Re-sleeve Gastrectomy - An Efficient Revisional Bariatric Procedure - 3 Years Results

Background: Laparoscopic gastric sleeve is a well-known bariatric procedure with good results on weight loss and remission of comorbidities. For patients with weight regain and a large sleeved stomach, the laparoscopic re-sleeve (re-LSG) can be considered a revisional option. Aim: The objective of this study is to evaluate the results of laparoscopic re-sleeve as revisional procedure in patients with weight regain after gastric sleeve, in a Center of Excellence in Bariatric Surgery (BS-CoE). Method A retrospective evaluation of a prospectively maintained database identified 27 patients who underwent laparoscopic gastric re-sleeve after gastric sleeve from January 2013 - December 2016 in our BS-CoE. Patients were monitored in conformity with our standard bariatric program and the efficiency of re-sleeve in terms of weight loss and comorbidities outcome was evaluated at 6 months, 1 year and 3 years postoperative. Results: Re-sleeve gastrectomy was performed by laparoscopic approach in all cases and 24 (89%) patients had concurrent surgical procedures, all of them hiatal hernia repair. No intra or postoperative complications were found except one case of gastric tube stenosis. Mean BMI before resleeve was 35.69 kg/m(2) (range 28,58-52) and follow-up results at 6 months after re-sleeve revealed mean BMI was 28.39 +/- 5.32 kg/m(2) with EWL 83.88%, at 1 year mean BMI 27.23 +/- 5.23 kg/m(2) with EWL 94.45% and at 3 years BMI 27.65 +/- 5.13 kg/m(2) with EWL 85.41%. There are statistically significant differences (p < 0.01), between BMI before re-sleeve and BMI for all other moments of measurement 6 months, 1 year and 3 years after re-sleeve. All the 6 patients (22%) with comorbidities before re-sleeve had remission of their diseases at ne year postoperative, but 1 patient had recurrence of hypertension at 3 years postoperative. Conclusion: Laparoscopic redo sleeve is an efficient revisional surgery option for weight regain after primary gastric sleeve with effective weight loss and improvement of comorbidities in a medium term follow-up.