Approach to Poor Weight Loss After Laparoscopic Sleeve Gastrectomy: Re-sleeve Vs. Gastric Bypass

Al-Sabah, Suleiman; Alsharqawi, Nourah; Al-Mulla, Ahmed; Akrof, Shehab; Alenezi, Khaled; Buhaimed, Waleed; Al-Subaie, Saud; Haddad, Mohanned Al

doi:10.1007/s11695-016-2119-y

Cited by 75 publications

(26 citation statements)

References 14 publications

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“…Another proposed procedure to improve weight loss after a prior SG is the revisional sleeve gastrectomy (Re-SG), which is particularly promising when the original sleeve has dilated. It is found that the overall percentage of excess weight loss following the Re-SG can reach up to 57% at 12 months and up to 60% at 20 months follow-up [ 28 , 29 ]. These percentages seem to exceed weight loss reported for RYGB in the current study; however, contrary to these outcomes Alsabah, S. et al found more weight loss following revisional RYGB than after a Re-SG [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Failed Sleeve Gastrectomy: Single Anastomosis Duodenoileal Bypass or Roux-en-Y Gastric Bypass? A Multicenter Cohort Study

et al. 2018

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BackgroundSleeve gastrectomy (SG) has become the most performed bariatric procedure to induce weight loss worldwide. Unfortunately, a significant portion of patients show insufficient weight loss or weight regain after a few years.ObjectiveTo investigate the effectiveness of the single anastomosis duodenoileal (SADI) bypass versus the Roux-en-Y gastric bypass (RYGB) on health outcomes in morbid obese patients who had undergone SG previously, with up to 2 years of follow-up.MethodsFrom 2007 to 2017, 140 patients received revisional laparoscopic surgery after SG in four specialized Dutch bariatric hospitals. Data was analyzed retrospectively and included comparisons for indication of surgery, vitamin/mineral deficiencies, and complications; divided into short-, medium-term. To compare weight loss, linear regression and linear mixed models were used.ResultsConversion of a SG to SADI was performed in 66 patients and to RYGB in 74 patients. For patients in which additional weight loss was the main indication for surgery, SADI achieved 8.7%, 12.4%, and 19.4% more total body weight loss at 6, 12, and 24 months compared to RYGB (all p < .001). When a RYGB was indicated in case of gastroesophageal reflux or dysphagia, it greatly reduced complaints almost directly after surgery. Furthermore, a similar amount of complications and nutritional deficiencies was observed for both groups. There was no intra- or post-operative mortality.ConclusionConversion into a SADI resulted in significantly more weight loss while complications rates and nutritional deficiencies were similar and may therefore be considered the recommended operation for patients in which only additional weight loss is required.

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Section: Discussionmentioning

confidence: 99%

Failed Sleeve Gastrectomy: Single Anastomosis Duodenoileal Bypass or Roux-en-Y Gastric Bypass? A Multicenter Cohort Study

et al. 2018

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“…Revisional surgery was found to be safe . Among 1,300 patients having SG, conversion to RYGB was associated with a mean loss of excess weight of 61.3% after 1 year . Based on retrospective analysis of two cohorts, endoscopic gastrojejunostomy revision also has demonstrated greater effectiveness than medical management for weight regain after RYGB .…”

Section: Executive Summarymentioning

confidence: 99%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

323

464

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Objective The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results New or updated topics in this CPG include: contextualization in an adiposity‐based chronic disease complications‐centric model, nuance‐based and algorithm/checklist‐assisted clinical decision‐making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusions Bariatric procedures remain a safe and effective intervention for higher‐risk patients with obesity. Clinical decision‐making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.

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“…28 Previous studies have investigated the type of procedure that is best after a SG has failed. 26 In one study with 36 patients, 26 there were no differences in %EWL between re-do SG and conversion to RYGB. Our approach after SG has failed is to perform a RRYGB.…”

Section: Discussionmentioning

confidence: 96%

“…25 Weight regain after bariatric surgery is a major concern for both the patient and the surgeon. 26,27 Research has demonstrated that weight regain is more common after SG (mostly restrictive procedure) than after malabsorptive procedures such as RYGB. 28 Previous studies have investigated the type of procedure that is best after a SG has failed.…”

Section: Discussionmentioning

confidence: 99%

Reduction in Medication Use for Postrobot-Assisted Roux-en-Y Gastric Bypass as a Revisional Bariatric Procedure

Gonzalez-HerediaRaquel

Sanchez-JohnsenLisa

QuadriPablo

et al. 2019

Bariatric Surgical Practice and Patient Care

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Introduction: Revisional bariatric surgery is sometimes required due to inadequate weight loss, reoccurrence of comorbidities, or long-term complications following a previous bariatric procedure. However, the use of revisional surgery, based on the status of medical comorbidities, warrants further investigation. As such, the aim of this study was to examine medication usage for hypertension (HTN), type 2 diabetes mellitus (T2DM), and dyslipidemia (DLP) pre and postrobot-assisted Roux-en-Y gastric bypass (RRYGB) surgery as a revisional bariatric procedure. Materials and Methods: This is a retrospective review of a prospectively maintained database that included patients who underwent a RRYGB as a revisional procedure due to inadequate weight loss between January 2008 and January 2016 at the

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Approach to Poor Weight Loss After Laparoscopic Sleeve Gastrectomy: Re-sleeve Vs. Gastric Bypass

Abstract: Following our algorithm, revising an LSG with an LRSG or LRYGB for poor weight loss is feasible with good outcomes. Larger and longer follow-up studies are needed to verify our results.

Cited by 75 publications

References 14 publications

Failed Sleeve Gastrectomy: Single Anastomosis Duodenoileal Bypass or Roux-en-Y Gastric Bypass? A Multicenter Cohort Study

Failed Sleeve Gastrectomy: Single Anastomosis Duodenoileal Bypass or Roux-en-Y Gastric Bypass? A Multicenter Cohort Study

Reduction in Medication Use for Postrobot-Assisted Roux-en-Y Gastric Bypass as a Revisional Bariatric Procedure

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