Laparoscopic Conversion of VBG to CRnYGB Including Technical Problems and Complication Management

Revisionary surgery after VBG is known to be mostly performed in an open fashion. As ruptures of the stapler line were common, the typical revisionary procedure was the restapling of the vertical suture line or the complete separation of the pouch and remnant stomach with a GIA stapler [2]. Fobi et al. used the gastric bypass as a revisionary procedure. He reformed the vertical gastric pouch, left the banding in place and performed the bypass. This led to the development of the primary banded Roux- en-Y gastric bypass procedure [9]. It is also possible to perform a sleeve gastrectomy with resection of the banding [10]. Weiner et al. proposed performing the Scopinaro procedure after VBG: The distal stomach with the banding is resected, the vertical stomach pouch is connected to the alimentary limb and an intestinal reconstruction with formation of a 50 cm common channel is performed. In our opinion, all of these techniques can be used as revisions after VBG except for the restoration of the VBG [2, 11]. It is reported that the re-VGB shows even higher revision rates than the primary VBG [2]. The procedure should be individually chosen and discussed in inter-disciplinary teams. The BAROS should be evaluated in all patients. Contraindications should be considered prior to all redo procedures. All of our patients underwent a psychological and endo-crinological examination and each patient underwent thorough medical examination including 3D MSCT stomach volumetry [12]. Himpens’ procedure schedule can be used as an orientation to the surgical options which exist [13]. To improve and shorten the learning curve, we introduced the monthly Videosurgery Conference, where intra-operative complications and rare cases are discussed. To improve practical skills, all our residents have to attend the videosurgery course (40 h in the Videosurgical Lab) and five different Pig Labs during residency training. The development of our School of Videosurgery (SVS) allows us to introduce technical innovations and shorten the learning curve for new procedures, not only for fellows but also for residents in standard videosurgical cases.