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


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.


Sleeve gastrectomy Weight regain Weight recidivism Revisional surgery Failure bariatric surgery 


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.


  1. 1.
    Pi-Sunyer FX. The medical risks of obesity. Obes Surg. 2002;12(Supplement 1):S6–S11.CrossRefGoogle Scholar
  2. 2.
    Ghoorah K, Campbell P, Kent A, Maznyczka A, Kunadian V. Obesity and cardiovascular outcomes: a review. Eur Heart J Acute Cardiovasc Care. 2014. doi: 10.1177/2048872614523349.
  3. 3.
    Gloy VL et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f5934.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Lannoo M, Dillemans B. Laparoscopy for primary and secondary bariatric procedures. Best Pract Res Clin Gastroenterol. 2014;28(1):159–73.PubMedCrossRefGoogle Scholar
  5. 5.
    Trastulli S et al. Laparoscopic sleeve gastrectomy compared with other bariatric surgical procedures: a systematic review of randomized trials. Surg Obes Relat Dis. 2013;9(5):816–29.PubMedCrossRefGoogle Scholar
  6. 6.
    Diamantis T et al. Review of long-term weight loss results after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2014;10(1):177–83.PubMedCrossRefGoogle Scholar
  7. 7.
    van Rutte PW et al. To sleeve or not to sleeve in bariatric surgery? ISRN Surg. 2012;2012:674042.PubMedCentralPubMedGoogle Scholar
  8. 8.
    Vage V et al. Changes in obesity-related diseases and biochemical variables after laparoscopic sleeve gastrectomy: a two-year follow-up study. BMC Surg. 2014;14(1):8.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Li JF et al. Comparison of the long-term results of Roux-en-Y gastric bypass and sleeve gastrectomy for morbid obesity: a systematic review and meta-analysis of randomized and nonrandomized trials. Surg Laparosc Endosc Percutan Tech. 2014;24(1):1–11.PubMedCrossRefGoogle Scholar
  10. 10.
    Lim CS et al. Revisional bariatric surgery. Obes Surg. 2009;19(7):827–32.PubMedCrossRefGoogle Scholar
  11. 11.
    Lacy A et al. Revisional surgery after sleeve gastrectomy. Surg Laparosc Endosc Percutan Tech. 2010;20(5):351–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Bastos EC et al. Determinants of weight regain after bariatric surgery. Arq Bras Cir Dig. 2013;26 Suppl 1:26–32.PubMedCrossRefGoogle Scholar
  13. 13.
    Mittermair R, Sucher R, Perathoner A. Results and complications after laparoscopic sleeve gastrectomy. Surg Today. 2013. doi: 10.1007/s00595-013-0688-0.
  14. 14.
    Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252(2):319–24.PubMedCrossRefGoogle Scholar
  15. 15.
    Levine MS, Carucci LR. Imaging of bariatric surgery: normal anatomy and postoperative complications. Radiology. 2014;270(2):327–41.PubMedCrossRefGoogle Scholar
  16. 16.
    Khaitan L et al. Laparoscopic revision of bariatric procedures: is it feasible? Am Surg. 2005;71(1):6–10. discussion 10-2.PubMedGoogle Scholar
  17. 17.
    Stefanidis D et al. Revisional bariatric surgery: perioperative morbidity is determined by type of procedure. Surg Endosc. 2013;27(12):4504–10.PubMedCrossRefGoogle Scholar
  18. 18.
    Shimizu H et al. Revisional bariatric surgery for unsuccessful weight loss and complications. Obes Surg. 2013;23(11):1766–73.PubMedCrossRefGoogle Scholar
  19. 19.
    Cohen R et al. Laparoscopic revisional bariatric surgery: myths and facts. Surg Endosc. 2005;19(6):822–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Topart P. Comment on: Laparoscopic repeat sleeve gastrectomy versus duodenal switch after isolated sleeve gastrectomy for obesity. Surg Obes Relat Dis. 2011;7(1):43–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Langer FB et al. Strategies for weight regain after sleeve gastrectomy. Surg Laparosc Endosc Percutan Tech. 2010;20(3):159–61.PubMedCrossRefGoogle Scholar
  22. 22.
    Weiner RA, Theodoridou S, Weiner S. Failure of laparoscopic sleeve gastrectomy—further procedure? Obes Facts. 2011;4 Suppl 1:42–6.PubMedGoogle Scholar
  23. 23.
    Noel P, Nedelcu M, Nocca D, Schneck AS, Gugenheim J, Iannelli A, Gagner M. Revised sleeve gastrectomy: another option for weight loss failure after sleeve gastrectomy. Surg Endosc. 2014;28(4):1096–102.Google Scholar
  24. 24.
    Moszkowicz D et al. Laparoscopic omega-loop gastric bypass for the conversion of failed sleeve gastrectomy: early experience. J Visc Surg. 2013;150(6):373–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Abdel-Galil E, Sabry A. Laparoscopic butterfly gastroplasty after failed sleeve gastrectomy in morbidly obese patient. Obes Surg. 2013;23(8):1211.Google Scholar
  26. 26.
    Dapri G, Cadiere GB, Himpens J. Laparoscopic repeat sleeve gastrectomy versus duodenal switch after isolated sleeve gastrectomy for obesity. Surg Obes Relat Dis. 2011;7(1):38–43.PubMedCrossRefGoogle Scholar
  27. 27.
    Gautier T et al. Indications and mid-term results of conversion from sleeve gastrectomy to Roux-en-Y gastric bypass. Obes Surg. 2013;23(2):212–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Iannelli A et al. Re-sleeve gastrectomy for failed laparoscopic sleeve gastrectomy: a feasibility study. Obes Surg. 2011;21(7):832–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Langer FB et al. Conversion from sleeve gastrectomy to Roux-en-Y gastric bypass—indications and outcome. Obes Surg. 2010;20(7):835–40.PubMedCrossRefGoogle Scholar
  30. 30.
    Lech P et al. Sleeve gastrectomy as a revisional bariatric surgery. Obes Surg. 2013;23(8):1208–9.Google Scholar
  31. 31.
    Nienhuijs SW et al. Revision after sleeve gastrectomy. Obes Surg. 2011;21(8):1003.Google Scholar
  32. 32.
    Rebibo L et al. Repeat sleeve gastrectomy compared with primary sleeve gastrectomy: a single-center, matched case study. Obes Surg. 2012;22(12):1909–15.PubMedCrossRefGoogle Scholar
  33. 33.
    van Rutte PW et al. Indications and short-term outcomes of revisional surgery after failed or complicated sleeve gastrectomy. Obes Surg. 2012;22(12):1903–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Wadhawan R. Revision of sleeve gastrectomy to Roux-en-Y gastric bypass—our technique and early results. Obes Surg. 2013;2013(23):8.Google Scholar
  35. 35.
    Prevot F et al. Two lessons from a 5-year follow-up study of laparoscopic sleeve gastrectomy: persistent, relevant weight loss and a short surgical learning curve. Surgery. 2014;155(2):292–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Mueller S, Runkel N, Brydniak R. Sleeve gastrectomy: a procedure in a state of flux. Surg Technol Int. 2011;XXI:121–5.PubMedGoogle Scholar
  37. 37.
    Gluck B et al. Laparoscopic sleeve gastrectomy is a safe and effective bariatric procedure for the lower BMI (35.0-43.0 kg/m2) population. Obes Surg. 2011;21(8):1168–71.PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Mukherjee S et al. Sleeve gastrectomy as a bridge to a second bariatric procedure in superobese patients—a single institution experience. Surg Obes Relat Dis. 2012;8(2):140–4.PubMedCrossRefGoogle Scholar
  39. 39.
    Basso N et al. Laparoscopic sleeve gastrectomy as first stage or definitive intent in 300 consecutive cases. Surg Endosc. 2011;25(2):444–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Iannelli A et al. Laparoscopic sleeve gastrectomy followed by duodenal switch in selected patients versus single-stage duodenal switch for superobesity: case-control study. Surg Obes Relat Dis. 2013;9(4):531–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Topart P, Becouarn G, Ritz P. Biliopancreatic diversion with duodenal switch or gastric bypass for failed gastric banding: retrospective study from two institutions with preliminary results. Surg Obes Relat Dis. 2007;3(5):521–5.PubMedCrossRefGoogle Scholar
  42. 42.
    Parikh M, Pomp A, Gagner M. Laparoscopic conversion of failed gastric bypass to duodenal switch: technical considerations and preliminary outcomes. Surg Obes Relat Dis. 2007;3(6):611–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Trelles N, Gagner M. Revision bariatric surgery: laparoscopic conversion of failed gastric bypass to biliopancreatic diversion with duodenal switch. Minerva Chir. 2009;64(3):277–84.PubMedGoogle Scholar
  44. 44.
    Dorman RB et al. Benefits and complications of the duodenal switch/biliopancreatic diversion compared to the Roux-en-Y gastric bypass. Surgery. 2012;152(4):758–65. discussion 765-7.PubMedCrossRefGoogle Scholar
  45. 45.
    Buchwald H et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142(4):621–32. discussion 632-5.PubMedCrossRefGoogle Scholar
  46. 46.
    Zundel N, Hernandez JD. Revisional surgery after restrictive procedures for morbid obesity. Surg Laparosc Endosc Percutan Tech. 2010;20(5):338–43.PubMedCrossRefGoogle Scholar
  47. 47.
    Deguines JB et al. Is the residual gastric volume after laparoscopic sleeve gastrectomy an objective criterion for adapting the treatment strategy after failure? Surg Obes Relat Dis. 2013;9(5):660–6.PubMedCrossRefGoogle Scholar
  48. 48.
    Rutledge T, Groesz LM, Savu M. Psychiatric factors and weight loss patterns following gastric bypass surgery in a veteran population. Obes Surg. 2011;21(1):29–35.PubMedCentralPubMedCrossRefGoogle Scholar
  49. 49.
    Deitel M, Gagner M. Findings of the third international consensus summit on sleeve gastrectomy (SG). Obes Surg. 2011;21(8):1025–6.Google Scholar
  50. 50.
    Buchwald H et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.PubMedCrossRefGoogle Scholar
  51. 51.
    Kim WW et al. Laparoscopic vs. open biliopancreatic diversion with duodenal switch: a comparative study. J Gastrointest Surg. 2003;7(4):552–7.PubMedCrossRefGoogle Scholar
  52. 52.
    Baltasar A et al. Re-sleeve gastrectomy. Obes Surg. 2006;16(11):1535–8.PubMedCrossRefGoogle Scholar
  53. 53.
    Victorzon M. Revisional bariatric surgery by conversion to gastric bypass or sleeve–good short-term outcomes at higher risks. Obes Surg. 2012;22(1):29–33.PubMedCrossRefGoogle Scholar
  54. 54.
    Kellogg TA. Revisional bariatric surgery. Surg Clin N Am. 2011;91(6):1353–71. x.PubMedCrossRefGoogle Scholar

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

Personalised recommendations