Background:
Bariatric Surgery is an evidence-based approach to treatment of severe obesity. Vertical Banded Gastroplasty (VBG) is a technique that gained popularity in the 1990’s, but was eventually abandoned due to long-term complications including intermittent gastric outlet obstruction. Revision requires conversion to RYGB or reversal with a gastrogastrostomy. Both procedures are technically challenging and come with their own complications.


Hypothesis:
Simple division of the mesh would resolve gastric outlet obstruction symptoms


Methods: 
Six patients presented to the Edmonton Bariatric Surgery Revision Clinic from November 2014 to July 2016. The preoperative assessment, operative approach and postoperative follow-up was reviewed.


Results:
Preoperative investigations included gastroscopy and fluoroscopy which confirmed the diagnosis of gastric outlet obstruction in all six patients. A laparoscopic approach was successful in 83% of patients. The mesh was identified and divided in 83% of patients and entirely removed in 33%. There was complete resolution of symptoms in all patient on postoperative day one and at the 30-day follow-up. 

Conclusion:
The study presents a less involved procedure to treat gastric outlet obstruction secondary to VBG. This procedures has low morbidity, excellent short-term success, and allows for the option to convert to RYGB in the future should the procedure be indicated.

A Minimalist Approach to Gastric Outlet Obstruction Secondary to Vertical Banded Gastroplasty