Background

Vertical band gastroplasty (VBG) was a popular weight loss procedure in the 1980s and 90s but has fallen out of favor due to availability of less invasive restrictive procedures as well as high incidence of complications such as band erosion and migration, staple-line disruption and stenosis [1]. Failed VBG is usually managed with a revision to Roux-en-Y Gastric Bypass (RNYGB) or reversal with a gastrogastrostomy [2,3]. We present a case of a 71-year-old man who developed symptomatic stenosis after undergoing VBG over forty years ago who underwent a laparoscopic reversal with a gastrogastrostomy.

Methods

A 71-year-old man with a remote history of vertical band gastroplasty presented with progressively worsening symptoms of dysphagia, solid food intolerance, reflux, and weight loss. A work-up with upper endoscopy revealed a stricture at his band site, that could not be traversed, or balloon dilated. A large pouch with gastric bezoar, and no ulcers were also noted during endoscopy. The patient underwent a laparoscopic revision with extensive lysis of adhesions, gastrogastrostomy and intraoperative endoscopy.

Results

The patient tolerated the procedure well and had an uncomplicated recovery. He is now one year removed from surgery, with complete resolution of dysphagia. The patient is tolerating a regular diet, gaining weight, and has resumed normal activities of daily living.

Conclusions

Strictured vertical band gastroplasty can be safely managed with a laparoscopic gastrogastrostomy.