Comparison of long-term outcome of Biliopancreatic Diversion and Roux-En-Y Gastric Bypass as revision procedures for failed Vertical Banded Gastroplasty.

Background Vertical banded gastroplasty (VBG) and silastic ring vertical gastroplasty (SRVG) have been associated with high long-term failure rates due to complications such as staple-line dehiscence and weight regain, and band-related obstructive symptoms. The optimal revisional surgical approach for failed VBG/SRVG remains debated. This study evaluates the long-term outcomes of the two revisional bariatric procedures biliopancreatic diversion (BPD) and Roux-en-Y gastric bypass (RYGB) in patients with failed VBG/SRVG. Methods A retrospective comparative study was conducted, including 60 patients who underwent revisional surgery for failed VBG/SRVG between 2004 and 2018. Twenty-nine patients underwent BPD and 31 underwent RYGB. Outcomes assessed included weight loss, quality of life, re-hospitalizations, and long-term gastrointestinal and nutritional complications. Median follow-up was 10.5 years (range 8.5–14.7). Data were analyzed using appropriate statistical tests, with P  < 0.05 considered statistically significant. Results Both procedures achieved significant improvements in weight loss and quality of life. However, BPD was associated with a significantly higher incidence of diarrhea (75.9% vs. 21.4%; P  < 0.001), gallstones (37.9% vs. 10.7%; P  = 0.029), anal complications (44.8% vs. 7.1%; P  = 0.002) and compared to RYGB, as well as nutritional deficiencies. Marginal ulcers (28.9% vs. 14.3%) and gastroesophageal reflux were also more common in the BPD group, though not statistically significant. Conversely, three RYGB patients required surgical intervention for bowel obstruction due to internal hernia, whereas no such cases occurred in the BPD group (not statistically significant). Conclusion In comparison to patients who underwent RYGB, those who received BPD as a revision for failed VBG/SRVG experienced significantly higher rates of long-term complications, particularly diarrhea, gallstones, anal complications as well as nutritional deficiencies. These findings emphasize the importance of considering long-term outcomes when selecting a revisional bariatric procedure.