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Obesity Surgery

, Volume 24, Issue 10, pp 1757–1763 | Cite as

Revisional Bariatric Surgery Following Failed Primary Laparoscopic Sleeve Gastrectomy: A Systematic Review

  • Douglas Cheung
  • Noah J. Switzer
  • Richdeep S. Gill
  • Xinzhe Shi
  • Shahzeer KarmaliEmail author
Review

Abstract

Revisional bariatric surgery following laparoscopic sleeve gastrectomy (LSG) failure presents a clinical challenge for the bariatric surgeon. Limited evidence exists in selecting the appropriate revisional operation: laparoscopic gastric bypass (LGB), laparoscopic re-sleeve gastrectomy (LRSG), or other surgical intervention (OSI), to address weight regain. We systematically reviewed the literature to assess the efficacy of existing revisional surgery. A comprehensive search of electronic databases (e.g., Medline, Embase, Scopus, Web of Science, and the Cochrane Library) was completed. All randomized controlled trials, non-randomized comparison study, and case series were included. Eleven primary studies (218 patients) were identified and included in the systematic review. Studies were grouped into three main categories: LGB, LRSG, and OSI. Preoperative body mass index (BMI) was 41.9 kg/m2 (LGB), 38.5 kg/m2 (LRSG), and 44.4 kg/m2 (OSI). After conversion to LGB, BMI decreased to 33.7 and 35.7 kg/m2 at 12 and 24 months of follow-up, respectively. Excess weight loss (EWL) was 60 and 48 % over the same periods. After LRSG, BMI decreased to 30.4 and 35.3 kg/m2 with corresponding EWL of 68 and 44 %, at 12 and 24 months, respectively. After OSI, BMI decreased to 27.3 kg/m2 with an EWL of 75 % at 24-month follow-up but could not be analyzed due to incomplete data collection in primary studies. Both LGB and LRSG achieve effective weight loss following failed LSG. The less technically challenging nature of LRSG may be more widely applicable. Further research is required to elicit sustainability in long-term weight loss benefits.

Keywords

Sleeve gastrectomy Weight regain Weight recidivism Revisional surgery Failure bariatric surgery 

Notes

Conflict of Interest

Douglas Cheung has no disclosures. Noah Switzer has no disclosures. Richdeep Gill has no disclosures. Xinzhe Shi has no disclosures. Shahzeer Karmali was a consultant for Ethicon and Covidien.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Douglas Cheung
    • 1
  • Noah J. Switzer
    • 2
  • Richdeep S. Gill
    • 2
  • Xinzhe Shi
    • 3
  • Shahzeer Karmali
    • 2
    • 3
    Email author
  1. 1.Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
  2. 2.Department of SurgeryUniversity of AlbertaEdmontonCanada
  3. 3.Center for the Advancement of Minimally Invasive Surgery (CAMIS)Royal Alexandria HospitalEdmontonCanada

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