Surgical Endoscopy

, Volume 28, Issue 4, pp 1096–1102

Revised sleeve gastrectomy: another option for weight loss failure after sleeve gastrectomy

  • Patrick Noel
  • Marius Nedelcu
  • David Nocca
  • Anne-Sophie Schneck
  • Jean Gugenheim
  • Antonio Iannelli
  • Michel Gagner
Article

Abstract

Introduction

Laparoscopic sleeve gastrectomy (LSG) is becoming a very common bariatric procedure, based on several advantages it carries over more complex bariatric procedures such as gastric bypass or duodenal switch (DS), and a better quality of life over gastric banding. However, in the long-term follow-up, weight loss failure and intractable severe reflux after primary LSG can necessitate further surgical interventions, and revisional sleeve gastrectomy (ReSG) can represent an option to correct these.

Methods

From October 2008 to June 2013, 36 patients underwent an ReSG for progressive weight regain, insufficient weight, or severe gastroesophageal reflux in ‘La Casamance’ Private Hospital. All patients with weight loss failure after primary LSG underwent radiological evaluation. If Gastrografin swallow showed a huge unresected fundus or an upper gastric pouch dilatation, or if the computed tomography (CT) scan volumetry revealed a gastric tube superior to 250 cc, ReSG was proposed.

Results

Thirty-six patients (34 women, two men; mean age 41.3 years) with a body mass index (BMI) of 39.9 underwent ReSG. Thirteen patients (36.1 %) had their original LSG surgery performed at another hospital and were referred to us for weight loss failure. Twenty-four patients (66.6 %) out of 36 had a history of gastric banding with weight loss failure. Thirteen patients (36.1 %) were super-obese (BMI > 50) before primary LSG. The LSG was realized for patients with morbid obesity with a mean BMI of 47.1 (range 35.4–77.9). The mean interval time from the primary LSG to ReSG was 34.5 months (range 9–67 months). The indication for ReSG was insufficient weight loss for 19 patients (52.8 %), weight regain for 15 patients (41.7 %), and 2 patients underwent ReSG for invalidating gastroesophageal reflux disease. In 24 cases the Gastrografin swallow results were interpreted as primary dilatation, and in the remaining 12 cases results were interpreted as secondary dilatation. The CT scan volumetry was realized in 21 cases, and it has revealed a mean gastric volume of 387.8 cc (range 275–555 cc). All 36 cases were completed by laparoscopy with no intraoperative incidents. The mean operative time was 43 min (range 29–70 min), and the mean hospital stay was 3.9 days (range 3–16 days). One perigastric hematoma was recorded. The mean BMI decreased to 29.2 (range 20.24–37.5); the mean percentage of excess weight loss was 58.5 % (±25.3) (p < 0.0004) for a mean follow-up of 20 months (range 6–56 months).

Conclusions

The ReSG may be a valid option for failure of primary LSG for both primary or secondary dilatation. Long-term results of ReSG are awaited to prove efficiency. Further prospective clinical trials are required to compare the outcomes of ReSG with those of Roux en Y Gastric Bypass or DS for weight loss failure after LSG.

Keywords

Revised sleeve gastrectomy 

References

  1. 1.
    Iannelli A, Schneck AS, Topart P, Carles M, Hébuterne X, Gugenheim J (2013) Laparoscopic sleeve gastrectomy followed by duodenal switch in selected patients versus single-stage duodenal switch for superobesity: case-control study. Surg Obes Relat Dis 9(4):531–538PubMedCrossRefGoogle Scholar
  2. 2.
    Regan JP, Inabnet WB, Gagner M, Pomp A (2003) Early experience with two-staged laparoscopic Roux-en-Y gastric bypass as an alternative in the super–super obese patient. Obes Surg 13:861–864PubMedCrossRefGoogle Scholar
  3. 3.
    Fezzi M, Kolotkin RL, Nedelcu M et al (2011) Improvement in quality of life after laparoscopic sleeve gastrectomy. Obes Surg 21(8):1161–1167PubMedCrossRefGoogle Scholar
  4. 4.
    Gagner M, Rogula T (2003) Laparoscopic reoperative sleeve gastrectomy for poor weight loss after biliopancreatic diversion with duodenal switch. Obes Surg 13:649–654PubMedCrossRefGoogle Scholar
  5. 5.
    Baltasar A, Serra C, Pérez N, Bou R, Bengochea M (2006) Re-sleeve gastrectomy. Obes Surg 16:1535–1538PubMedCrossRefGoogle Scholar
  6. 6.
    Dapri G, Cadière GB, Himpens J (2011) Laparoscopic repeat sleeve gastrectomy versus duodenal switch after isolated sleeve gastrectomy for obesity. Surg Obes Relat Dis 7(1):38–43PubMedCrossRefGoogle Scholar
  7. 7.
    Iannelli A, Schneck AS, Noel P, Ben Amor I, Krawczykowski D, Gugenheim J (2011) Re-sleeve gastrectomy for failed laparoscopic sleeve gastrectomy: a feasibility study. Obes Surg 21(7):832–835PubMedCrossRefGoogle Scholar
  8. 8.
    Rebibo L, Fuks D, Verhaeghe P, Deguines JB, Dhahri A, Regimbeau JM (2012) Repeat sleeve gastrectomy compared with primary sleeve gastrectomy: a single-center, matched case study. Obes Surg 22(12):1909–1915PubMedCrossRefGoogle Scholar
  9. 9.
    Noel P, Nedelcu M, Nocca D (2013) The revised sleeve gastrectomy: technical considerations. Surg Obes Relat Dis. doi:10.1016/j.soard.2013.06.008 PubMedGoogle Scholar
  10. 10.
    Noel P, Iannelli A, Sejor E, Schneck AS, Gugenheim J (2013) Laparoscopic sleeve gastrectomy: how I do it. Surg Laparosc Endosc Percutan Tech 23(1):e14–e16PubMedCrossRefGoogle Scholar
  11. 11.
    Weiner RA, Weiner S, Pomhoff I et al (2007) Laparoscopic sleeve gastrectomy: influence of sleeve size and 120 resected gastric volume. Obes Surg 17:1297–1305PubMedCrossRefGoogle Scholar
  12. 12.
    Lin E, Gletsu N, Fugate K et al (2004) The effects of gastric surgery on systemic ghrelin levels in the morbidly obese. Arch Surg 139:780–784PubMedCrossRefGoogle Scholar
  13. 13.
    Himpens J, Dobbeleir J, Peeters G (2010) Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg 252(2):319–324PubMedCrossRefGoogle Scholar
  14. 14.
    Braghetto I, Cortes C, Herquiñigo D et al (2009) Evaluation of the radiological gastric capacity and evolution of the BMI 2–3 years after sleeve gastrectomy. Obes Surg 19:1262–1269PubMedCrossRefGoogle Scholar
  15. 15.
    Langer FB, Bohdjalian A, Falbervawer FX et al (2006) Does gastric dilatation limit the success of sleeve gastrectomy as a sole operation for morbid obesity? Obes Surg 16:166–171PubMedCrossRefGoogle Scholar
  16. 16.
    Yehoshua RT, Eidelman LA, Stein M et al (2008) Laparoscopic sleeve gastrectomy: volume and pressure assessment. Obes Surg 18:1083–1088PubMedCrossRefGoogle Scholar
  17. 17.
    Trelles N, Gagner M, Palermo M, Pomp A, Dakin G, Parikh M (2010) Gastrocolic fistula after re-sleeve gastrectomy: outcomes after esophageal stent implantation. Surg Obes Relat Dis 6(3):308–312PubMedCrossRefGoogle Scholar
  18. 18.
    Soricelli E, Iossa A, Casella G, Abbatini F, Calì B, Basso N (2013) Sleeve gastrectomy and crural repair in obese patients with gastroesophageal reflux disease and/or hiatal hernia. Surg Obes Relat Dis 9(3):356–361PubMedCrossRefGoogle Scholar
  19. 19.
    Heacock L, Parikh M, Jain R, Balthazar E, Hindman N (2012) Improving the diagnostic accuracy of hiatal hernia in patients undergoing bariatric surgery. Obes Surg 22(11):1730–1733PubMedCrossRefGoogle Scholar
  20. 20.
    Parikh M, Gagner M (2008) Laparoscopic hiatal hernia repair and repeat sleeve gastrectomy for gastroesophageal reflux disease after duodenal switch. Surg Obes Relat Dis 4(1):73–75PubMedCrossRefGoogle Scholar
  21. 21.
    Petersen WV, Meile T, Küper MA, Zdichavsky M, Königsrainer A, Schneider JH (2012) Functional importance of laparoscopic sleeve gastrectomy for the lower esophageal sphincter in patients with morbid obesity. Obes Surg 22(3):360–366PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Patrick Noel
    • 1
  • Marius Nedelcu
    • 1
    • 2
  • David Nocca
    • 2
  • Anne-Sophie Schneck
    • 3
  • Jean Gugenheim
    • 3
  • Antonio Iannelli
    • 3
  • Michel Gagner
    • 4
  1. 1.Hôpital Prive La CasamanceAubagneFrance
  2. 2.Centre Hospitalier Régional Universitaire MontpellierMontpellierFrance
  3. 3.Hôpital ArchetUniversité de NiceNiceFrance
  4. 4.Hôpital Du Sacre CœurMontrealCanada

Personalised recommendations