Endoscopic revision (stomaphyx) versus formal surgical revision (gastric bypass) for failed vertical band gastroplasty

Background. weight regain secondary to vbg pouch dilation is a typical referral for bariatric surgeons. in this study we compare an endoluminal pouch reduction (stomaphyx) to rygb for revision. methods. a retrospective review was completed for patients with a previous vbg presenting with weight regain between 2003-2010. results. thirty patients were identified for study 23 rygb,14 stomaphyx. significant post procedure bmi loss was seen in each cohort (rygb,47.7 ± 7 kg/m2 to 35 ± 7 kg/m2; stomaphyx 43 ± 10 kg/m2 to 40 ± 9 kg/m2,p = 0.0007). whereas nausea and headache were the only complications observed in stomaphyx patients,the rygb group had a 43.5% complication rate and 1 mortality. complications following rygb include: incisional hernia (13%),anastomotic leak (8.7%),respiratory failure (8.7%),fistula (8.7%),and perforation (4.35%). the median length of stay following rygb was 6 days compared to 1.5 ± 0.5 days following stomaphyx. conclusion. this study suggests that while rygb revision may achieve greater weight loss,the complication rates and severity is discouraging. stomaphyx may be a safe alternative. further technical modifications of the device and longer follow-up may clarify the role of this approach. © 2013 johan bolton et al.