Laparoscopic Sleeve Gastrectomy After Endoscopic Sleeve Gastroplasty: Technical Aspects and Short-Term Outcomes

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.