Revisional Surgery After Failed Vertical Banded Gastroplasty: Restoration of Vertical Banded Gastroplasty or Conversion to Gastric Bypass

Background: An increasing number of patients with a failed primary bariatric procedure present themselves for secondary treatment. Only a few studies have investigated critically the success of revisional surgery. In the present study, the effectiveness of revisional surgery for failed vertical banded gastroplasty (VBG) is analyzed: restoration of the VBG (reVBG) is compared to conversion to a Roux-en-Y gastric bypass (RYGB). Patients and Methods: From 1980 to 1996, 136 consecutive morbidly obese patients underwent primary RYGB (n = 20) or VBG (n = 16). Weight loss, indications and complications after revisional surgery were registered. The rate of revisional surgery after primary and secondary bariatric procedures was estimated by means of a Kaplan-Meier analysis. Results: Kaplan-Meier analysis revealed that 56% of the patients will eventually require revisional surgery after initial VBG over a 12-year period compared to 12% after initial RYGB (P < 0.01). After reVBG 68% will need revisional surgery over a 5-year period, while no further revisional surgery was required after conversion to a RYGB (P < 0.05). Body mass index dropped significantly after reVBG or conversion to RYGB for insufficient weight loss (P < 0.05), however, more revisional surgery was necessary after reVBG to achieve this result. The complication rate was comparable between reVBG and conversion to RYGB (33%). Conclusion: Conversion of a failed VBG to a RYGB is more effective than a reVBG, because conversion to RYGB provides satisfactory weight loss without requiring further revisional surgery.     

Laparoscopic Conversion of Vertical Banded Gastroplasty with an Antireflux Wrap into Roux-en-Y Gastric Bypass

Background Vertical banded gastroplasty (VBG) is associated with a significant rate of revision because of regain of weight due to staple-line disruption, gastric pouch and stoma dilation, change to sweet eating, outlet stenosis with vomiting and reflux. To avoid reflux, some surgeons added an antireflux wrap. Methods We report laparoscopic revision of VBG with antireflux wrap to Roux-en-Y gastric bypass (RYGBP) in 4 patients. The indication for revision was insufficient weight loss in all 4 patients, with stenosis of the stoma resistant to endoscopic balloon dilation in one and reflux esophagitis in one, who shifted to high-calorie liquids. Revision was performed 73.5 months (range 57–84) after the primary procedure, at mean BMI 39.5 (range 37–41). Results Mean operative time was 193.7 min (165–220). There was no conversion to open surgery. There was no mortality. One patient developed a stenosis at the gastrojejunostomy that was managed successfully with endoscopic balloon dilation. Mean length of stay was 6.8 days (range 4–9). At mean follow-up of 11.2 months (range 11–18), mean BMI is 28.5 (range 27–30), and all patients were free of co-morbidities. Conclusions Laparoscopic revision of VBG with an antireflux wrap into an LRYGBP is feasible and effective in achieving weight loss, but the safety requires assessment by a larger series.     

Roux-en-Y Gastric Bypass after Failed Vertical Banded Gastroplasty

BACKGROUND: Vertical banded gastroplasty (VBG) was the restrictive procedure of choice for many years. However, VBG has been associated with a high rate of long-term failure. We reviewed our experience of conversion of failed VBG to Roux-en-Y gastric bypass (RYGBP). METHODS: The data on all patients undergoing conversion of failed VBG to RYGBP were reviewed. Failed VBG was defined as insufficient weight loss (BMI > 35 kg/m2) and/or VBG-related complications. RESULTS: We performed 24 conversions from VBG to RYGBP. Median age was 40 +/- 8 years (range 28 to 61). Preoperative weight was 111 +/- 25 kg (range 85 to 181), and median BMI was 41 +/- 8 kg/m2 (range 30 to 69 kg/m2). Indication for conversion was: VBG failure in 18 patients and VBG complications in 6 patients. A gastrectomy (total or proximal) had to be performed in 5 cases (21%). The conversion was performed by laparoscopy in 13 cases. Postoperative complications occurred in 4 patients (16.7%). There were no leaks, nor mortality. Postoperative BMI was 31 kg/m2 (range 25 to 42) at a median follow-up of 12 months (range 3 to 36 months). The average percentage of excess weight loss was 62% at 1 year. CONCLUSION: VBG has been associated with a significant reoperation rate for failure and/or complications. Conversion to RYGBP is effective in terms of weight loss and treatment of complications after VBG. Gastrectomy and resection of the staple-line could reduce such complications as leaks and mucocele. Although technically challenging, conversion of VBG to RYGBP is feasible, with acceptable morbidity and no mortality. The conversion is feasible laparoscopically.     

Converting Vertical Banded Gastroplasty to a Lesser Curvature Gastric Bypass: Technical Considerations

Background: Vertical banded gastroplasty (VBG) is occasionally followed by poor weight loss or complications requiring reoperation. Several studies have analyzed the morbidity and mortality associated with conversions of VBG to gastric bypass, but few have described the actual technique. The most frequent complications related to this type of reoperation are gastrointestinal leaks. Materials and Methods: The authors analyzed 60 consecutive conversions from VBG to lesser curvature gastric bypass, performed on 60 patients. The cases were analyzed for surgical technique, complications and weight loss. In all the cases the operation was limited to the lesser curvature of the stomach, and certain technical maneuvers were done to facilitate the creation of the pouch and anastomosis. Results: There were three major complications, and two patients required reoperation. There were no gastrointestinal leaks or mortality. Percentage weight loss at 5 years was similar to primary gastric bypasses. Conclusion: Converting failed or complicated VBGs to lesser curvature gastric bypasses are safe and effective weight loss operations. By performing several specific technical maneuvers and limiting the operation to the highly vascular lesser curvature, complications can be reduced to a minimum.     

Distal Roux-en-Y Gastric Bypass Conversion Operation for Failed Vertical Banded Gastroplasty

Forty-five cases of failed vertical banded gastroplasty were converted to gastric bypass with distal Roux-en-Y constructed with a 250 cm alimentary limb and a 150 cm common channel. The gastroenterostomy is side-to-side, unrestricted and is at least 3 cm wide. We believe that this wide anastomosis is responsible for the zero incidence of stomal ulcers in this group. A nasogastric tube is not used and the patient is placed on ranitidine 150 mg one b.i.d. for the first 4 weeks. The weight loss is excellent and sustained, and the resulting life-style is very close to that of a normal person. All varieties of foods are tolerated in adequate amounts, and diarrhea occurs only if the patient indulges in fatty foods. Hypoproteinemia is generally mild and transient except in five early cases where TPN was needed, and four of these required elongation of the intestinal segments. Wound infection was 4.5%, and there was no mortality.     

Vertical Banded Gastroplasty vs Gastric Bypass: 10 Years follow-up

In 1982, a prospective study to evaluate and compare the operations for treatment of morbid obesity, vertical banded gastroplasty (VBG) and gastric bypass (GBP), was carried out at the Center for Surgical Treatment of Obesity in Los Angeles. The VBG was performed as described by Dr Mason with a 5.0 cm circumference Marlex band. The GBP was the horizontal GBP with ≤ 50 cc pouch as described by Mason and modified by Printen and Griffen. One hundred patients had the VBG and 100 had the GBP. At 10 years follow-up, only 43 of the VBG patients and 46 of the GBP patients can be found. The groups are compared as to the perioperative complications, late complications and weight loss. VBG compared favorably with GBP for control of morbid obesity. GBP yields better weight loss and maintenance at all times of follow-up. Both procedures are equal in terms of morbidity and mortality.     

Vertical Banded Gastroplasty Versus Standard or Distal Roux-en-Y Gastric Bypass Based on Specific Selection Criteria in the Morbidly Obese: Preliminary Results

Background: Predicting successful outcomes after bariatric surgical procedures has been difficult, and the establishment of specific selection criteria has been a subject of ongoing research. In an effort to choose the most appropriate surgical procedure for each patient, we have established a specific set of selection criteria for each procedure based on degree of obesity, preoperative dietary habits, eating behavior, and various metabolic features. Methods: From June 1994 to December 1998, 90 bariatric surgical procedures were performed at the authors' institution by a single surgeon (F.K.) based on specific selection criteria. Vertical banded gastroplasty (VBG) was performed in 35 patients, standard Roux-en-Y gastric bypass (RYGB) in 38 patients, and distal RYGB in 17 patients. All patients were monitored postoperatively 1, 3, 6, and 12 months and once per year thereafter, with an additional visit at 18 months in distal RYGB patients. Results: Early postoperative morbidity (<30 days) did not differ significantly between the three groups and averaged 9% of total patients. Long-term postoperative morbidity (>30 days) included 9 incisional hernias (2 in the VBG group, 5 after RYGB, and 2 in the distal RYGB group). There were 6 cases of staple-line disruption, 4 after VBG and 2 after standard RYGB, 1 of which resulted in stomal ulcer. Early postoperative mortality was 0%, and long-term mortality was 1.1%, which was due to pulmonary embolism in 1 standard RYGB patient on the 65th postoperative day. Average percentage of excess weight loss (%EWL) was 62% the first year, 61% the second year, and 50% the third year in VBG patients, and 63.6%, 65%, and 63.3%, respectively, in standard RYGB patients. In distal RYGB patients, where the patient number was significantly smaller, the %EWL at 1 and 2 years, respectively, was 51% and 53%. The most significant metabolic/nutritional complication was the appearance of hypoproteinemia (hypoalbuminemia) in 1 distal RYGB patient 20 months after surgery, which was corrected by total parenteral nutrition and subsequent increase in dietary protein intake. Significant improvement or resolution of pre-existing comorbid conditions was observed in all patient groups. The postoperative quality of eating, as evaluated by variety of food intake and frequency of vomiting, was significantly better in RYGB patients. Conclusions: These results show that selection of the bariatric surgical procedure to be performed in each patient based on specific criteria leads to acceptable weight loss, improvement in preexisting comorbid conditions, and a high degree of patient satisfaction in most patients. On the basis of our own observations as well as those of others, our selection criteria have become more strict over time and our selection of VBG as the operation of choice increasingly infrequent.     

Laparoscopic Conversion of Vertical Banded Gastroplasty (Mason MacLean) into Roux-en-Y Gastric Bypass

Background Revision of bariatric procedures is required in 10 to 25% of patients either for insufficient weight loss or for complications. Patients undergoing vertical banded gastroplasty (VBG; Mason MacLean) may require revision in up to half of the cases in the long term. Roux-en-Y gastric bypass (RYGBP) is considered the procedure of choice for revision of VBG gastroplasty. Patients and Methods Eighteen patients, 16 women and 2 men with a mean age of 41.7 years (range 27–72) and a mean BMI at 37.6 kg/m² (range 22.5–47), underwent laparoscopic conversion of VBG into RYGBP. Indications for revisional surgery were insufficient weight loss (11 patients), stoma stenosis (4 patients), and acid reflux (3 patients). Results Operative time was on average 203 min (range 60–300 min), and conversion was required in one patient (5.5%). There was no early postoperative mortality, and four patients (22.2%) developed immediate postoperative complications (gastrojejunostomy leak 1; stenosis of the gastrojejunal anastomosis 2; liver abscess 1). One patient died 6 months after conversion because of a bleeding anastomotic ulcer (late mortality 5.5%). Two patients (11.5%) developed late complications (incisional hernia 1; internal hernia 1). At a mean follow-up of 23, 4 months BMI is on average 29.8 kg/m² (range 22.7–37). Conclusion Although revision of failed VBG into RYGBP gives good functional results, the risk of postoperative serious complications must be carefully evaluated before revision.     

Vertical Banded Gastroplasty--Gastric Bypass: preliminary report

Vertical banded gastroplasty-gastric bypass is a surgical technique combining the advantages of the vertical banded gastroplasty with those of gastric bypass. The procedure was performed on 148 morbidly obese individuals: 83% were female and 17% were male. Ages ranged from 15 to 64 years, with a mean age of 35. Mean percentage weight was 215% of ideal. The vertical banded gastroplasty is constructed by creating a 10 cc vertical pouch along the lesser curvature with a 5.5 cm supporting band. The pouch is fashioned in a way that the lower portion is free and mobile. This free segment of stomach is anastomosed by triangulation to a Roux-en-Y loop of jejunum, which is brought up in a retrocolic, retrogastric fashion. With 100% follow-up in the 19 patients who have reached 1 year, average excess weight loss has been substantial. There was one early postoperative complication requiring surgery. Two patients required late revisional operations. Vertical banded gastroplasty-gastric bypass is a relatively simple procedure to perform and has a low rate of complications. Gastric bypass in combination with a small banded pouch along the lesser curvature should result in substantial and permanent weight loss.     

Vertical Banded Gastroplasty and Distal Gastric Bypass as Primary Procedures: A Comparison

Background: Comparing primary vertical banded gastroplasty (VBG) and distal gastric bypass (DGBP) patients might assist decision-making based on patient profiles and desired outcomes. Methods: A prospective study of 81 vertical banded gastroplasty and 60 distal gastric bypass patients. Technical aspects, complications, weight loss, post-op compliance and satisfaction are reported. Length of follow-up is 48 months (VBG) and 36 (DGBP). Lost-to-follow-up 41% (VBG) and 22% (DGBP). Ten per cent VBGs were revised, with 1% takedown. Three per cent DGBPs were converted to proximal GBPs. Demographics are comparable. Results: Operative time was 40 min VBG and 88 DGBP; blood loss 187 cc vs 335 cc; and hospital stay 3 versus 4 days. Exclusive VBG complications include: 1% staple-line leak, 4% intra-abdominal abscess, 1% respiratory failure, 5% pneumonia, 1% intra-abdominal bleed, 1% small bowel obstruction, 2% infected incision, 2% fistula, 2% stenotic or obstructed stoma, and 1% bezoar. Exclusive DGBP complications include: 2% GI bleed, 12% marginal ulcer, 5% reflux esophagitis, 13% hypocalcemia, 23% hypovitaminosis A and D (12% requiring B₁₂ therapy). Shared complications include hypoproteinemia 6% VBG versus 40% DGBP; excess vomiting (>6 months post-op) 7% versus 10%, excess diarrhea 2% versus 20%, dehydration 1% versus 8%, re-hospitalization 4% versus 15% (hyperalimentation), post-op cholecystectomy 1% versus 5%, weight regain 48% versus 1%. VBG experienced an average of 64% excess weight lost at 36 months versus DGBP 89% excess weight lost. VBG follow-up compliance is generally poor but good for DGBP. Compliance with diet and supplements is equivalent (50%). Satisfaction is 85% and 93% respectively. Conclusion: The DGBP provides better long-term weight loss, but nutritional deficiencies occur more often and require close follow-up. The surgery is more complex, but as a primary procedure there are few major complications.     

Nutrient Intake following Vertical Banded Gastroplasty or Gastric Bypass

Background: This study explored eating habits, nutrient intake, and blood vitamin and mineral levels to determine whether severely obese subjects (BMI 40-50 kg m⁻²) post-vertical banded gastroplasty (VBG) or gastric bypass Roux-en-Y (GBR) are at risk of developing compounded under-nutrition. Methods: A dietary follow-up of 36 VBG and 19 GBR was maintained for 18 months via 7-day food intake diaries and 24-h recalls. Food intake was analysed for energy and nutrient composition and for its relative amount to recommended dietary allowances (RDA). Results: Weight loss was greatest during the first 6 months, continued at a slower rate for the next 6 months, nearly ceasing thereafter. The results following GBR were not substantially different from those following VBG 18 months postoperatively. The median weight loss at 1 year postoperatively was 48, 46, 48 and 36 kg; expressed as residual excess body weight: 0.2, 16, 13 and 22% for GBR Men, Women, VBG Men, Women, respectively. According to the classification proposed by Reinhold, all subjects achieved excellent treatment outcomes 18 months postoperatively. Despite the relatively low reported energy intake (20-50% below RDA), no correlation was found between rate of weight loss and energy intake at 6 months postoperatively. The intake of most vitamins and minerals was below 50% of RDA during the 18 months follow-up. The increase in energy intake did not improve the level of the nonenergy-contributing nutrients. Compliance to multivitamin and mineral supplement intake deteriorated with time. Conclusion: The low to within-normal range of blood vitamin and mineral levels 12 months postoperatively suggests the slow development of subclinical nutritional deficiency which could jeopardize the subjects' long-term health status.     

Vertical Banded Gastroplasty at More than 5 Years

Background: Optimal evaluation of the results of surgery for morbid obesity requires a long-term follow-up for at least 5 years. Methods: One hundred patients were operated by vertical banded gastroplasty (VBG) and revised with a follow-up of no less than 5 years. Sixty patients were morbidly obese with a body mass index (BMI) of between 40 and 50 kg/m², and 40 were superobese with a BMI of >50 kg/m². Follow-up included 93 patients (93%). Results: Initial surgical mortality was nil. Twenty-five patients required surgery for complications related to the technique (25%) and one patient died due to pulmonary embolism after a re-stapling operation. The percentage excess weight loss was 54.3%, and the BMI was 33 kg/m² for the 84 patients followed to 5 years post VBG. Only 40 out of 92 patients (43.5%), obtained the weight loss benefit due to the operation. None of them is able to eat a regular diet, and the quality of food intake has been severely affected in some of them. Conclusions: VBG is, in our experience, a safe and technically simple operation, but the long-term results are questionable. The reoperation rate was high, and weight loss and quality of life are superior with other operations.     

Different Effects of Vertical Banded Gastroplasty and Roux-en-Y Gastric Bypass on Meal Inhibition of Ghrelin Secretion in Morbidly Obese Patients

A decrease in ghrelin plasma levels in morbidly obese patients subjected to bariatric surgery has been considered to help increase body weight loss. Contradictory results have been described after Roux-en-Y gastric bypass (RYGBP), and no study to date has compared RYGBP and vertical banded gastroplasty (VBG), the two main operations performed in the United States. We investigated the effects of RYGBP (10 patients) and VBG (12 patients) on basal and postmeal ghrelin plasma levels in 22 morbidly obese patients (20 F and 2 M), mean age 42.1 ± 3.7 years, mean weight 115 ± 3.9 kg, mean body mass index (BMI) 43.5 ± 1.7. Before surgery and after a 20% reduction in BMI, ghrelin concentrations (pg/mL; radioimmunoassay [RIA], DRG Diagnostics, Germany) were measured in all patients 45 min before and for 3 h after a standard liquid meal (Osmolite RTH solution, 500 mL, 504 kcal). The results were expressed as mean ± SD. Differences between times and groups were evaluated by Student's t-test and one-way analysis of variance (ANOVA). We found that basal ghrelin plasma levels were reduced after RYGBP (to 73.1 ± 6 pg/mL, p <. 05) but increased after VBG (to 172 ± 26 pg/mL, p <. 0009). After a standard liquid meal, ghrelin plasma levels decreased significantly over 1 h in VBG patients, whereas they remained unchanged in RYGBP patients. Since these results were obtained under the same metabolic and anthropometric conditions, we conclude that RYGBP acts through permanent inhibition of ghrelin secretion, whereas VBG merely restores the mechanisms of ghrelin regulation by nutrients.     

Weight Loss and Complications After Vertical Banded Gastroplasty

We have performed 124 vertical banded gastroplasties (VBG) according to Mason, except that we used a collar 5.5 cm in circumference. We carried out a midline incision in 68 cases and a left subcostal incision in 56, with double application of a 2-row stapler with reinforcement in the first 69 cases and a single application of a 4-row stapler in 55 (15 with reinforcement, 40 without). We have followed 107 (86.2%) patients for a mean of 30 months (range 3-84). The mortality rate was nil. The intraoperative complications were three spleen lacerations (splenectomy), and the early complications were two gastric leaks (re-intervention) and one gastric bleeding. The late complications were one gastric perforation (re-intervention), four outlet stenoses (one re-intervention), one bleeding by collar erosion and nine ventral hernias (occurring only with the midline incision). The percentage excess weight loss was 46.3 ± 16.4 at 6 months, 53.4 ± 17.9 at 1 year, 47.8 ± 19.6 at 3 years, and 45 ± 23.3 at 5 years. In 12 cases the weight loss was unsatisfactory (less than 30% of the initial excess weight). Often such failures were due to staple-line disruption. We have had no staple-line disruptions since we stopped performing the reinforcement. VBG has a low incidence of complications, but sometimes these may be serious. In our opinion, the technical procedures which offer a stronger vertical partition give better results for weight loss.     

Laparoscopic Vertical Banded Gastroplasty: The Milwaukee Experience

Background: laparoscopic techniques are being developed for bariatric surgery. Methods: eleven morbidly obese patients underwent laparoscopic vertical banded gastroplasty in 1993-1994. Results: average length of hospital stay was 3.9 days, mean operating time was 202 min, and the average hospital charges were $12 800. These numbers were compared to the most recent open gastric bypass patients, where average length of stay was 7.4 days, mean operating time was 105 min, and the average hospital charges were $9800 (adjusted value of $16 700). There were no post-operative complications in the laparoscopically-performed VBG patients. Conclusion: laparoscopic VBG is feasible and cost-saving. Weight loss and long term results await ongoing follow-up.     

Vertical Banded Gastroplasty - Gastric Bypass in Mexican Patients with Severe Obesity: 1 Year Experience

Background: Different surgical alternatives for the treatment of severe obesity have been described. The two most common surgical procedures are the Vertical Banded Gastroplasty (VBG) and the Rouxen-Y Gastric Bypass (GBP). Methods: This work describes the results seen during the first 12 months after a surgical technique named Vertical Banded Gastroplasty-Gastric Bypass on 221 Mexican patients with severe obesity operated on between March 1993 and August 1996. Results: 73.3% of the patients were female with an average age of 33.4 years with a standard deviation (SD) of 10 years. The initial mean overweight was 62.2 kg (SD = 26.5 kg). The percentage of ideal weight was 202.3% (SD = 39.4%). The initial body mass index (BMI) was 44.9 kg/m² (SD = 9.1). The average of excess weight loss in a year was 81.2% (SD = 15.6%) and the BMI was lowered to 26.7 kg/m² (SD = 5.9). An interesting finding was that the greater the initial overweight, the lesser the resulting weight loss (r = 0.57, P < 0.001). Conclusions: The procedure was fairly easy to perform. The results were excellent in terms of weight loss and postoperative complications. It is an early experience and the long-term results are still inconclusive; regular check-ups should indicate the procedure's long-term effectiveness.     

Conversion of Jejunoileal Bypass to Silastic Ring Vertical Gastroplasty

A gastric restrictive procedure is usually performed simultaneous with takedown of a jejunoileal bypass (JIB) to prevent weight regain. However, the preferred gastric restrictive procedure has not been established. Currently, we combine JIB takedown with silastic ring vertical gastroplasty (SRVG), and report our experience with 36 patients treated over a 5-year period. Indications for JIB takedown were diarrhea (69%), arthralgias (53%), liver disease (34%), nephrolithiasis (25%), and increasing weight (33%). Mean weight at the time of JIB takedown was 232 ± 12 (SEM) lb (105 ± 5 kg) (77 ± 8% EBW (excess body weight)). Follow-up was complete in 33 (92%) patients. Post-reversal weight was 202 ± 14 lb (92 ± 6 kg) (55 ± 8% EBW) at 1 year and 218 ± 12 lb (99 ± 5 kg) (67 ± 8% EBW) (not significant) at a mean follow-up of 2.9 years. Twenty-one (64%) patients lost weight or were stable (± 5% EBW), while 12 (36%) gained a mean of 39 ± 7 lb (18 ± 3 kg) (range 16-80 lb (7 ± 36 kg)). Resolution of preoperative complaints was noted in all patients with diarrhea and 53% with migratory arthralgias. Major early postoperative morbidity occurred in 11%, with no mortality. We conclude that SRVG is a safe and effective procedure to combine with JIB takedown.     

Long-Term Results of Vertical Banded Gastroplasty: Marlex versus Dacron Banding

Background: The VBG was originally performed with a Marlex band and characterized by a satisfactory weight loss and low morbidity. The effect of the material used for the banding procedure (Marlex vs Dacron) in vertical banded gastroplasty (VBG) is evaluated. Methods: In 49 consecutive obese patients treated with a VBG, a Marlex band was used in 17 patients and a Dacron band in 32 patients. Data were analyzed retrospectively with regard to the type of band, weight loss and complications. Results: A significant difference was found in the percentage excess weight 5 years postoperatively in favor of the Dacron group (59.2% vs 39.2%; p < 0.05) because of more band-related complications in the Marlex group. The difference in percentage excess weight disappeared 8 years postoperatively (43.3% vs 46.8%), due to the renewed weight loss of the Marlex group following reoperation. Conclusion: The Dacron band is superior to the Marlex band in VBG because sustained weight loss is satisfactory and morbidity is low.     

Improvement in Obesity-associated Medical Conditions following Vertical Banded Gastroplasty and Gastrointestinal Bypass

Thirty-nine patients undergoing either Silastictrade mark ring vertical banded gastroplasty (SRVG, n = 23) or Roux-en-Y gastrointestinal bypass (RGB, n = 16) over a 1-year period were analyzed retrospectively. Weight loss averaged 40 kg (89 lb). Clinical diabetes mellitus was markedly improved in seven out of nine patients (p = 0.023). Shortness of breath resolved in all 26 patients who had this condition preoperatively (p < 0.001). Orthopedic problems, high blood pressure, and self-assessment of general health and quality of life were also dramatically improved. We conclude that bariatric surgery serves as an effective method to alleviate a multitude of conditions associated with morbid obesity.     

What to Expect in the Excluded Stomach Mucosa after Vertical Banded Roux-en-Y Gastric Bypass for Morbid Obesity

Mucosal alterations after vertical banded Roux-en-Y gastric bypass have not been clearly evaluated. The aim of this paper was to analyze the histological findings and the presence of Helicobacter pylori in the excluded stomach. Forty consecutive patients who underwent Roux-en-Y gastric bypass longer than 36 months were selected for double-balloon enteroscopy. The excluded stomach was reached in 35/40 patients (88%). Morphological alterations were analyzed through hematoxilin and eosin and the presence of H. pylori was confirmed with Giemsa staining. Thirty patients (86%) were female, and the mean age was 43 years old. The mean postoperative time was 78 months (36-110 months). Histologically, all patients had chronic gastritis in the bypassed stomach, with pangastritis in 33/35 (94%). Five cases (5/35, 14%) presented atrophy and four of them also had intestinal metaplasia. Helicobacter pylori was detected in 7/35 (20%) of the excluded stomach and in 12/35 (34%) of the functional pouch. All patients positive for H. pylori in the excluded stomach were also positive in the functional pouch, p = 0.0005. Helicobacter pylori is still present in the excluded stomach after Roux-en-Y gastric bypass and might be considered for treatment. Histological findings indicated high prevalence of atrophy and intestinal metaplasia in this selected population.