Re-sleeve gastrectomy as revisional bariatric procedure after biliopancreatic diversion with duodenal switch.

BACKGROUND: Re-sleeve gastrectomy (re-SG) is a possible option to increase weight loss after biliopancreatic diversion with duodenal switch (BPD-DS). We report the feasibility, efficacy and safety of re-SG in patients presenting with long-term weight regain after BPD-DS.

METHODS: From October 2010 to December 2013, a total of 17 patients (12 female, 5 male) with a mean age of 42.1 ± 19.4 years underwent re-SG, mainly because of weight regain after BPD-DS. Re-SG was performed laparoscopically over a 32 French stomach tube.

RESULTS: At the time of BPD-DS, the mean weight and BMI of all patients were 130.1 ± 17.9 kg and 46.1 ± 6.5 kg/m(2), respectively. The mean time interval between BPD-DS and re-SG was 63.1 ± 20.3 months. At the time of re-SG, the mean weight and BMI were 115.4 ± 14.2 kg and 39.8 ± 5.3 kg/m(2), and the %EWL after BPD-DS was 22.9 ± 17.4 %. Three conversions (17.6 %) to open surgery were required. No mortality occurred. One patient (5.9 %) developed a leak within the first week after re-SG that was treated conservatively with an endoluminal stent. The mean follow-up was 37.2 ± 7.1 months after re-SG. One- and three-year follow-up showed a mean weight, BMI, and cumulative %EWL of 96.0 ± 17.1 kg, 33.8 ± 7.3 kg/m(2), and 53.1 ± 18.3 % (17/17 patients; 100 %), and 100.3 ± 21.1 kg, 35.1 ± 8.3 kg/m(2), and 47.2 ± 19.7 % (13/17 patients; 76 %) after re-SG, respectively.

CONCLUSIONS: This study shows that re-SG in patients with weight regain after BPD-DS is a feasible, effective and safe option as a revisional bariatric procedure. However, patients have to be carefully considered for revisional surgery since re-SG is associated with the potential risk of surgical complications.