Vertical banded gastroplasty combined with Roux-en-Y gastrojejunostomy to enable effective weight loss without compromising access to stomach, duodenum and biliary tract for selected patients

Abstract

Aim: To evaluate the feasibility of vertical banded gastroplasty combined with Roux-en-Y gastric bypass as an operational gastro-gastric outlet technique with the potential to allow appropriate management of whole biliary and upper gastrointestinal tract after bariatric surgery without compromising weight loss. Methods: This study included 24 patients (mean age: 36.8 years, range 18 to 58 years, 62.5% female) who had undergone vertical banded gastroplasty combined with Roux-en-Y gastric bypass between 2003 and 2016 in our clinic and had completed a 7-year postoperative follow up. Data on operative characteristics, length of hospital stay and follow up data on postoperative complications and weight loss were recorded for each patient. Results: Mean operative time was 180±45 minutes while length of hospital stay was 6.0±1.0 days. There was no mortality, and only one patient (4.2%) was reoperated for hemorrhage on the first postoperative day. The most common patient complaints were early nausea and vomiting in 11 patients (45.83%), which disappeared in the second postoperative month, while 7 patients (29.2%) had dysphagia in the early postoperative period. No marginal ulcers or ulcers on anastomosis were found. Mean percentage of excess weight loss values recorded at the end of the first, second, third, fifth and seventh year following vertical banded gastroplasty combined with Roux-en-Y gastric bypass were 68.1±13.8 71.3±8.8 70.8±14.6, 68.2±11.3 and 61.4±13.3, respectively. Conclusions: Our findings indicate the feasibility of vertical banded gastroplasty combined with Roux-en-Y gastric bypass as a bariatric surgical procedure providing better postoperative evaluation and management of the whole upper gastrointestinal system through the stomach window created with the band along with acceptable weight loss in selected patients.