Background

Vertical banded gastroplasty (VBG) has fell out of favor these days due to disappointing mid and long-term outcomes and high rates of revisional surgery. Traditionally, Roux-en-Y gastric bypass has been the procedure of choice to convert a failed VBG. Nevertheless, complications related to this technique have led to search a different procedure that preserves the former surgery with the additional benefit of weight loss and metabolic outcomes.

Methods

A retrospective review of prospectively collected data from all patients who had undergone revision of VBG to SADI was performed. The data on the symptoms, weight loss, co-morbidities, and complications were collected.

Results

Seven patients (100% female, 55.8 +/- 8.7 years old) underwent revisional surgery. The median preoperative body mass index (BMI) before the VBG was 50.9 kg/m2 (IQR, 54.7-46.2). The minimum median BMI after VBG was 29.4 kg/m2(IQR, 33.5-25.7). The indications for revisional surgery were weight regain in four patients (57%) and complications of prior surgery in three patients (43%) due to stenosis of the gastric band. The median preoperative BMI was 42.9 kg/m2 (IQR, 45.7-30.53). Surgical approach was laparoscopic in all patients. At an average follow-up of 12 months, the median BMI was 37.75 kg/m2 (IQR, 38.9-29.6). The majority of patients had improvement or resolutions of sypmtons after revisional surgery.

Conclusions

Laparoscopic SADI after failed VBG is a safe and feasible procedure that can provide adequate weight loss and reversal of weight-related co-morbidities.