Department of Surgery, Hôpital du Chablais, 1860, Aigle-Monthey, Switzerland.
Obes Surg. 2012 Oct;22(10):1554-61. doi: 10.1007/s11695-012-0692-2.
Vertical banded gastroplasty (VBG) has long been the main restrictive procedure for morbid obesity but has many long-term complications for which conversion to Roux-en-Y gastric bypass (RYGBP) is often considered the best option.
This series regroups patients operated on by three different surgeons in four different centers. All data were collected prospectively, then pooled and analyzed retrospectively.
Out of 2,522 RYGBP performed between 1998 and 2010, 538 were reoperations, including 203 laparoscopic RYGBP after VBG. There were 175 women and 28 men. The mean BMI before VBG was 43.2 ± 6.3, and the mean BMI before reoperation was 37.4 ± 8.3. Most patients had more than one indication for reoperation and/or had regained significant weight. There was no conversion to open surgery. A total of 24 patients (11.8 %) developed complications, including nine (4.5 %) who required reoperation and one death. With a follow-up of 88.9 % after 8 years, the mean BMI after 1, 3, 5, 7, and 9 years was 29.1, 28.8, 28.7, 29.9, and 28.8, respectively.
On the basis of this experience, the largest with laparoscopic reoperative RYGBP after failed VBG, we conclude that this procedure can safely be performed in experienced hands, with weight loss results similar to those observed after primary RYGBP. In patients with too difficult an anatomy below the cardia, dividing the esophagus just above the esophago-gastric junction and performing an esophagojejunostomy may be a safe alternative to converting to a Scopinaro-type BPD, obviating the additional long-term risks associated with malabsorption.
垂直束带胃成形术（VBG）长期以来一直是治疗病态肥胖的主要限制程序，但有许多长期并发症，因此常被认为是转换为 Roux-en-Y 胃旁路术（RYGBP）的最佳选择。
本系列研究汇集了由三位不同外科医生在四个不同中心进行手术的患者。所有数据均前瞻性收集，然后汇集并进行回顾性分析。
在 1998 年至 2010 年间进行的 2522 例 RYGBP 中，有 538 例为再次手术，其中 203 例为 VBG 后的腹腔镜 RYGBP。患者中有 175 名女性和 28 名男性。VBG 前平均 BMI 为 43.2±6.3，再次手术前平均 BMI 为 37.4±8.3。大多数患者有不止一个再次手术的指征和/或体重显著增加。无一例转为开放手术。共有 24 例（11.8%）发生并发症，其中 9 例（4.5%）需要再次手术，1 例死亡。随访 8 年后，88.9%的患者平均 BMI 在 1 年、3 年、5 年、7 年和 9 年后分别为 29.1、28.8、28.7、29.9 和 28.8。
基于这一经验，即最大的 VBG 失败后腹腔镜再次 RYGBP 经验，我们得出结论，在有经验的医生手中，该手术可以安全进行，减肥效果与初次 RYGBP 相似。对于贲门下方解剖结构过于困难的患者，将食管在食管胃结合部上方切断，并进行食管空肠吻合术，可能是一种安全的替代方案，可以避免与吸收不良相关的额外长期风险，而无需进行 Scopinaro 式 BPD。
