Operations for failed vertical banded gastroplasty.

Although vertical banded gastroplasty is considered as a safe and efficient bariatric procedure, reoperation rates either because of failure, or the induction of unacceptable side effects are important. In this study we evaluated 54 obese subjects with a history of vertical banded gastroplasty. One patient (2%) died postoperatively due to pulmonary embolism. Seven patients (13%) underwent a reoperation. A new vertical banded gastroplasty because of dilatation of the pouch with weight regain resulted in a loss of 26% of the initial weight after 3 years (1 patient). The vertical staple line disrupted in 4 patients: restapling failed after 1.5 year (1 patient), conversion into a gastric bypass resulted in a loss of only 12% of the initial weight after 3 years (1 patient), conversion into a biliopancreatic diversion resulted in a loss of 43 and 32% of body weight after 18 and 6 months, respectively (2 patients). In 2 cases a Nissen fundoplication was performed with good result for reflux oesophagitis. Since regastroplasty was not entirely successful in our hands, we consider biliopancreatic diversion as the method of choice for failed vertical banded gastroplasty.