesidade mórbida