Skip to main content

Advertisement

SpringerLink
Log in

Repeat Sleeve Gastrectomy Compared with Primary Sleeve Gastrectomy: A Single-Center, Matched Case Study

  • Clinical Report
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Longitudinal sleeve gastrectomy (LSG) has been validated for the treatment of morbid obesity. However, treatment failures can appear several months after SG. Additional malabsorptive surgery is generally recommended in such cases. The objective of the present study was to evaluate the outcomes of repeat SG (re-SG) relative to first-line SG. This was a retrospective study included 15 patients underwent re-SG after failure of first-line SG (i.e. University Hospital, France; Public Practice). These patients were matched (for age, gender, body mass index and comorbidities) 1:2 with 30 patients having undergone first-line SG. The efficacy criteria comprised intra-operative data and postoperative data. The overall study population comprised 45 patients. The re-SG and first-line SG groups did not differ significantly in terms of median age (p = NS). The median BMI was similar in the two groups (43 kg/m2 vs. 42.3 kg/m2, p = NS). The two groups were similar in terms of the prevalence of comorbidities. The mean operating time was longer in the re-SG group (116 vs. 86 min; p ≤ 0.01). The postoperative complication rate was twice as high in the re-SG group (p = 0.31). Two patients in the re-SG group developed a gastric fistula (p = 0.25) and one of the latter died. At 12 months, the Excess Weight Loss was 66 % (re-SG group) and 77 % (first-line SG group) (p = 0.05). Re-SG is feasible but appears to be associated with a greater risk of complications. Nevertheless, re-SG can produce results (in terms of weight loss), equivalent to those obtained after first-line SG.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Marceau P, Biron S, Bourque RA, et al. Biliopancreatic diversion with a new type of gastrectomy. Obes Surg. 1993;3:29–35.

    Article  PubMed  Google Scholar 

  2. Deitel M, Crosby RD, Gagner M. The first international consensus summit for sleeve gastrectomy (SG), New York City, October 25–27, 2007. Obes Surg. 2008;18:487–96.

    Article  PubMed  Google Scholar 

  3. Gagner M, Deitel M, Kalberer TL, et al. The second international consensus summit for sleeve gastrectomy, March 19–21, 2009. Surg Obes Relat Dis. 2009;5:476–85.

    Article  PubMed  Google Scholar 

  4. Weiner RA, Theodoridou S, Weiner S. Failure of laparoscopic sleeve gastrectomy—further procedure? Obes Facts. 2011;4 Suppl 1:42–6.

    PubMed  Google Scholar 

  5. Iannelli A, Schneck AS, Dahman M, et al. Two-step laparoscopic duodenal switch for super obesity: a feasibility study. Surg Endosc. 2009;23:2385–9.

    Article  PubMed  Google Scholar 

  6. Gagner M, Rogula T. Laparoscopic reoperative sleeve gastrectomy for poor weight loss after biliopancreatic diversion with duodenal switch. Obes Surg. 2003;13:649–54.

    Article  PubMed  Google Scholar 

  7. Baltasar A, Serra C, Pérez N, et al. Re-sleeve gastrectomy. Obes Surg. 2006;16:1535–8.

    Article  PubMed  Google Scholar 

  8. Gastrectomie Longitudinale [sleeve gastrectomy] pour obésité. Hautes autorité de la santé. Recommandations 2008.

  9. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  Google Scholar 

  10. Deitel M, Greenstein RJ. Recommendations for reporting weight loss. Obes Surg. 2003;13:159–60.

    Article  PubMed  Google Scholar 

  11. Verhaeghe P, Dhahri A, Qassemyar Q, et al. Technique de la gastrectomie longitudinal (sleeve gastrectomy) par laparoscopie. EMC (Elsevier Masson SAS, Paris), Techniques chirurgicales – Appareil digestif, 40–385, 2011.

  12. Hedley AA, Ogden CL, Johnson CL, et al. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA. 2004;291:2847–50.

    Article  PubMed  CAS  Google Scholar 

  13. Charles MA, Eschwège E, Basdevant A. Monitoring the obesity epidemic in France: the Obepi surveys 1997–2006. Obesity. 2008;16:2182–6.

    Article  PubMed  Google Scholar 

  14. Sumithran P, Prendergast LA, Delbridge E, et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011;365:1597–604.

    Article  PubMed  CAS  Google Scholar 

  15. Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240:416–23. discussion 423-4.

    Article  PubMed  Google Scholar 

  16. D’Hondt M, Vanneste S, Pottel H, et al. Laparoscopic sleeve gastrectomy as a single-stage procedure for the treatment of morbid obesity and the resulting quality of life, resolution of comorbidities, food tolerance, and 6-year weight loss. Surg Endosc. 2011;25:2498–504.

    Article  PubMed  Google Scholar 

  17. Sabbagh C, Verhaeghe P, Dhahri A, et al. Two-year results on morbidity, weight loss and quality of life of sleeve gastrectomy as first procedure, sleeve gastrectomy after failure of gastric banding and gastric banding. Obes Surg. 2010;20:679–84.

    Article  PubMed  Google Scholar 

  18. Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg. 2006;16:1138–44.

    Article  PubMed  Google Scholar 

  19. Burgos AM, Braghetto I, Csendes A, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg. 2009;19:1672–7.

    Article  PubMed  Google Scholar 

  20. Fuks D, Verhaeghe P, Brehant O, et al. Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery. 2009;145:106–13.

    Article  PubMed  Google Scholar 

  21. Deguines JB, Verhaeghe P, Robert B, et al. Le volume gastrique résiduel deux ans après une gastrectomie longitudinal: critère de stratégie thérapeutique en cas d’échec? J Visc Surg. 2011;148(Suppl: 34).

    Google Scholar 

  22. Oria HE, Moorehead MK. Bariatric analysis and reporting outcome system (BAROS). Obes Surg. 1998;8:487–99.

    Article  PubMed  CAS  Google Scholar 

  23. Reinhold RB. Critical analysis of long-term weight loss following gastric bypass. Surg Gynecol Obstet. 1982;155:385–94.

    PubMed  CAS  Google Scholar 

  24. Brolin RE, Kenler HA, Gorman RC, et al. The dilemma of outcome assessment after operations for morbid obesity. Surgery. 1989;105:337–46.

    PubMed  CAS  Google Scholar 

  25. Weiner RA, Weiner S, Pomhoff I, et al. Laparoscopic sleeve gastrectomy—influence of sleeve size and resected gastric volume. Obes Surg. 2007;17:1297–305.

    Article  PubMed  Google Scholar 

  26. Lin E, Gletsu N, Fugate K, et al. The effects of gastric surgery on systemic ghrelin levels in the morbidly obese. Arch Surg. 2004;139:780–4.

    Article  PubMed  Google Scholar 

  27. Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obes Surg. 1998;8:267–82.

    Article  PubMed  CAS  Google Scholar 

  28. 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;13:861–4.

    Article  PubMed  CAS  Google Scholar 

  29. Topart P, Becouarn G, Ritz P. Comparative early outcomes of three laparoscopic bariatric procedures: sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis. 2012;8:250–4.

    Article  PubMed  Google Scholar 

  30. Hutter MM, Schirmer BD, Jones DB, et al. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg. 2011;254:410–20. discussion 420-2.

    Article  PubMed  Google Scholar 

  31. Deitel M, Gagner M, Erickson AL, et al. Third international summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7:749–59.

    Article  PubMed  Google Scholar 

  32. Braghetto I, Cortes C, Herquiñigo D, et al. Evaluation of the radiological gastric capacity and evolution of the BMI 2–3 years after sleeve gastrectomy. Obes Surg. 2009;19:1262–9.

    Article  PubMed  Google Scholar 

  33. Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26:1509–15.

    Article  PubMed  Google Scholar 

  34. Csendes A, Burdiles P, Burgos AM, et al. Conservative management of anastomotic leaks after 557 open gastric bypasses. Obes Surg. 2005;15:1252–6.

    Article  PubMed  Google Scholar 

  35. Higa KD, Boone KB, Ho T. Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients—what have we learned? Obes Surg. 2000;10:509–13.

    Article  PubMed  CAS  Google Scholar 

  36. Iannelli A, Schneck AS, Noel P, et al. Re-sleeve gastrectomy for failed laparoscopic sleeve gastrectomy: a feasibility study. Obes Surg. 2011;21:832–5.

    Article  PubMed  Google Scholar 

  37. Langer FB, Bohdjalian A, Shakeri-Leidenmühler S, et al. Conversion from sleeve gastrectomy to Roux-en-Y gastric bypass—indications and outcome. Obes Surg. 2010;20:835–40.

    Article  PubMed  Google Scholar 

  38. Spyropoulos C, Kehagias I, Panagiotopoulos S, et al. Revisional bariatric surgery: 13-year experience from a tertiary institution. Arch Surg. 2010;145:173–7.

    Article  PubMed  Google Scholar 

  39. Gehrer S, Kern B, Peters T, et al. Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y gastric bypass (LRYGB)—a prospective study. Obes Surg. 2010;20:447–53.

    Article  PubMed  Google Scholar 

  40. Skroubis G, Sakellaropoulos G, Pouggouras K, et al. Comparison of nutritional deficiencies after Roux-en-Y gastric bypass and after biliopancreatic diversion with Roux-en-Y gastric bypass. Obes Surg. 2002;12:551–8.

    Article  PubMed  Google Scholar 

  41. Aasheim ET. Wernicke encephalopathy after bariatric surgery: a systematic review. Ann Surg. 2008;248:714–20.

    PubMed  Google Scholar 

Download references

Acknowledgments

I would like to acknowledge Christelle Blot for her valuable help in this work.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, Place Victor Pauchet, 80054, Amiens Cedex 01, France

    Lionel Rebibo, David Fuks, Pierre Verhaeghe, Jean-Baptiste Deguines, Abdennaceur Dhahri & Jean-Marc Regimbeau

Authors
  1. Lionel Rebibo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Fuks
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pierre Verhaeghe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jean-Baptiste Deguines
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Abdennaceur Dhahri
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jean-Marc Regimbeau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jean-Marc Regimbeau.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rebibo, L., Fuks, D., Verhaeghe, P. et al. Repeat Sleeve Gastrectomy Compared with Primary Sleeve Gastrectomy: A Single-Center, Matched Case Study. OBES SURG 22, 1909–1915 (2012). https://doi.org/10.1007/s11695-012-0779-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-012-0779-9

Keywords

Search

Navigation