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Revision After Sleeve Gastrectomy

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Global Bariatric Surgery

Abstract

Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric surgery in the world. With increasing popularity, the failure rate of this surgery is also increasing. LSG shows poor weight loss results especially in morbidly obese patients. Thus, it is a challenge for the bariatric surgeons around the world to come up with the right strategy to manage these patients. Nutritional and psychological counseling is a must for all patients as the most common cause of weight recidivism is the failure of adherence to dietary and lifestyle regimen. Medical management should be given to selected patients. Upper gastrointestinal series and esophagogastroduodenoscopy are essential in diagnosing the gastric pouch dilation which can cause weight loss failure. Re-sleeve is the treatment option for these patients. If restrictive component is the cause of failure, then placing gastric band around the sleeve is an option. All the other causes require metabolic surgical intervention. Conversion of LSG to Roux-en-Y gastric bypass gives optimal weight loss; however, the risk of weight regain is high. Duodenal switch (DS) gives an excellent weight loss, but the patients are at increased risk for postoperative complications and malabsorption. Recently, a modification of DS, single-anastomosis duodenal switch (SADS), is becoming popular with weight loss equals to DS and acceptable morbidity. Two-stage approach to SADS is technically simpler and allows surgeons to do the LSG first with the conversion happening when failure is identified. However, longer follow-up is needed to understand its limitations. Thus, proper selection of the patients is a key to successfully manage the failure after LSG.

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  1. Bariatric Research, Bariatric Medicine Institute, Salt Lake City, UT, USA

    Daniel Cottam, Hinali Zaveri, Amit Surve & Austin Cottam

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  1. University of Illinois at Chicago, Chicago, IL, USA

    Rami Lutfi

  2. University of Buenos Aires, Buenos Aires, Argentina

    Mariano Palermo

  3. Saint-Pierre University Hospital, European School of Laparoscopic Surgery, Brussels, Belgium

    Guy-Bernard Cadière

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Cottam, D., Zaveri, H., Surve, A., Cottam, A. (2018). Revision After Sleeve Gastrectomy. In: Lutfi, R., Palermo, M., Cadière, GB. (eds) Global Bariatric Surgery . Springer, Cham. https://doi.org/10.1007/978-3-319-93545-4_17

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