Revisional Surgery After Laparoscopic Sleeve Gastrectomy

Abstract

The laparoscopic sleeve gastrectomy has become a popular procedure in the armory of bariatric surgery. However, failures with this procedure are often difficult to manage in the absence of any single defined pathway. Complications that emerge are often debilitating and frequently demand prompt corrective surgery. Operations aimed at improving weight loss include the restoration of the original sleeve in case of anatomical deformation, the addition of malabsorption or hormonal effects by augmenting the sleeve with several variations of bypasses, and the revision of the sleeve gastrectomy in those with severe reflux in conjunction with poor weight loss. Other revisional procedures address typical complications with the rectification of anatomical or functional blemishes in the sleeve and the hiatus, and, infrequently, deal with chronic fistulae. Reoperation on a sleeve gastrectomy is a delicate endeavor because of the risks of leaks and further failures. It demands advanced laparoscopic skills and specific technical precautions. All patients require careful preoperative evaluation, and expectations should be addressed before further surgery is offered.