Endoscopic revision for failed vertical band gastroplasty

• Published in: Journal of obesity
• Main Authors: Bolton, Johan, Gill, Richdeep S, Jahdali, Akram Al, Byrns, Simon, Shi, Xinzhe, Birch, Daniel W, Karmali, Shahzeer
• Format: Journal Article
• Language: English
• Published: John Wiley & Sons, Inc 01.01.2013
• Subjects: Care and treatment; Comparative analysis; Complications and side effects; Health aspects; Obesity; Patient outcomes; Surgery; Vertical banded gastroplasty; Canada
• ISSN: 2090-0708
• DOI: 10.1155/2013/108507

Background. Weight regain secondary to VBG pouch dilation is a typical referral for Bariatric surgeons. In this study we compare an endoluminal pouch reduction (Stomaphyx) to RYGB for revision. Methods. A retrospective review was completed for patients with a previous VBG presenting with weight regain between 2003-2010. Results. Thirty patients were identified for study 23 RYGB, 14 StomaphyX. Significant post procedure BMI loss was seen in each cohort (RYGB, 47.7 ± 7kg/[m.sup.2] to 35 [+ or -] 7kg/[m.sup.2]; StomaphyX43 ± 10 kg/[m.sup.2] to 40 ± 9kg/[m.sup.2], P = 0.0007). Whereas nausea and headache were the only complications observed in StomaphyX patients, the RYGB group had a 43.5% complication rate and 1 mortality. Complications following RYGB include: incisional hernia (13%), anastomotic leak (8.7%), respiratory failure (8.7%), fistula (8.7%), and perforation (4.35%). The median length of stay following RYGB was 6 days compared to 1.5 ± 0.5 days following StomaphyX. Conclusion. This study suggests that while RYGB revision may achieve greater weight loss, the complication rates and severity is discouraging. StomaphyX may be a safe alternative. Further technical modifications of the device and longer follow-up may clarify the role of this approach.