Obesity Surgery

, Volume 19, Issue 5, pp 645–649 | Cite as

Feasibility of Sleeve Gastrectomy as a Revision Operation for Failed Silastic Ring Vertical Gastroplasty

  • Ram ElazaryEmail author
  • David Hazzan
  • Liat Appelbaum
  • Avraham I. Rivkind
  • Andrei Keidar
Research Article



Restrictive bariatric operations are efficient with low morbidity but entail high rate of failure on follow up of several years. We present our experience in laparoscopic revision of patients who previously underwent silastic ring vertical gastroplasty (SRVG) into laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB).


Data on 12 patients who underwent revisional operations after SRVG was prospectively collected. Six patients underwent LRYGB and six patients underwent LSG. The pathogeneses for failures of SRVG were disruption of staple line, enlargement of gastric pouch, and opening of the ring.


The average age and body mass index (BMI) were 39 and 43, respectively, in the LSG group versus average age and BMI of 39 and 45, respectively, in the LRYGP group (p = 0.45 and p = 0.35, respectively). The average operative time were 206 and 368 min in the LSG and LRYGB groups, respectively (p < 0.01). There were five postoperative complications among LSG group versus two complications in LRYGB group (p < 0.01). Patients who underwent LSG suffered from the following complications: staple line leak in two patients, intra-abdominal hematoma in one patient, intra-abdominal collection in one patient, and gastric outlet obstruction in one patient. Anastomotic leak and wound infection were the complications seen among patients underwent LRYGB. All complications were treated conservatively without necessitating immediate reoperations. Follow-up has shown adequate reduction of body weight and improved quality of life in both groups of patients.


Revisional bariatric operation is a challenging laparoscopic procedure with higher morbidity compared to primary bariatric operations. Morbidity of LSG compared to LRYGB as a revisional procedure for SRVG is significantly higher.


Morbid obesity Sleeve gastrectomy Silastic ring vertical gastroplasty Failed bariatric procedure 


  1. 1.
    Kaminski DL. Gastric restrictive procedures to treat obesity: reasons for failure and long-term evaluation of the results of operative revision. Int J Surg Investig 2001;2:413–21.PubMedGoogle Scholar
  2. 2.
    Brolin RE, Cody RP. Impact of technological advances on complications of revisional bariatric operations. J Am Coll Surg 2008;206:1137–44.CrossRefGoogle Scholar
  3. 3.
    Khaitan L, Van Sickle K, Gonzalez R, et al. Laparoscopic revision of bariatric procedures: is it feasible? Am Surg 2005;71:6–10.PubMedGoogle Scholar
  4. 4.
    Gagner M, Gumbs AA. Gastric banding: conversion to sleeve, bypass, or DS. Surg Endosc 2007;21:1931–5.CrossRefGoogle Scholar
  5. 5.
    Parikh M, Pomp A, Gagner M. Laparoscopic conversion of failed gastric bypass to duodenal switch: technical considerations and preliminary outcomes. Surg Obes Relat Dis 2007;3:611–8.CrossRefGoogle Scholar
  6. 6.
    Gonzalez R, Gallagher SF, Haines K, et al. Operative technique for converting a failed vertical banded gastroplasty to Roux-en-Y gastric bypass. J Am Coll Surg 2005;201:366–74.CrossRefGoogle Scholar
  7. 7.
    Iannelli A, Amato D, Addeo P, et al. Laparoscopic conversion of vertical banded gastroplasty (Mason MacLean) into Roux-en-Y Gastric Bypass. Obes Surg 2008;18:43–6.CrossRefGoogle Scholar
  8. 8.
    Mognol P, Chosidow D, Marmuse JP. Roux-en-Y gastric bypass after failed vertical banded gastroplasty. Obes Surg 2007;17:1431–4.CrossRefGoogle Scholar
  9. 9.
    Gumbs AA, Pomp A, Gagner M. Revisional bariatric surgery for inadequate weight loss. Obes Surg 2007;17:1137–45.CrossRefGoogle Scholar
  10. 10.
    Iannelli A, Dainese R, Piche T, et al. Laparoscopic sleeve gastrectomy for morbid obesity. World J Gastroenterol 2008;14:821–7.CrossRefGoogle Scholar
  11. 11.
    Ren CJ, Patterson E, Gagner M. Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg 2000;10:514–23.CrossRefGoogle Scholar
  12. 12.
    Gumbs AA, Gagner M, Dakin G, et al. Sleeve gastrectomy for morbid obesity. Obes Surg 2007;17:962–9.CrossRefGoogle Scholar
  13. 13.
    Gagner M, Rogula T. Laparoscopic reoperative sleeve gastrectomy for poor weight loss after biliopancreatic diversion with duodenal switch. Obes Surg 2003;13:649–54.CrossRefGoogle Scholar
  14. 14.
    Bernante P, Foletto M, Busetto L, et al. Feasibility of laparoscopic sleeve gastrectomy as a revision procedure for prior laparoscopic gastric banding. Obes Surg 2006;16:1327–30.CrossRefGoogle Scholar
  15. 15.
    Feng JJ, Gagner M. Laparoscopic biliopancreatic diversion with duodenal switch. Semin Laparosc Surg 2002;9:125–9.CrossRefGoogle Scholar
  16. 16.
    Kotidis EV, Koliakos GG, Baltzopoulos VG, et al. Serum ghrelin, leptin and adiponectin levels before and after weight loss: comparison of three methods of treatment—a prospective study. Obes Surg 2006;16:1425–32.CrossRefGoogle Scholar
  17. 17.
    Cohen R, Uzzan B, Bihan H, et al. Ghrelin levels and sleeve gastrectomy in super–super-obesity. Obes Surg 2005;15:1501–2.CrossRefGoogle Scholar
  18. 18.
    Lalor PF, Tucker ON, Szomstein S, et al. Complications after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2008;4:33–8.CrossRefGoogle Scholar
  19. 19.
    Deitel M, Crosby RD, Gagner M. The First International Consensus Summit for Sleeve Gastrectomy (SG), New York City, October 25–27, 2007. Obes Surg 2008;18:487–96.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Ram Elazary
    • 1
    Email author
  • David Hazzan
    • 2
  • Liat Appelbaum
    • 3
  • Avraham I. Rivkind
    • 1
  • Andrei Keidar
    • 1
  1. 1.General Surgery DepartmentHadassah-Hebrew University Medical CenterJerusalemIsrael
  2. 2.General Surgery DepartmentCarmel Medical CenterHaifaIsrael
  3. 3.Radiology DepartmentHadassah-Hebrew University Medical CenterJerusalemIsrael

Personalised recommendations