Lesser curvature Roux-en-Y gastric bypass as an alternative procedure to failed vertical banded gastroplasty:: Surgical technique and short term results

Purpose : The incidence of revisional surgery for failed vertical banded gastroplasty has increased markedly over the last years. Conversion to gastric bypass is considered as a good alternative with satisfactory long term weight loss without further revisional surgery. Nevertheless, significant morbidity and mortality is still associated with this procedure. New technical aspects make it safer and more effective. The aim of the work is to expose a surgical bypass technique to attempt to reduce morbidity. Patients and methods : Thirty patients have undergone conversions from failed vertical banded gastroplasty to a lesser curvature Roux-en-Y Gastric Bypass. Surgical technique is described in detail and early complications and initial weight loss were analyzed (mean follow-up: 12 months). Results : The key points of the operation were the small vertical pouch, the complete transection of the distal bypassed stomach, the interposition of a jejunal limb between the two gastric shares and the latero-lateral gastrojejunal anastomosis without proximal ring interposition. For the entire series, we noticed one major complication, an acute pancreatitis causing anastomotic fistula and four mild complications, one bleeding on the excluded stomach, one bronchopneumonia, one pleural effusion and one wound dehiscence. The percentage of excess weight loss attained 56.1% at one year follow-up. Conclusions : There have been tremendous improvements in the safety of gastric bypass over the years. One year follow-up indicates that our surgical bypass procedure is secure with a low complication rate.