Abstract
Background
Endoscopic sleeve gastroplasty (ESG) utilizes full-thickness sutures to plicate the greater curvature of the stomach. As with other weight loss interventions, some patients end up requiring revision to another procedure for insufficient weight loss or weight regain, discomfort, and procedure-related adverse events.
Objectives
In this paper, we report our technique and short-term outcomes of revisional sleeve gastrectomy (LSG) after ESG.
Setting
Specialized medical center with standardized multidisciplinary protocols for medical, surgical, and endoscopic management of obesity.
Methods
A combined laparoscopic-endoscopic technique that identifies plication orientation and the location of anchors and sutures was employed. This prepares the stomach for safe stapling, excluding sutures and anchors from the staple line and the retained sleeve. Hereby, we report this technique with its short-term safety and efficacy outcomes.
Results
Twenty patients (16 female; mean age 40 ± 6 years) underwent revisional LSG from a total of 1665 (1.2%) who underwent primary ESG. Mean body mass index at the time of primary and revision procedures were 35.0 ± 4.0 and 35.2 ± 3.8 kg/m2, respectively. Nadir % total weight loss (%TWL) after primary ESG was 7.7 ± 3.5%. %TWL at 6 and 12 months after LSG was 21.0 ± 2.7 (n = 11) and 25.6 ± 4.1 (n = 8), respectively. There were no missed follow-up visits. Additionally, there was no mortality, prolonged hospital stay, adverse events, reoperations, or readmissions.
Conclusions
Based on this combined laparoscopic-endoscopic technique, laparoscopic sleeve gastrectomy is a safe and feasible revision option for patients who fail ESG.
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References
Abu Dayyeh BK, Rajan E, Gostout CJ. Endoscopic sleeve gastroplasty: a potential endoscopic alternative to surgical sleeve gastrectomy for treatment of obesity. Gastrointest Endosc. 2013;78(3):530–5.
Alqahtani AR, Al-Darwish A, Alqahtani Y, et al. Short-term outcomes of endoscopic sleeve gastroplasty in 1,000 consecutive patients. Gastrointest Endosc. 2018;89:1132–8. https://doi.org/10.1016/j.gie.2018.12.012.
Sharaiha RZ, Kumta NA, Saumoy M, et al. Endoscopic sleeve gastroplasty significantly reduces body mass index and metabolic complications in obese patients. Clin Gastroenterol Hepatol. 2017;15(4):504–10.
Abu Dayyeh BK, Acosta A, Camilleri M, et al. Endoscopic sleeve gastroplasty alters gastric physiology and induces loss of body weight in obese individuals. Clin Gastroenterol Hepatol. 2017;15(1):37–43.e1.
National Institutes of Health. NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med 1991;115(12):956–961.
Cummings DE, Cohen RV. Bariatric/metabolic surgery to treat type 2 diabetes in patients with a BMI <35 kg/m2. Diabetes Care. 2016;39(6):924–33.
De Luca M, Angrisani L, Himpens J, et al. Indications for surgery for obesity and weight-related diseases: position statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg. 2016;26(8):1659–96.
Kumar N, Abu Dayyeh BK, Lopez-Nava Breviere G, et al. Endoscopic sutured gastroplasty: procedure evolution from first-in-man cases through current technique. Surg Endosc. 2018;32(4):2159–64.
ASGE Bariatric Endoscopy Task Force; ASGE Technology Committee, Abu Dayyeh BK, et al. Endoscopic bariatric therapies. Gastrointest Endosc. 2015;81(5):1073–86.
Angrisani L, Santonicola A, Iovino P, et al. IFSO Worldwide Survey 2016: primary, endoluminal, and revisional procedures. Obes Surg. 2018;28:3783–94. https://doi.org/10.1007/s11695-018-3450-2.
Brethauer SA, Chand B, Schauer PR, et al. Transoral gastric volume reduction as intervention for weight management: 12-month follow-up of TRIM trial. Surg Obes Relat Dis. 2012;8(3):296–303.
Sartoretto A, Sui Z, Hill C, et al. Endoscopic sleeve gastroplasty (ESG) is a reproducible and effective endoscopic bariatric therapy suitable for widespread clinical adoption: a large, international multicenter study. Obes Surg. 2018;28(7):1812–21.
Lopez-Nava G, Galvao M, Bautista-Castaño I, et al. Endoscopic sleeve gastroplasty with 1-year follow-up: factors predictive of success. Endosc Int Open. 2016;4(2):E222–7.
Fayad L, Adam A, Schweitzer M, et al. Endoscopic sleeve gastroplasty versus laparoscopic sleeve gastrectomy: a case-matched study. Gastrointest Endosc. 2019;89(4):782–8.
Lopez-Nava G, Sharaiha RZ, Vargas EJ, et al. Endoscopic sleeve gastroplasty for obesity: a multicenter study of 248 patients with 24 months follow-up. Obes Surg. 2017;27(10):2649–55.
Nimeri A, Al Hadad M, Khoursheed M, et al. The Peri-operative Bariatric surgery Care in the Middle East Region. Obes Surg. 2017;27(6):1543–7.
Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.
Alqahtani AR, Elahmedi MO, Al Qahtani AR, et al. 5-year outcomes of 1-stage gastric band removal and sleeve gastrectomy. Surg Obes Relat Dis. 2016;12(10):1769–76.
Zerrweck C, Rodríguez JG, Aramburo E, et al. Revisional surgery following laparoscopic gastric plication. Obes Surg. 2017;27(1):38–43.
Ferrer-Márquez M, Ferrer-Ayza M, Rubio-Gil F, et al. Revision bariatric surgery after endoscopic sleeve gastroplasty. Cir Cir. 2017;85(5):428–31. Spanish
ElGeidie A, Gadel Hak N, Abdulla T. Stapler’s malfunction during laparoscopic sleeve gastrectomy: an unusual but correctable complication. Surg Obes Relat Dis. 2013;9(1):144–6.
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Informed consent was obtained from all individual participants included in the study. All procedures performed were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments. This study received approval from our Institutional Review Board.
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Alqahtani, A.R., Elahmedi, M., Alqahtani, Y.A. et al. Laparoscopic Sleeve Gastrectomy After Endoscopic Sleeve Gastroplasty: Technical Aspects and Short-Term Outcomes. OBES SURG 29, 3547–3552 (2019). https://doi.org/10.1007/s11695-019-04024-x
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DOI: https://doi.org/10.1007/s11695-019-04024-x