EC Gastroenterology and Digestive System

Background: Sleeve gastrectomy is currently considered as a primary bariatric surgery. This is because of its relative simplicity and satisfactory results. As observed with other bariatric procedures, surgeons are confronted with insufficient weight loss or weight regain, insufficient resolution of metabolic disorders and intractable severe reflux.

Objectives: The aim of this study was to report the indications for and the outcomes of revisional surgery after sleeve gastrectomy.

Methods: 11 (5%) patients underwent a revision surgery after sleeve gastrectomy procedure for insufficient weight loss or/and severe reflux. All patients with failure after primary sleeve gastrectomy underwent endoscopic and radiologic evaluation. The patients were subdivided in a first group undergoing revision as part of a two-step procedure, a second group with failure of a primary sleeve gastrectomy (insufficient weight loss or/and severe reflux).

Results: Mean initial body mass index and excess weight were 47,7 ± 10,1 (35 - 81,5) kg/m² and 76,8 ± 32,6 (46 - 169) kg, respectively before primary sleeve gastrectomy. The mean interval between the two procedures was almost 23 ± 9,2 months in first group and 43 ± 27,4 months in second group. The mean body mass index and % excess weight loss was 49,7 ± 7,1 kg/m² and 34,2 ± 15,7% for the first group and 37,2 ± 3,0 kg/m² and 18,9 ± 11,9% for the second group, respectively before revisional surgery. Five patients had a two-step procedure because of super obesity in the first group. In the second group: three patients underwent conversion to Roux-en-Y gastric bypass for insufficient weight loss and severe reflux and three patients to re-sleeve gastrectomy for insufficient weight loss and severe reflux. All reflux symptoms were resolved without any medication. The mean body mass index and % excess weight loss was 30,4 ± 4 kg/m² and 68,8 ± 11,3% for the first group and 27,7 ± 5,4 kg/m² and 62,1 ± 20,6% for the second group, respectively. Only one postoperative complication was observed as a staple line leakage. Revision related mortality was 0%.

Conclusion: The revision rate was 5%. Revision of a sleeve gastrectomy is safe, feasible and effective in the short term in patients that do not achieve sufficient weight loss and in those patients who have sever reflux after the initial sleeve gastrectomy.

 Keywords: Morbid Obesity; Sleeve Gastrectomy; Revisional Surgery; Roux-En-Y Gastric Bypass; Weight Loss Failure; Biliopancreatic Diversion with Duodenal Switch

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