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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

Conversion of Vertical Banded Gastroplasty to Roux-en-Y Gastric Bypass Results in Restoration of the Positive Effect on Weight Loss and Co-morbidities: Evaluation of 101 Patients

Background Vertical banded gastroplasty (VBG) is a widely used restrictive procedure in bariatric surgery. However, the re-operation rate after this operation is high. In the case of VBG failure, a conversion to Rouxen-Y gastric bypass (RYGBP) is an option. A study was undertaken to evaluate the results of the conversion from VBG to RYGBP. Methods 101 patients had conversion from VBG to RYGBP. Patients were separated into 3 groups, based on the indication for conversion: weight regain (group 1), excessive weight loss (group 2) and severe eating difficulties (group 3). Data for the study were collected by retrospective analysis of prospectively recorded data. Results Weight regain (group 1) was the reason for conversion in 73.3% of patients. Staple-line disruption was the most important cause for the weight regain (74.3%). Excessive weight loss (group 2) affected 14% of patients and was caused by outlet stenosis in 78.6% of patients. The remaining 13% had severe eating difficulties as a result of outlet stenosis (46.1%), pouch dilatation (30.8%) and pouch diverticula (23.1%). Mean BMI before conversion to RYGBP was 40.5, 22.3 and 29.8 kg/m2 in group 1, 2 and 3, respectively. Minor or major direct postoperative complications were observed in 2.0% to 7.0%. Long-term complications were more frequent, and consisted mainly of anastomotic stenosis (22.7%) and incisional hernia (16.8%). Follow-up after conversion was achieved in all patients (100%), with a mean period of 38 ± 29 months. BMI decreased from 40.5 to 30.1 kg/m2, increased from 22.3 to 25.3 kg/m2. and decreased slightly from 29.8 to 29.0 kg/m2 in group 1, 2 and 3, respectively. All patients in group 3 noticed an improvement in eating difficulties. Conclusion Complications after conversion from failed VBG to RYGBP are substantial and need to be considered. However, the conversion itself is a successful operation in terms of effect on body weight and treating eating difficulties after VBG.     

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 - 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.     

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.     

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.     

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.     

Gastric Bypass and Vertical Banded Gastroplasty- a Prospective Randomized Comparison and 5-Year Follow-up

Background: a prospective randomized study was undertaken to compare the outcome of vertical banded gastroplasty (VBG) and gastric bypass (GBP) in patients with clinically severe obesity. Methods: eligibility criteria included Class IV obesity, <50 years old and a history of at least one attempt of non-operative weight loss. Patients were managed conservatively for 3 months prior to surgery. Patients were followed post-operatively and monitored for early and late complications and their weight loss outcome for up to 5 years. Results: 44 patients were recruited. Two patients withdrew within 4 weeks and were excluded. Twenty subjects had a GBP and 22 a VBG. There were no significant differences with respect to age, gender, maximum or pre-operative weight between the groups (p > 0.05). Patients who underwent GBP demonstrated significantly greater post-operative weight loss (p < 0.05) which was apparent from 6 months onwards. There were no deaths, pulmonary emboli, post-operative leaks or wound dehiscence. There were no instances of staple-line disruption. Symptomatic ulcer disease, confirmed endoscopically, developed in 25% of GBP patients. Nine patients developed gallstones post-operatively of whom five were in the VBG and four in the GBP group. Conclusions: weight loss following GBP was maintained, while VBG patients slowly regained.     

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.     

Salvage of Failed Vertical Gastroplasty by the Addition of a Distal Gastric Bypass

Thirty-one patients underwent conversion of failed vertical banded gastroplasty by the addition of a distal gastric bypass. At the time of surgery eight patients had the gastroplasty stoma debanded, six with very small stomas and chronic dysphagia and two because the bands were eroded. In five additional patients staple-line breakdown was repaired. Thus, three groups were followed up: (1) debanded, (2) staple-line repaired, and (3) those with unmodified stomas. Mean follow-up post-conversion ranged from 3.5 to 5 years for all groups, some patients being followed for as long as 8 years. Weight loss data were analysed for the three separate groups. Mean percentage greatest excess weight loss was 73% for the main follow-up group and debanded patients and 85.4% for those having staple-line repair. The results indicate that while weight loss was satisfactory across all groups, the greatest and best maintained weight loss occurred in patients with intact or reconstructed staple-lines and with stomas near 10 mm in diameter.     

Laparoscopic Adjustable Silicone Gastric Banding vs Laparoscopic Vertical Banded Gastroplasty in Morbidly Obese Patients: Long-Term Results of a Prospective Randomized Controlled Clinical Trial

Background  Aim of the study is to present long-term results of a prospective randomized single-institution clinical trial comparing laparoscopic adjustable silicone gastric banding (LASGB) with laparoscopic vertical banded gastroplasty (LVBG) in morbid obesity. Methods  A total of 100 morbidly obese patients (body mass index 40 to 50 kg/m²) were randomized to LASGB (n = 49) or LVBG (n = 51) and followed up for a minimum of 7 years. Results  Mean operative time was 65.4 min in LASGBs and 94.2 min in LVBGs (p < 0.05); mean hospital stay was 3.7 and 6.6 days, respectively (p < 0.05). Late complication rates were 36.7% in LASGBs vs 15.7% in LVBGs at 3 years (p < 0.05), 46.9% vs 43.1% at 5 years (NS), and 55.1% vs 47.1% at 7 years (NS). Late reoperation rates were 28.6% in LASGBs and 2.0% in LVBGs at 3 years (p < 0.001), 38.8% and 2.0% at 5 years (p < 0.001), and 46.9% and 7.8% at 7 years (p < 0.001). Excess weight loss in LASGBs was 41.8% at 3 years, 33.2% at 5 years, and 29.9% at 7 years; excess weight loss in LVBGs was 60.9%, 57%, and 53.1%, respectively (p < 0.05). Conclusions  This study demonstrates that in a carefully selected group of patients, LVBG is significantly more effective than LASGB in terms of late complications, late reoperations, and long-term results on weight loss.     

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.