Salvation Gastric Bypass as Conversion from Failed, Open Banded Vertical Gastroplasty

Introduction: Vertical-banded gastroplasty used to be one of the most performed bariatric procedures, but it fallen out of interest due to other emerging procedures and non-satisfactory long-term results. Options for revision include conversion to sleeve gastrectomy, a Roux-en-Y gastric bypass (RYGB) or VBG reversal via gastrogastrostomy. Objectives: To evaluate the role of laparoscopic RYGBP in the treatment of a previous, failed open VBG. Methods: we present the video of a laparoscopic conversion from previous open, adjustable banded vertical gastroplasty. Patient was operated in other center in 1997 at a BMI of 55.3 kg/m2 and arrived a minimumof 30 kg/m2. In 2017 she presented for weight regain and reflux disease (BMI 41 kg/m2), requesting further attention. Intraoperative difficulties, adhesiolisys, band removal, unexpected situations are presented. Results: Conversion to laparoscopic RYGBP was safe and efficient, with no need for open surgery conversion, and further weight loss recorded. Postoperative prolonged respiratory problems registered, successfully treated conservatively. An important improvement of the patients’ symptoms and satisfaction was achieved 6 months postoperatively, with suspension of medical therapy, at a BMI of 35 kg/m2. Conclusions: Conversion of open VBG to RYGB is feasible and safe and can be performed with an acceptable complication rates, especially in experienced bariatric centers. It gives excellentweight loss results and relief of outlet obstruction.