Outcome of revisional procedures up to 14 years after sleeve gastrectomy: A single-center experience

Objective

In the long-term, laparoscopic sleeve gastrectomy (SG) may be associated with insufficient weight loss, weight regain, development of gastroesophageal reflux disease (GERD) as well as persistence or relapse of comorbidities. The study's objective was to present results regarding weight loss, evolution of comorbidities and reoperation rate of patients who underwent a revisional bariatric procedure after SG.

Methods

Retrospective single-center analysis of a prospective database on patients who had a minimal follow-up of two years after conversion from SG to either a proximal Roux-en-Y gastric bypass (PRYGB), biliopancreatic diversion type duodenal switch (BPD/DS), long bilio-pancreatic limb-Roux-en-Y gastric bypass (LRYGB) or re-sleeve gastrectomy (RSG).

Results

Over a time period of 14 years, 549 SGs were performed. A total of 71 patients (13.0%) underwent a conversion from SG to PRYGB (n = 28, 39.4%), BPD/DS (n = 19, 26.8%), LRYGB (n = 17, 23.9%) and RSG (n = 7, 9.9%). Indications for the revisional procedures were GERD (33.8%), insufficient weight loss/weight regain (32.4%), a combination of both (31.0%) or stenosis/kinking of the sleeve (2.8%). The mean time from SG to revision was 5.2 ± 3.1 years and the mean pre-revisional body mass index (BMI) was 38.0 ± 7.5 kg/m2. The mean follow-up time after revision was 5.1 ± 3.1 years. The overall percentage of total weight loss (%TWL) was greatest after BPD/DS (36.6%) and LRYGB (32.9%) compared to RSG (20.0%; p = 0.04; p = 0.01). Patients with BPD/DS had significantly higher additional %TWL (26.2%) after conversion compared to PRYGB (15.6%, p = 0.04) and RSG (10.9%, p = 0.01). In case of GERD, reoperation led to a resolution of symptoms in 81.6% after RYGB. 19.7% of patients underwent an additional revisional procedure for internal herniation, chronic diarrhea after BDP/DS, common bile duct stones and weight regain.

Conclusion

In the event of insufficient weight loss/weight regain after SG, conversion to BPD/DS provides a significant post-revisional weight loss. RYGB leads to good symptom control in patients suffering from GERD.