Obesity Surgery

, 18:1544

Is a Pouch Compulsory in Roux-en-Y Gastric Bypass After Failed Adjustable Gastric Banding?

  • A. Perathoner
  • H. Weiss
  • W. Santner
  • G. Brandacher
  • E. Laimer
  • E. Höller
  • F. Aigner
  • A. Klaus
Research Article

DOI: 10.1007/s11695-008-9586-8

Cite this article as:
Perathoner, A., Weiss, H., Santner, W. et al. OBES SURG (2008) 18: 1544. doi:10.1007/s11695-008-9586-8

Abstract

Background

Pouch formation after failed gastric banding bears a risk of anastomotic leakage, bleeding or ischemic damage due to an impaired vascular supply or demanding preparation in the scarry tissue. We evaluated the clinical outcome in patients following Roux-en-Y gastric bypass (RYBP) with and without gastric pouch reconstruction after removal of adjustable gastric bands.

Methods

This study comprised 24 morbidly obese patients undergoing RYBP as their final bariatric procedure. Group 1 consisted of eight patients after band migration or pouch dilatation. An esophago-jejunal anastomosis was performed. Group 2 comprised 16 patients with esophageal motility disorders or pouch dilation after banding. A regular-sized pouch was created. Clinical parameters, such as weight loss, complications and a satiety score were assessed. Serum values of ghrelin and gastrin were measured.

Results

All but one procedure (Group 2) could be performed by laparoscopy. Mortality rate was 0%. One patient of Group 1 developed a liver abscess that required percutaneous drainage and one patient of Group 2 developed stenosis at the gastrojejunostomy that necessitated endoscopic balloon-dilation. All patients significantly reduced body weight (p < 0.01 compared to preoperative values) during a median follow-up of 37.5 and 31.5 months, respectively. Two out of 16 (12.5%) patients of Group 2 showed pathologic postoperative DeMeester scores. Esophageal body peristalsis did not reveal statistically significant differences between the two groups. Parameters of satiety assessment did not differ between the two groups as did serum values of gastrin and ghrelin.

Conclusion

RYBP in patients experiencing adjustable gastric band failure is technically demanding. Esophago-jejunostomy avoids preparation in scarred tissue whereas routine pouch formation may increase the risk for complications. Adapted procedural strategy is recommended based on intraoperative decision making.

Keywords

Gastric banding Failure Redo surgery Conversion Gastric bypass 

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • A. Perathoner
    • 1
  • H. Weiss
    • 1
  • W. Santner
    • 2
  • G. Brandacher
    • 1
  • E. Laimer
    • 1
  • E. Höller
    • 1
  • F. Aigner
    • 1
  • A. Klaus
    • 1
  1. 1.Department of General and Transplant SurgeryMedical University InnsbruckInnsbruckAustria
  2. 2.Department of RadiologyMedical University InnsbruckInnsbruckAustria