Background

Once a common bariatric procedure, vertical banded gastroplasty (VBG) has fallen out of favor for its complications such as band erosions and stenosis, but more importantly the need for revisional surgery in long-term. It is reported that 56% of patients with VBG have shown to fail to maintain weight loss and required revisional procedures. Currently, laparoscopic Roux-en-Y gastric bypass (LRYGB) is a choice of revisional procedure, a safe and effective procedure but still maintains complications such as internal hernia, dumping syndrome and nutritional complications. In this video, we demonstrate that laparoscopic sleeve gastrectomy is an effective alternative revisional procedure

Methods

A 40 year old female who underwent open VBG in 2000 presents with failed weight loss and dysphagia. Preoperative weight was 235-lbs, BMI 43. Preoperative endoscopy demonstrated tight vertical banded and a large-sized pouch. During discussion for revisional surgery, LRYGB was advised, but the patient pursued to proceed with laparoscopic sleeve gastrectomy

Results

The patient had postoperative one year follow up with improved dysphagia and oral intolerance. Patient demonstrated significant weight loss, from 235-lbs to 156-lbs (BMI from 43 to 28.5) in one year follow up. Patient did not have any postoperative complications and perioperative course was uneventful.

Conclusions

LRYGB is still a recommended revisional procedure for failed VBG, however laparoscopic sleeve gastrectomy, higher risk and more difficult revisional procedure, is an effective and comparable alternative in weight loss when performed successfully as we demonstrated in this video.