IBC Oxford University Oral Abstract 41 - Efficacy and safety of laparoscopic conversion of failed vertical banded gastroplasty (VBG) to laparoscopic minigastric bypass (LMGB)

Abstract Background/Introduction Obesity has become one of the most important health issues in developing and developed countries, with dramatic increase over the last decades. Morbid obesity is associated with serious comorbidities, such as type 2 diabetes, hypertension, arthritis, and sleep apnea, which cause an estimated 6 to 12 times greater mortality rate than the normal populations. Bariatric surgery is the only method for sustained weight loss in morbid obesity. However, 10–25% of patients will require re-operation for unsatisfactory weight loss or weight regain after restrictive surgery. Re-operation is associated with higher morbidity and mortality. Objectives The objective of the current study is to evaluate the safety and efficacy of laparoscopic mini-gastric bypass (LMGB) as convention surgery for failed vertical banded gastroplasty (VBG). Methods From February 2021 to November2023, 43 consecutive patients underwent LMGB for failed VBG. Average age was 32.4 years (range 21 to 49) and average BMI before re-operation was 42.6 kg/m2. There were 18 male and 25 female patients. All the patients underwent complete preoperative work-up, including blood chemistry, endocrine status, abdominal ultrasound, upper gastrointestinal barium studies, and gastroendoscopy. Visits to a psychiatrist and dietician were arranged, and explanations for a clear understanding of the benefits, risks, and long-term consequences of a malabsorptive procedure were done. The LMGBs were essentially the same as described by Rutledge technique. All patients received a quality-of-life questionnaire evaluation at their preoperative and postoperative follow-up at 6 months using the Gastrointestinal Quality of-Life Index (GIQLI). Results All the re-operations were completed laparoscopically. Average operative time was 164.5 minutes (range 140 to 280). All the patients were followed regularly every 3 months, and the mean BMI at 1 year after the LMGB was 31.6 kg/m2 (P < 0.001 compared with BMI before revision). Three patients (3.9%) complained of epigastralgia and marginal ulcers were diagnosed by endoscopy. A proton-pump inhibitor was prescribed, and all the ulcers healed on medical treatment Conclusion Based on the results of the current study, LMGB is an effective and safe revision operation for patients with failed VBG with excellent weight loss and accepted improvement in other causes of failure of VBG.