Laparoscopic sleeve gastrectomy (LSG) has rapidly become a preferred surgical procedure for morbid obesity due to its efficacy and low complication rates, as well as the technical ease of performing it. The past few years have seen significant growth in procedure numbers, and LSG has achieved becoming the most frequently performed bariatric procedure in France in 2011 and in the USA in 2013 [1, 2]. In 2013, 42,815 bariatric procedures were performed in France of which 56% were sleeve gastrectomy. According to the French National Health Insurance Fund, this figure has tripled in 7 years.
This growth can be attributed to the better outcome and quality of life of the sleeve compared to adjustable gastric bands , in addition to the several advantages that LSG carries over more complex bariatric procedures, such as LRYGB or DS from a technical standpoint, as well as to the absence of the side effects of bypass procedures specifically dumping syndrome, marginal ulcers, malabsorption, small bowel obstruction, and internal hernia and a better quality of life over gastric banding.
The rising numbers of LSG procedures now being performed (France: 480 cases in 2005 vs. 13,557 cases in 2011 and 23,976 in 2013, up to 56% of all bariatric procedure) will likely be followed by increasing numbers of patients who will experience weight loss failure (insufficient weight loss or weight regain) or will develop certain complications, such as gastroesophageal reflux disease (GERD), and will seek conversion to another bariatric procedure. A second intervention, such as revisional sleeve gastrectomy (ReSG) [4–9], LRYGB , or biliopancreatic diversion with DS (BPD-DS) [11–13] can be proposed for inadequate weight loss or weight regain. Single-anastomosis duodenoileal (SADI) bypass with sleeve gastrectomy represents a new alternative to standard DS, but limited results are present in the literature , and this new bariatric procedure must be validated over time (this procedure is discussed in detail in another chapter).
Regardless of the revisional surgery of choice, it is also necessary to know the reasons for failure or suboptimal outcome. Behavioral and dietary reasons should be ruled out before deciding to take patients for a higher-risk revisional surgery.
Laparoscopic sleeve gastrectomy Resleeve gastrectomy Revisional surgery Weight regain Insufficient weight loss Bariatric surgery
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