Resleeve for failed laparoscopic sleeve gastrectomy: systematic review and meta-analysis

Abstract

Despite excellent long-term results, insufficient weight loss, weight regain, and pathologic gastroesophageal reflux disease may require revisional procedures after laparoscopic sleeve gastrectomy (LSG). Resleeve gastrectomy (ReSG) for failed LSG, has been proposed as an alternative to more complex malabsorptive procedures. The aim of this systematic review and meta-analysis was to examine the current evidence on the therapeutic role and outcomes of ReSG for failed LSG. PubMed, EMBASE, and Web of Science data sets were consulted. A systematic review and Frequentist metaanalysis were performed. Ten studies published between 2010 and 2019 met the inclusion criteria for a total of 300 patients. The age of the patient population ranged from 20 to 66 years old and 80.5% were females. The elapsed time between the LSG and ReSG ranged from 9 to 132 months. The estimated pooled prevalence of postoperative leak and overall complications were 2.0% (95% confidence interval [CI] 5 .5%-4.7%) and 7.6% (95%CI 5 3.1%-13.4%). The estimated pooled mean operative time and hospital length of stay were 51 minutes (95%CI 5 49.4-52.6) and 3.3 days (95%CI 5 3.13-3.51). The postoperative follow-up ranged from 12 to 36 months and the estimated pooled mean percentage excess weight loss was 61.46% (95%CI 5 55.9-66.9). The overall mortality ranged from 0% to 2.2%. ReSG after failed LSG seems feasible and safe with acceptable postoperative leak rate, overall complications, and mortality. The effectiveness of ReSG in term of weight loss seems promising in the short-term but further studies are warranted to explore its effect on patients' quality of life, postoperative gastroesophageal reflux disease, and long-term weight loss. (Surg Obes Relat Dis 2020;-:1-9.

Interventions for the Management of Post–Sleeve GERD

“…56 While no intraoperative complications occurred, morbidity was reported from 0 to 14.7% with staple line leak and bleeding being most common and mortality was reported from 0 to 2.2%. 56 EWL results were promising between 18 and 127.2%; however, no studies reported on GERD outcomes. 56 There are very limited data regarding ReSG and GERD improvement, although it has been somewhat effective for weight loss.…”

“…56 EWL results were promising between 18 and 127.2%; however, no studies reported on GERD outcomes. 56 There are very limited data regarding ReSG and GERD improvement, although it has been somewhat effective for weight loss.…”

“…Aiolfi et al published a meta-analysis that looked at 10 studies with a total of 300 patients who underwent ReSleeve following a failed SG. 56 The most common indications for the procedure included insufficient weight loss, weight regain, and GERD. 56 While no intraoperative complications occurred, morbidity was reported from 0 to 14.7% with staple line leak and bleeding being most common and mortality was reported from 0 to 2.2%.…”

“…56 The most common indications for the procedure included insufficient weight loss, weight regain, and GERD. 56 While no intraoperative complications occurred, morbidity was reported from 0 to 14.7% with staple line leak and bleeding being most common and mortality was reported from 0 to 2.2%. 56 EWL results were promising between 18 and 127.2%; however, no studies reported on GERD outcomes.…”

Efficacy and Drawbacks of Single-Anastomosis Duodeno-Ileal Bypass After Sleeve Gastrectomy in a Tertiary Referral Bariatric Center

“…Concerning the surgical technique, SADI after SG may or may not include a re-sleeve of the gastric tube. Re-sleeve is associated with a higher rate of postoperative leaks, which is estimated to be around 2% [17], compared to primary SG [18]. To avoid a potential source of additional postoperative complications, in our center, we avoid re-sleeving the gastric BMI, body mass index; EWL, excess weight loss; TWL, total weight loss; N., number pouch during SADI.…”