Abstract
Background
Sleeve gastrectomy (SG) is an upcoming primary treatment modality for morbid obesity. The aim of this study was to report the indications for and the outcomes of revisional surgery after SG.
Methods
Four hundred sixteen individuals underwent a SG between August 2006 and July 2010 with a minimum follow-up of 12 months. The patients that needed revision were identified from our prospective registry. Patients were subdivided in a first group undergoing revision as part of a two-step procedure, a second group with failure of a secondary SG, and a third group with failure of a primary SG.
Results
Twenty-three patients (5.5 %) had an unplanned revision. Fourteen (3.4 %) had a two-step procedure because of super obesity. A significant additional weight loss was achieved after revision; no complications occurred in this group. Five patients with failure of a secondary SG had no significant additional weight loss after revision. Reflux disease was cured. Eighteen patients in the third group showed significant additional weight loss and remission of diabetes and hypertension. Both reflux disease and dysphagia did not heal in all affected patients after revision. The early complication rate in the whole cohort was 23.4 %; staple line leakage was 5.4 %, and bleeding was 8.1 %. Revision-related mortality was 0 %.
Conclusion
In a large series of sleeve gastrectomies, the unplanned revision rate was 5.5 %. Revision of a sleeve gastrectomy is feasible in patients that do not achieve sufficient weight loss and in those patients developing complications after the initial sleeve gastrectomy.
Similar content being viewed by others
References
Bennett JM, Mehta S, Rhodes M. Surgery for morbid obesity. Postgrad Med J. 2007;83(975):8–15.
Ikramuddin S, Buchwald H. How bariatric and metabolic operations control metabolic syndrome. Br J Surg. 2011;98(10):1339–41.
Karamanakos SN, Vagenas K, Kalfarentzos F. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247(3):401–7.
Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5(4):469–75.
Anonymous. Updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. 2010;6(1):1–5.
Deitel M, Gagner M, Erickson AL, et al. Third International Summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7(6):749–59.
Kehagias I, Karamanakos SN, Argentou M, et al. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI < 50 kg/m2. Obes Surg. 2011;21(11):1650–6.
Leyba JL, Aulestia SN, Llopis SN. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the treatment of morbid obesity. A prospective study of 117 patients. Obes Surg. 2011;21(2):212–6.
Gagner M. Laparoscopic sleeve gastrectomy is the right terminology. Surg Obes Relat Dis. 2012;8(1):127–9.
Saber AA, El-Ghazaly TH. Feasibility of single-access laparoscopic sleeve gastrectomy in super-super obese patients. Surg Innov. 2010;17(1):36–40.
Lacy A, Ibarzabal A, Pando E, et al. Revisional surgery after sleeve gastrectomy. Surg Laparosc Endosc Percutan Tech. 2010;20(5):351–6.
Langer FB, Bohdjalian A, Shakeri-Leidenmuhler S, et al. Conversion from sleeve gastrectomy to Roux-en-Y gastric bypass—indications and outcome. Obes Surg. 2010;20(7):835–40.
Regan JP, Inabnet WB, Gagner M, et al. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg. 2003;13(6):861–4.
Himpens J, Dapri G, Cadiere 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.
Chiu S, Birch DW, Shi X, et al. Effect of sleeve gastrectomy on gastroesophageal reflux disease: a systematic review. Surg Obes Relat Dis. 2011;7(4):510–5.
De Groot NL, Burgerhart JS, Van De Meeberg PC, et al. Systematic review: the effects of conservative and surgical treatment for obesity on gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2009;30(11–12):1091–102.
Carter PR, LeBlanc KA, Hausmann MG, et al. Association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2011;7(5):569–72.
Morales MP, Wheeler AA, Ramaswamy A, et al. Laparoscopic revisional surgery after Roux-en-Y gastric bypass and sleeve gastrectomy. Surg Obes Relat Dis. 2010;6(5):485–90.
Moon HS, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg. 2005;15(10):1469–75.
Stroh C, Birk D, Flade-Kuthe R, et al. Status of bariatric surgery in Germany—results of the nationwide survey on bariatric surgery 2005–2007. Obes Facts. 2009;2 Suppl 1:2–7.
Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234(3):279–89.
Conflict of Interest
The authors report no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
van Rutte, P.W.J., Smulders, J.F., de Zoete, J.P. et al. Indications and Short-Term Outcomes of Revisional Surgery After Failed or Complicated Sleeve Gastrectomy. OBES SURG 22, 1903–1908 (2012). https://doi.org/10.1007/s11695-012-0774-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-012-0774-1