Revisional one-anastomosis gastric bypass for failed laparoscopic sleeve gastrectomy

Artur Binda; Joanna Żurkowska; Agnieszka Gonciarska; Emilia Kudlicka; Krzysztof Barski; Paweł Jaworski; Piotr Jankowski; Michał Wąsowski; Wiesław Tarnowski

doi:10.1007/s13304-024-01820-8

Revisional one-anastomosis gastric bypass for failed laparoscopic sleeve gastrectomy

Updates Surg. 2024 Apr 9. doi: 10.1007/s13304-024-01820-8. Online ahead of print.

Authors

Artur Binda¹, Joanna Żurkowska², Agnieszka Gonciarska², Emilia Kudlicka², Krzysztof Barski², Paweł Jaworski², Piotr Jankowski³, Michał Wąsowski³, Wiesław Tarnowski²

Affiliations

¹ Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland. artur.binda@interia.com.
² Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland.
³ Department of General Medicine and Gerontocardiology, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland.

PMID: 38594580
DOI: 10.1007/s13304-024-01820-8

Abstract

The study aimed to evaluate the mid-term weight loss outcomes and complications of revisional one-anastomosis gastric bypass (OAGB) following failed laparoscopic sleeve gastrectomy (LSG). A total of 586 patients underwent LSG from January 2010 to February 2018. Revisional OAGB (rOAGB) was performed in 22 (3.8%) patients. A retrospective analysis of prospectively collected data from 20 patients with at least 12 months of follow-up after the revisional OAGB was carried out. The indications for revisional surgery were as follows: insufficient weight loss-4 (20%), weight regain-13 (65%), weight regain and symptoms of gastroesophageal reflux disease (GERD)-2 (10%), and dysphagia with gastroesophageal reflux-1 (5%). The mean interval between the LSG and rOAGB was 35.3 ± 15.4 months (range 4-64). The mean follow-up time after rOAGB was 45.5 ± 17.1 months (range 12-54). At the end of the follow-up after rOAGB, %TWL was 26.4 ± 8.9%, and %EWL was 58.5 ± 21.6%, based on pre-LSG body weight. In all three patients with intractable GERD, the clinical symptoms of reflux retreated after revisional OAGB. The overall complication rate was 20%. In conclusion, the main indications for revision after LSG are weight regain, insufficient weight loss, and intractable GERD. Revisional OAGB emerges as a viable surgical alternative for unsuccessful LSG, presenting notable weight loss outcomes; however, it may be linked to an increased incidence of complications.

Keywords: Failed laparoscopic sleeve gastrectomy; Gastroesophageal reflux; Insufficient weight loss; Revisional one-anastomosis gastric bypass; Weight regain.