Unsatisfactory weight loss after vertical banded gastroplasty: is conversion to Roux-en-Y gastric bypass successful?

Abstract

Background: In 1991, the National Institutes of Health sanctioned 2 operations for treatment of morbid obesity: vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGB). Long-term results with VBG are disappointing. We wondered whether patients who had "adapted" to the VBG anatomy and had regained weight would lose weight after conversion to RYGB.

Methods: We reviewed data on patients undergoing conversion of VBG to RGYB.

Results: Fifty-four patients (mean body mass index [BMI] of 46 kg/m2 [range, 36-66]) underwent standard (48 patients) or distal (malabsorptive) (6 patients) RYGB. There were no perioperative deaths; postoperative morbidity delaying discharge occurred in 7 patients (13%). Follow-up (complete in 51 patients, x=6.1 years) was obtained by mail questionnaires and patient contact. Mean BMI decreased to 35 kg/m 2 (range, 22-47), and 59% of the patients with >1 year follow-up had a BMI <35 kg/m2 . The number of patients requiring positive pressure oxygen for sleep apnea decreased by half; most patients discontinued or decreased the number of medications treating weight-related comorbidities. At last follow-up, 90% of patients were satisfied subjectively with the results.

Conclusions: Conversion of VBG to RYGB is safe and provides weight loss, improved quality of life, and reversal of weight related comorbidities.