Vertical banded gastroplasty (VBG) was commonly performed in the 1980's and 1990's for the surgical treatment of severe obesity. It has essentially been abandoned as a bariatric surgical treatment option in the United States due to poor long-term outcomes and complications. Conversion of VBG to Roux-en-Y gastric bypass is considered to be the optimal treatment of choice. Open techniques of revisional bariatric surgery conversion of VBG to Roux-en-Y gastric bypass have been described. This video demonstrates the laparoscopic approach to revision of VBG to Roux-en-Y gastric bypass.

The steps involved include trocar placement, lysis of adhesions, identifying the proximal stomach anatomy and band, creating the new gastric pouch, dividing adhesions in the lesser sac, creating the Roux limb and jejuno-jejunostomy, and creating the gastro-jejunostomy. These steps and technical pearls are demonstrated on the video.

Excess weight loss averages 60% at years 1, 2, and 3. GERD is improved in all. Diabetes resolved in 80%. 2 leaks, no deaths.

Laparoscopic revision of previous vertical banded gastroplasty to Roux-en-Y gastric bypass, though complicated, is feasible and safe. It provides resolution of obesity-related health problems, improvement in symptoms related to the band, and adequate weight loss.