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

Thirty-one patients underwent conversion of a failed horizontal gastroplasty by addition of a distal gastric bypass. Twenty-seven patients had complete long-term follow-up and their data are presented. The patients were separated into three groups depending on the initial gastroplasty pouch sizes (varying between 25 and 60 ml). At the time of surgery stoma sizes were evaluated, some being found near 10 mm, others being smaller, that were debanded, and others larger that were not repaired. Follow-up after distal gastric bypass was 5.7 years (mean). Analysis of the weight loss data showed that the addition of a distal gastric bypass resulted in mean greatest excess weight losses near 80% for all groups. Over many years excess weight losses diminished but only one patient was a weight loss failure. Weight loss was best maintained and side-effects were fewest where the stoma size was near 10 mm. Pouch sizes themselves could not be positively correlated with weight loss, stoma size being much more important. Four patients had manifestations of the acid peptic ulcer diathesis and were effectively dealt with by means of vagotomy and hiatus herniorrhaphy.