Long-term results after revisions of failed primary vertical banded gastroplasty

Table 1 Baseline characteristics (n = 152)

	Re-VBG n = 21 (13.8%) Mean ± SD	cSG n = 16 (10.5%) Mean ± SD	cRYGB n = 115 (75.7%) Mean ± SD	P value
Age (yr)	42.3 ± 8.6	41.6 ± 11.4	43.0 ± 8.9	0.828
Male:female	5:16	3:13	19:96	0.674
Body mass index before VBG (kg/m2)	42.6 ± 5.4	43.6 ± 5.0	44.1 ± 4.9	0.445
Preoperative comorbidities
Type 2 diabetes mellitus (n)	4	2	13	0.538
Hypertension (n)	4	2	25	0.79
Dyslipidemia (n)	0	3	11	0.111
Sleep apnea (n)	1	1	2	0.249
Osteo-articular disease (n)	5	0	9	0.038
Patients with 1 or more comorbidity	10	5	41	0.512
Operative time (min)	77.0 ± 39.2	100.6 ± 19.6	130.7 ± 47.3	< 0.001
Length of hospital stay (d)	3.1 ± 2.9	3.8 ± 2.2	4.1 ± 5.8	0.761
Interval between VBG and revision (mo)	12.3 ± 10.7	30.7 ± 26.5	47.8 ± 34.8	< 0.001
Average %EWL after VBG (%)	61.7 ± 27.0	38.7 ± 22.9	43.5 ± 25.0	0.007

Re-VBG: Revision of the vertical banded gastroplasty; cSG: Conversion to sleeve gastrectomy; cRYGB: Conversion to Roux-en-Y gastric bypass; VBG: Vertical banded gastroplasty; %EWL: Percentage of excess weight loss.

Table 2 Complaints before revision (n = 152)

	Re-VBG n = 21 (n)	cSG n = 16 (n)	cRYGB n = 115 (n)	Total (%)	P value
Vomiting/ dysphagia/food intolerance	17	8	36	40.2	< 0.001
Weight regain	1	4	42	30.8	0.007
Insufficient weight loss	3	4	25	21.1	0.665
Unknown	0	0	6	3.9	0.792
Severe GERD	0	0	4	2.6	1.000
Decline comorbidities	0	0	1	0.7	1.000
Excessive weight loss	0	0	1	0.7	1.000

Re-VBG: Revision of the vertical banded gastroplasty; cSG: Conversion to sleeve gastrectomy; cRYGB: Conversion to Roux-en-Y gastric bypass; GERD: Gastro esophageal reflux disease.

Table 3 Results after primary revision at last follow-up (n = 152)

	Re-VBG n = 21 Mean ± SD	cSG n = 16 Mean ± SD	cRYGB n = 115 Mean ± SD	Corrected P value
				Re-VBGvscSG	cRYGB vs Re-VBG	cRYGBvscSG
Follow-up (mo)	39.1 ± 48.7	49.3 ± 17.6	50.0 ± 33.3
Average %EWL after VBG (%)	61.7 ± 27.0	38.7 ± 22.9	43.5 ± 25.0
Additional %EWL	-14.6 ± 19.9	17.9 ± 32.7
Total %EWL (%)	45.4 ± 25.5	56.6 ± 24.4	71.7 ± 23.8	0.614	0.006	0.025
Total body weight loss (%)	18.4 ± 11.1	24.1 ± 11.6	30.4 ± 10.1	0.049	< 0.001	0.016
Change body mass index (kg/m2)	8.1 ± 5.8	10.8 ± 5.8	13.5 ± 5.1	0.119	< 0.001	0.042
Reinhold (%EWL > 50%) (%)	47.6	56.3	82.6	0.7911 (0.211; 2.972)	0.3421 (0.125; 0.934)	0.2711 (0.090; 0.812)
Long-term complications (%)	61.9	62.5	15.7	0.8331 (0.214; 3.244)	10.1051 (3.600; 28.367)	8.4211 (2.733; 25.950)
2nd revisional procedure (n, %)	10 (47.6%)	5 (31.3%)	1 (0.9%)	NA	NA	NA
Improvement/ resolution in patients with 1 or more comorbidities (%)	80 (8/10)	60 (3/5)	92.7 (38/41)	0.3751 (0.081; 1.738)	1.2471 (0.476; 3.265)	0.4681 (0.126; 1.740)

¹Odds ratio (95%CI). Re-VBG: Revision of the vertical banded gastroplasty; cSG: Conversion to sleeve gastrectomy; cRYGB: Conversion to Roux-en-Y gastric bypass; %EWL: Excess weight loss; NA: Not available. P value is corrected for operative time, time between VBG and revision, osteo-articular disease and mean %EWL after VBG. No correction possible in logistic regression analysis due to limited events and group sizes. In case of a second revisional procedure, follow-up until second was taken into account.

Table 4 Long-term complaints after revision (n = 152)

	Re-VBG n = 21 (n)	cSG n = 16 (n)	cRYGB n = 115 (n)	Total (%)
Vomiting/dysphagia/ food intolerance	4	4	6	9.2
Weight regain	6	4	4	9.2
Insufficient weight loss	2	1	0	2.0
Petersen’s hernia	NA	NA	4	2.6
Incisional hernia	0	0	3	2.0
Recurrent abdominal pain	1	1	1	2.0
None	8	6	97	73.0

Re-VBG: Revision of the vertical banded gastroplasty; cSG: Conversion to sleeve gastrectomy; cRYGB: Conversion to Roux-en-Y gastric bypass; NA: Not available.

Table 5 Subgroup analysis (n = 152) (weight regain/insufficient weight loss vs other complaints)

	WR/IWL n = 79 Mean ± SD	Other n = 73 Mean ± SD	P value
Age (yr)	41.6 ± 7.4	43.9 ± 10.7	0.121
Male:female (n)	13:66	14:59	0.661
Body mass index before VBG (kg/m2)	44.7 ± 5.0	42.8 ± 4.8	0.016
Operative time (min)	128.2 ± 46.3	109.7 ± 48.6	0.02
Length of hospital stay (d)	4.3 ± 6.8	3.4 ± 2.0	0.858
Type of revision
Re-VBG	4	17	0.004
cSG	8	8
cRYGB	67	48
Average %EWL after VBG (%)	31.3 ± 19.0	61.2 ± 23.1	< 0.001
Postoperative complications < 30 d (n, %)	12 (15.2%)	6 (8.2%)	0.184
Total %EWL (%)	67.5 ± 23.7	65.2 ± 28.1	0.583
Reinhold (%EWL > 50%) (%)	79.7	74	0.398
Long-term complications (%)	22.8	28.8	0.399
2nd revisional procedure (n)	5	11	0.079
Improvement/resolution rate (%, n)
Type 2 diabetes mellitus	90 (9/10)	55.6 (5/9)	NA
Hypertension	76.9 (10/13)	44.4 (8/18)	NA
Dyslipidemia	100 (9/9)	100 (5/5)	NA
Sleep apnea	0 (0/1)	66.7 (2/3)	NA
Osteo-articular disease	57.1 (4/7)	57.1 (4/7)	NA

WR: Weight regain; IWL: Insufficient weight loss; Re-VBG: Revision of the vertical banded gastroplasty; cSG: Conversion to sleeve gastrectomy; cRYGB: Conversion to Roux-en-Y gastric bypass; %EWL: Excess weight loss; NA: Not available.