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

摘要

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/m 2 [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/m 2 . 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.