Conversion and Revisional Surgery: Sleeve Gastrectomy

Chapter

Abstract

Sleeve gastrectomy (SG) was initially conceived as a component of a biliopancreatic diversion and duodenal switch operation. Later, noting significant weight loss with the gastric sleeve alone, the paradigm shifted toward SG as the first stage of a two-stage biliopancreatic diversion and duodenal switch and eventually gained significant popularity as a stand-alone bariatric operation. Thus SG has always been a revisable procedure. Numerous indications for revision of a prior SG exist, with an equal number of possible operative conversion. Generally SG revisional surgery addresses complications of a SG, most notably either staple-line leak or stenosis, mechanical issues related to sleeve construction, and development of treatments of new comorbid conditions, failure to lose weight, or weight recidivism. In other cases SG revision is pre-planned as a second operation in patients with super-morbid obesity. Consideration of the indication for revision commonly directs the surgeon to the most reasonable revisional operation.

Keywords

Sleeve gastrectomy Gastric sleeve stenosis Revisional bariatric surgery Conversion Staple-line disruption Chronic leak Gastroesophageal reflux disease (GERD) 

References

  1. 1.
    Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obes Surg. 1998;8(3):267–82.CrossRefPubMedGoogle Scholar
  2. 2.
    Marceau P, Hould FS, Simard S, Lebel S, Bourque RA, Potvin M, et al. Biliopancreatic diversion with duodenal switch. World J Surg. 1998;22(9):947–54.CrossRefPubMedGoogle Scholar
  3. 3.
    Trelles N, Gagner M. Sleeve gastrectomy. Oper Tech Gen Surg. 2007;9(3):123–31.CrossRefGoogle Scholar
  4. 4.
    Singh K. Laparoscopic sleeve gastrectomy: a stage procedure for super-super obese patients. In: Nguyen NT, EJ DM, Ikramuddin S, Hutter M, editors. SAGES manual: a practical guide to bariatric surgery. New York: Springer Science; 2008. p. 131–41.CrossRefGoogle Scholar
  5. 5.
    Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, Arvidsson D, Baker RS, Basso N, et al. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2012;8(1):8–19.CrossRefGoogle Scholar
  6. 6.
    Deitel M, Crosby RD, Gagner M. The first international consensus summit for sleeve gastrectomy (SG), new York City, October 25-27, 2007. Obes Surg. 2008;18(5):487–96.CrossRefPubMedGoogle Scholar
  7. 7.
    Gagner M, Deitel M, Kalberer TL, Erickson AL, Crosby RD. The second international consensus summit for sleeve gastrectomy, march 19-21, 2009. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2009;5(4):476–85.CrossRefGoogle Scholar
  8. 8.
    Deitel M, Gagner M, Erickson AL, Crosby RD. Third international summit: current status of sleeve gastrectomy. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2011;7(6):749–59.CrossRefGoogle Scholar
  9. 9.
    Gagner M, Deitel M, Erickson AL, Crosby RD. Survey on laparoscopic sleeve gastrectomy (LSG) at the fourth international consensus summit on sleeve gastrectomy. Obes Surg. 2013;23(12):2013–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Gagner M, Hutchinson C, Rosenthal R. Fifth international consensus conference: current status of sleeve gastrectomy. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2016;12(4):750–6.CrossRefGoogle Scholar
  11. 11.
    Clinical Issues Committee of American Society for Metabolic and Bariatric Surgery. Sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2007;3(6):573–6.Google Scholar
  12. 12.
    ASMBS Clinical Issues Committee. Updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2012;8(3):e21–6.Google Scholar
  13. 13.
    Ferrer-Márquez M, Belda-Lozano R, Solvas-Salmerón MJ, Ferrer-Ayza M. Revisional surgery after laparoscopic sleeve gastrectomy. Surg Laparosc Endosc Percutan Tech. 2015;25(1):6–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Brethauer SA, Kothari S, Sudan R, Williams B, English WJ, Brengman M, et al. Systematic review on reoperative bariatric surgery: American Society for Metabolic and Bariatric Surgery Revision Task Force. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2014;10(5):952–72.CrossRefGoogle Scholar
  15. 15.
    conference NIH. Gastrointestinal surgery for severe obesity. Consensus development conference panel. Ann Intern Med. 1991;115(12):956–61.CrossRefGoogle Scholar
  16. 16.
    Reinhold RB. Critical analysis of long term weight loss following gastric bypass. Surg Gynecol Obstet. 1982;155(3):385–94.PubMedGoogle Scholar
  17. 17.
    Mann JP, Jakes AD, Hayden JD, Barth JH. Systematic review of definitions of failure in revisional bariatric surgery. Obes Surg. 2015;25(3):571–4.CrossRefPubMedGoogle Scholar
  18. 18.
    Abdemur A, Han S-M, Lo Menzo E, Szomstein S, Rosenthal R. Reasons and outcomes of conversion of laparoscopic sleeve gastrectomy to Roux-en-Y gastric bypass for nonresponders. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2016;12(1):113–8.CrossRefGoogle Scholar
  19. 19.
    El Chaar M, Stoltzfus J, Claros L, Miletics M. Indications for revisions following 630 consecutive laparoscopic sleeve gastrectomy cases: experience in a single accredited center. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2017;21(1):12–6.CrossRefGoogle Scholar
  20. 20.
    Arman GA, Himpens J, Dhaenens J, Ballet T, Vilallonga R, Leman G. Long-term (11+years) outcomes in weight, patient satisfaction, comorbidities, and gastroesophageal reflux treatment after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2016;12(10):1778–86.CrossRefGoogle Scholar
  21. 21.
    Stefanidis D, Malireddy K, Kuwada T, Phillips R, Zoog E, Gersin KS. Revisional bariatric surgery: perioperative morbidity is determined by type of procedure. Surg Endosc. 2013;27(12):4504–10.CrossRefPubMedGoogle Scholar
  22. 22.
    Hallowell PT, Stellato TA, Yao DA, Robinson A, Schuster MM, Graf KN. Should bariatric revisional surgery be avoided secondary to increased morbidity and mortality? Am J Surg. 2009;197(3):391–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Gagner M, Gentileschi P, de Csepel J, Kini S, Patterson E, Inabnet WB, et al. Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients. Obes Surg. 2002;12(2):254–60.CrossRefPubMedGoogle Scholar
  24. 24.
    Khaitan L, Van Sickle K, Gonzalez R, Lin E, Ramshaw B, Smith CD. Laparoscopic revision of bariatric procedures: is it feasible? Am Surg. 2005;71(1):6–10. discussion 10-12PubMedGoogle Scholar
  25. 25.
    Lacy A, Ibarzabal A, Obarzabal A, Pando E, Adelsdorfer C, Delitala A, et al. Revisional surgery after sleeve gastrectomy. Surg Laparosc Endosc Percutan Tech. 2010;20(5):351–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Noel P, Nedelcu M, Gagner M. Impact of the surgical experience on leak rate after laparoscopic sleeve gastrectomy. Obes Surg. 2016;26(8):1782–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Gagner M, Buchwald JN. Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2014;10(4):713–23.CrossRefGoogle Scholar
  28. 28.
    Yehoshua RT, Eidelman LA, Stein M, Fichman S, Mazor A, Chen J, et al. Laparoscopic sleeve gastrectomy–volume and pressure assessment. Obes Surg. 2008;18(9):1083–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Nedelcu AM, Skalli M, Deneve E, Fabre JM, Nocca D. Surgical management of chronic fistula after sleeve gastrectomy. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2013;9(6):879–84.CrossRefGoogle Scholar
  30. 30.
    Moszkowicz D, Arienzo R, Khettab I, Rahmi G, Zinzindohoué F, Berger A, et al. Sleeve gastrectomy severe complications: is it always a reasonable surgical option? Obes Surg. 2013;23(5):676–86.CrossRefPubMedGoogle Scholar
  31. 31.
    Ramos AC, Ramos MG, Campos JM, Galvão Neto M, Dos P, Bastos EL, de S. Laparoscopic total gastrectomy as an alternative treatment to postsleeve chronic fistula. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2015;11(3):552–6.CrossRefGoogle Scholar
  32. 32.
    Ben Yaacov A, Sadot E, Ben David M, Wasserberg N, Keidar A. Laparoscopic total gastrectomy with Roux-y esophagojejunostomy for chronic gastric fistula after laparoscopic sleeve gastrectomy. Obes Surg. 2014;24(3):425–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Safadi BY, Shamseddine G, Elias E, Alami RS. Definitive surgical management of staple line leak after sleeve gastrectomy. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2015;11(5):1037–43.CrossRefGoogle Scholar
  34. 34.
    Thompson CE, Ahmad H, Lo Menzo E, Szomstein S, Rosenthal RJ. Outcomes of laparoscopic proximal gastrectomy with esophagojejunal reconstruction for chronic staple line disruption after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2014;10(3):455–9.CrossRefGoogle Scholar
  35. 35.
    Sasson M, Ahmad H, Dip F, Lo Menzo E, Szomstein S, Rosenthal RJ. Comparison between major and minor surgical procedures for the treatment of chronic staple line disruption after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2016;12(5):969–75.CrossRefGoogle Scholar
  36. 36.
    Nguyen D, Dip F, Hendricks L, Lo Menzo E, Szomstein S, Rosenthal R. The surgical Management of Complex Fistulas after Sleeve Gastrectomy. Obes Surg. 2016;26(2):245–50.CrossRefPubMedGoogle Scholar
  37. 37.
    Parikh A, Alley JB, Peterson RM, Harnisch MC, Pfluke JM, Tapper DM, et al. Management options for symptomatic stenosis after laparoscopic vertical sleeve gastrectomy in the morbidly obese. Surg Endosc. 2012;26(3):738–46.CrossRefPubMedGoogle Scholar
  38. 38.
    Manos T, Nedelcu M, Cotirlet A, Eddbali I, Gagner M, Noel P. How to treat stenosis after sleeve gastrectomy? Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2017;13(2):150–4.CrossRefGoogle Scholar
  39. 39.
    Rebibo L, Hakim S, Dhahri A, Yzet T, Delcenserie R, Regimbeau J-M. Gastric stenosis after laparoscopic sleeve gastrectomy: diagnosis and management. Obes Surg. 2016;26(5):995–1001.CrossRefPubMedGoogle Scholar
  40. 40.
    Burgos AM, Csendes A, Braghetto I. Gastric stenosis after laparoscopic sleeve gastrectomy in morbidly obese patients. Obes Surg. 2013;23(9):1481–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Dapri G, Cadière GB, Himpens J. Laparoscopic seromyotomy for long stenosis after sleeve gastrectomy with or without duodenal switch. Obes Surg. 2009;19(4):495–9.CrossRefPubMedGoogle Scholar
  42. 42.
    Vilallonga R, Himpens J, van de Vrande S. Laparoscopic management of persistent strictures after laparoscopic sleeve gastrectomy. Obes Surg. 2013;23(10):1655–61.CrossRefPubMedGoogle Scholar
  43. 43.
    Altieri MS, Pryor AD. Gastroesophageal reflux disease after bariatric procedures. Surg Clin North Am. 2015;95(3):579–91.CrossRefPubMedGoogle Scholar
  44. 44.
    Melissas J, Braghetto I, Molina JC, Silecchia G, Iossa A, Iannelli A, et al. Gastroesophageal reflux disease and sleeve gastrectomy. Obes Surg. 2015;25(12):2430–5.CrossRefPubMedGoogle Scholar
  45. 45.
    Oor JE, Roks DJ, Ünlü Ç, Hazebroek EJ. Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Surg. 2016;211(1):250–67.CrossRefPubMedGoogle Scholar
  46. 46.
    Stenard F, Iannelli A. Laparoscopic sleeve gastrectomy and gastroesophageal reflux. World J Gastroenterol. 2015;21(36):10348–57.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Naik RD, Choksi YA, Vaezi MF. Impact of weight loss surgery on esophageal physiology. Gastroenterol Hepatol. 2015;11(12):801–9.Google Scholar
  48. 48.
    Hong D, Khajanchee YS, Pereira N, Lockhart B, Patterson EJ, Swanstrom LL. Manometric abnormalities and gastroesophageal reflux disease in the morbidly obese. Obes Surg. 2004;14(6):744–9.CrossRefPubMedGoogle Scholar
  49. 49.
    Mandeville Y, Van Looveren R, Vancoillie P-J, Verbeke X, Vandendriessche K, Vuylsteke P, et al. Moderating the enthusiasm of sleeve gastrectomy: up to fifty percent of reflux symptoms after ten years in a consecutive series of one hundred laparoscopic sleeve Gastrectomies. Obes Surg. 2017;27(7):1797–803.CrossRefPubMedGoogle Scholar
  50. 50.
    Hendricks L, Alvarenga E, Dhanabalsamy N, Lo Menzo E, Szomstein S, Rosenthal R. Impact of sleeve gastrectomy on gastroesophageal reflux disease in a morbidly obese population undergoing bariatric surgery. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2016;12(3):511–7.CrossRefGoogle Scholar
  51. 51.
    Wölnerhanssen B, Peterli R. State of the art: sleeve gastrectomy. Dig Surg. 2014;31(1):40–7.CrossRefPubMedGoogle Scholar
  52. 52.
    Himpens J, Dapri G, Cadière GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006;16(11):1450–6.CrossRefPubMedGoogle Scholar
  53. 53.
    Casillas RA, Um SS, Zelada Getty JL, Sachs S, Kim BB. Revision of primary sleeve gastrectomy to Roux-en-Y gastric bypass: indications and outcomes from a high-volume center. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2016;12(10):1817–25.CrossRefGoogle Scholar
  54. 54.
    Parmar CD, Mahawar KK, Boyle M, Schroeder N, Balupuri S, Small PK. Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass is effective for gastro-Oesophageal reflux disease but not for further weight loss. Obes Surg. 2017;27(7):1651–8.CrossRefPubMedGoogle Scholar
  55. 55.
    Csendes A, Burgos AM, Smok G, Burdiles P, Henriquez A. Effect of gastric bypass on Barrett’s esophagus and intestinal metaplasia of the cardia in patients with morbid obesity. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2006;10(2):259–64.CrossRefGoogle Scholar
  56. 56.
    Gorodner V, Buxhoeveden R, Clemente G, Sánchez C, Caro L, Grigaites A. Barrett’s esophagus after Roux-en-Y gastric bypass: does regression occur? Surg Endosc. 2017;31(4):1849–54.CrossRefPubMedGoogle Scholar
  57. 57.
    Desart K, Rossidis G, Michel M, Lux T, Ben-David K. Gastroesophageal reflux management with the LINX® system for gastroesophageal reflux disease following laparoscopic sleeve gastrectomy. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2015;19(10):1782–6.CrossRefGoogle Scholar
  58. 58.
    Deguines J-B, Verhaeghe P, Yzet T, Robert B, Cosse C, Regimbeau J-M. Is the residual gastric volume after laparoscopic sleeve gastrectomy an objective criterion for adapting the treatment strategy after failure? Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2013;9(5):660–6.CrossRefGoogle Scholar
  59. 59.
    Langer FB, Bohdjalian A, Shakeri-Leidenmühler S, Schoppmann SF, Zacherl J, Prager G. Conversion from sleeve gastrectomy to Roux-en-Y gastric bypass–indications and outcome. Obes Surg. 2010;20(7):835–40.CrossRefPubMedGoogle Scholar
  60. 60.
    Cheung D, Switzer NJ, Gill RS, Shi X, Karmali S. Revisional bariatric surgery following failed primary laparoscopic sleeve gastrectomy: a systematic review. Obes Surg. 2014;24(10):1757–63.CrossRefPubMedGoogle Scholar
  61. 61.
    Noel P, Nedelcu M, Nocca D, Schneck A-S, Gugenheim J, Iannelli A, et al. Revised sleeve gastrectomy: another option for weight loss failure after sleeve gastrectomy. Surg Endosc. 2014;28(4):1096–102.CrossRefPubMedGoogle Scholar
  62. 62.
    Nedelcu M, Noel P, Iannelli A, Gagner M. Revised sleeve gastrectomy (re-sleeve). Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2015;11(6):1282–8.CrossRefGoogle Scholar
  63. 63.
    Iannelli A, Schneck AS, Noel P, Ben Amor I, Krawczykowski D, Gugenheim J. Re-sleeve gastrectomy for failed laparoscopic sleeve gastrectomy: a feasibility study. Obes Surg. 2011;21(7):832–5.CrossRefPubMedGoogle Scholar
  64. 64.
    AlSabah S, Alsharqawi N, Almulla A, Akrof S, Alenezi K, Buhaimed W, et al. Approach to poor weight loss after laparoscopic sleeve gastrectomy: re-sleeve vs. gastric bypass. Obes Surg. 2016;26(10):2302–7.CrossRefPubMedGoogle Scholar
  65. 65.
    Poghosyan T, Lazzati A, Moszkowicz D, Danoussou D, Vychnevskaia K, Azoulay D, et al. Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: an audit of 34 patients. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2016;12(9):1646–51.CrossRefGoogle Scholar
  66. 66.
    Gautier T, Sarcher T, Contival N, Le Roux Y, Alves A. Indications and mid-term results of conversion from sleeve gastrectomy to Roux-en-Y gastric bypass. Obes Surg. 2013;23(2):212–5.CrossRefPubMedGoogle Scholar
  67. 67.
    Malinka T, Zerkowski J, Katharina I, Borbèly YM, Nett P, Kröll D. Three-year outcomes of Revisional laparoscopic gastric bypass after failed laparoscopic sleeve gastrectomy: a case-matched analysis. Obes Surg. 2017;27:2324–30. [Epub ahead of print]CrossRefPubMedGoogle Scholar
  68. 68.
    Homan J, Betzel B, Aarts EO, van Laarhoven KJHM, Janssen IMC, Berends FJ. Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2015;11(4):771–7.CrossRefGoogle Scholar
  69. 69.
    Carmeli I, Golomb I, Sadot E, Kashtan H, Keidar A. Laparoscopic conversion of sleeve gastrectomy to a biliopancreatic diversion with duodenal switch or a Roux-en-Y gastric bypass due to weight loss failure: our algorithm. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2015;11(1):79–85.CrossRefGoogle Scholar
  70. 70.
    Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2009;5(4):469–75.CrossRefGoogle Scholar
  71. 71.
    Silecchia G, Rizzello M, Casella G, Fioriti M, Soricelli E, Basso N. Two-stage laparoscopic biliopancreatic diversion with duodenal switch as treatment of high-risk super-obese patients: analysis of complications. Surg Endosc. 2009;23(5):1032–7.CrossRefPubMedGoogle Scholar
  72. 72.
    Mukherjee S, Devalia K, Rahman MG, Mannur KR. Sleeve gastrectomy as a bridge to a second bariatric procedure in superobese patients--a single institution experience. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2012;8(2):140–4.CrossRefGoogle Scholar
  73. 73.
    Alexandrou A, Felekouras E, Giannopoulos A, Tsigris C, Diamantis T. What is the actual fate of super-morbid-obese patients who undergo laparoscopic sleeve gastrectomy as the first step of a two-stage weight-reduction operative strategy? Obes Surg. 2012;22(10):1623–8.CrossRefPubMedGoogle Scholar
  74. 74.
    Iannelli A, Schneck A-S, Topart P, Carles M, Hébuterne X, Gugenheim J. Laparoscopic sleeve gastrectomy followed by duodenal switch in selected patients versus single-stage duodenal switch for superobesity: case-control study. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2013;9(4):531–8.CrossRefGoogle Scholar
  75. 75.
    Angrisani L. 2014: the year of the sleeve supremacy. Obes Surg. 2017;27(6):1626–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of General SurgeryCleveland ClinicClevelandUSA
  2. 2.Cleveland Clinic Abu Dhabi, Digestive Disease InstituteAbu DhabiUnited Arab Emirates

Personalised recommendations