Skip to main content
SpringerLink
Log in

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

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

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/m2, 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/m2, 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/m2, and 53.1 ± 18.3 % (17/17 patients; 100 %), and 100.3 ± 21.1 kg, 35.1 ± 8.3 kg/m2, 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.

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
Fig. 3

Similar content being viewed by others

References

  1. Buchwald H, Oien DM (2013) Metabolic/bariatric surgery worldwide 2011. Obes Surg 23(4):427–436

    Article  PubMed  Google Scholar 

  2. Marceau P, Biron S, Hould FS, Lebel S, Marceau S, Lescelleur O, Biertho L, Simard S (2009) Duodenal switch improved standard biliopancreatic diversion: a retrospective study. Surg Obes Relat Dis 5(1):43–47

    Article  PubMed  Google Scholar 

  3. Marceau P, Biron S, Marceau S, Hould FS, Lebel S, Lescelleur O, Biertho L, Simard S, Kral JG (2015) Long-term metabolic outcomes 5 to 20 years after biliopancreatic diversion. Obes Surg 25(9):1584–1593

    Article  PubMed  Google Scholar 

  4. Buchwald H (2002) Overview of bariatric surgery. J Am Coll Surg 194(3):367–375

    Article  PubMed  Google Scholar 

  5. Dapri G, Cadiere GB, Himpens J (2011) Laparoscopic repeat sleeve gastrectomy versus duodenal switch after isolated sleeve gastrectomy for obesity. Surg Obes Relat Dis 7(1):38–43

    Article  PubMed  Google Scholar 

  6. Dapri G, Cadiere GB, Himpens J (2011) Laparoscopic conversion of Roux-en-Y gastric bypass to distal gastric bypass for weight regain. J Laparoendosc Adv Surg Tech A 21(1):19–23

    Article  PubMed  Google Scholar 

  7. Brethauer SA, Kothari S, Sudan R, Williams B, English WJ, Brengman M, Kurian M, Hutter M, Stegemann L, Kallies K, Nguyen NT, Ponce J, Morton JM (2014) Systematic review on reoperative bariatric surgery: American Society for Metabolic and Bariatric Surgery Revision Task Force. Surg Obes Relat Dis 10(5):952–972

    Article  PubMed  Google Scholar 

  8. Green DD, Engel SG, Mitchell JE (2014) Psychological aspects of bariatric surgery. Curr Opin Psychiatry 27(6):448–452

    Article  PubMed  Google Scholar 

  9. Tutuian R (2014) Effects of bariatric surgery on gastroesophageal reflux. Curr Opin Gastroenterol 30(4):434–438

    Article  PubMed  Google Scholar 

  10. Keidar A, Appelbaum L, Schweiger C, Elazary R, Baltasar A (2010) Dilated upper sleeve can be associated with severe postoperative gastroesophageal dysmotility and reflux. Obes Surg 20(2):140–147

    Article  PubMed  Google Scholar 

  11. Wolnerhanssen B, Peterli R (2014) State of the art: sleeve gastrectomy. Dig Surg 31(1):40–47

    Article  PubMed  Google Scholar 

  12. Topart PA, Becouarn G (2015) Revision and reversal after biliopancreatic diversion for excessive side effects or ineffective weight loss: a review of the current literature on indications and procedures. Surg Obes Relat Dis 11(4):965–972

    Article  PubMed  Google Scholar 

  13. Cesana G, Uccelli M, Ciccarese F, Carrieri D, Castello G, Olmi S (2014) Laparoscopic re-sleeve gastrectomy as a treatment of weight regain after sleeve gastrectomy. World J Gastrointest Surg 6(6):101–106

    PubMed  PubMed Central  Google Scholar 

  14. Parikh M, Gagner M (2008) Laparoscopic hiatal hernia repair and repeat sleeve gastrectomy for gastroesophageal reflux disease after duodenal switch. Surg Obes Relat Dis 4(1):73–75

    Article  PubMed  Google Scholar 

  15. Gagner M, Rogula T (2003) Laparoscopic reoperative sleeve gastrectomy for poor weight loss after biliopancreatic diversion with duodenal switch. Obes Surg 13(4):649–654

    Article  PubMed  Google Scholar 

  16. Biron S, Hould FS, Lebel S, Marceau S, Lescelleur O, Simard S, Marceau P (2004) Twenty years of biliopancreatic diversion: what is the goal of the surgery? Obes Surg 14(2):160–164

    Article  PubMed  Google Scholar 

  17. Shimizu H, Annaberdyev S, Motamarry I, Kroh M, Schauer PR, Brethauer SA (2013) Revisional bariatric surgery for unsuccessful weight loss and complications. Obes Surg 23(11):1766–1773

    Article  PubMed  Google Scholar 

  18. Noel P, Nedelcu M, Nocca D, Schneck AS, Gugenheim J, Iannelli A, Gagner M (2014) Revised sleeve gastrectomy: another option for weight loss failure after sleeve gastrectomy. Surg Endosc 28(4):1096–1102

    Article  PubMed  Google Scholar 

  19. Cambi MP, Marchesini SD, Baretta GA (2015) Post-bariatric surgery weight regain: evaluation of nutritional profile of candidate patients for endoscopic argon plasma coagulation. Arq Bras Cir Dig 28(1):40–43

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bal BS, Finelli FC, Shope TR, Koch TR (2012) Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol 8(9):544–556

    Article  CAS  PubMed  Google Scholar 

  21. Shankar P, Boylan M, Sriram K (2010) Micronutrient deficiencies after bariatric surgery. Nutrition 26(11–12):1031–1037

    Article  CAS  PubMed  Google Scholar 

  22. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, Heinberg LJ, Kushner R, Adams TD, Shikora S, Dixon JB, Brethauer S (2013) Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic and Bariatric Surgery. Obesity 21(Suppl 1):S1–S27

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Baltasar A, Serra C, Perez N, Bou R, Bengochea M (2006) Re-sleeve gastrectomy. Obes Surg 16(11):1535–1538

    Article  PubMed  Google Scholar 

  24. Vidal P, Ramon JM, Busto M, Dominguez-Vega G, Goday A, Pera M, Grande L (2014) Residual gastric volume estimated with a new radiological volumetric model: relationship with weight loss after laparoscopic sleeve gastrectomy. Obes Surg 24(3):359–363

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, University Bern, 3010, Bern, Switzerland

    Philipp C. Nett, Dino Kröll & Yves Borbély

Authors
  1. Philipp C. Nett
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dino Kröll
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yves Borbély
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philipp C. Nett.

Ethics declarations

Disclosures

Philipp C. Nett, Dino Kröll, and Yves Borbély have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nett, P.C., Kröll, D. & Borbély, Y. Re-sleeve gastrectomy as revisional bariatric procedure after biliopancreatic diversion with duodenal switch. Surg Endosc 30, 3511–3515 (2016). https://doi.org/10.1007/s00464-015-4640-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4640-9

Keywords

Search

Navigation