Revisional Surgeries of Laparoscopic Sleeve Gastrectomy

Abstract

Bariatric surgery has become increasingly common due to the worldwide obesity epidemic. A shift from open to laparoscopic surgery, specifically, laparoscopic sleeve gastrectomy (LSG), has occurred in the last two decades because of the low morbidity and mortality rates of LSG. Although LSG is a promising treatment option for patients with morbid obesity due to restrictive and endocrine mechanisms, it requires modifications for a subset of patients because of weight regain and tough complications, such as gastroesophageal reflux, strictures, gastric leak, and persistent metabolic syndrome., Revision surgeries have become more and more indispensable in bariatric surgery, accounting for 7.4% in 2016. Mainstream revisional bariatric surgeries after LSG include Roux-en-Y gastric bypass, repeated sleeve gastrectomy, biliopancreatic diversion, duodenal switch, duodenal-jejunal bypass, one-anastomosis gastric bypass, single anastomosis duodeno-ileal bypass (SAID) and transit bipartition. This review mainly describes the revisional surgeries of LSG, including the indication, choice of surgical method, and subsequent effect.

Clinical outcomes after one anastomosis gastric bypass versus sleeve gastrectomy in super-super-obese patients

“…Furthermore, following an initial weight loss, there is the possibility of a two-stage procedure, adding laparoscopic Roux-en-Y Gastric Bypass (RYGB) or other options like Single Anastomosis Duodeno-ileal bypass with Sleeve Gastrectomy (SADI-S), Biliopancreatic Diversion with Duodenal Switch (BPD-DS) or One Anastomosis Gastric Bypass (OAGB) as a second step [ 5 , 9 ]. While weight loss is superior in SADI-S or BPD-DS in comparison to RYGB after failed SG, these methods are technically more challenging and might imply higher risks for complications [ 10 , 11 ]. RYGB has also been described as a primary procedure in SSO patients, but complication rates and length of stay usually have been reported to be significantly higher than after LSG [ 5 , 7 , 12 ].…”

Epicardial Fat in Patients Undergo Laparoscopical-Sleeve Gastrectomy

“…Alternative suggested mechanisms, including changes in "gastrointestinal hormone secretion", a reshuffle of "hypothalamic and vagal control", amendment in energy expenditure, and tweaking of "bile acid metabolism" and the "intestinal flora environment" thought to contribute to the postoperative benefits (12). As pericardial fat is part of body fat when there is a reduction in body fat as a whole the pericardial fat is reduced (13).…”

Laparoscopic Sleeve Gastrectomy With Transit Loop Bipartition and Transit Bipartition in Type 2 Diabetic Patients With Obesity: A Retrospective Analysis

“…Although LSG is usually safe and effective, some patients experience weight regain and persistent complications after the surgery, such as gastroesophageal reflux, strictures, gastric leak, and persistent metabolic syndrome. The development of these complications usually requires revisional surgeries 10 . When the hormonal effects of bariatric surgery techniques were evaluated more closely, it was apparent that beneficial metabolic results of bariatric procedures were mainly thanks to enterohormonal changes but not owing to restriction and malabsorption.…”