Clinical Trials Study
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World J Gastrointest Surg. Jun 27, 2014; 6(6): 101-106
Published online Jun 27, 2014. doi: 10.4240/wjgs.v6.i6.101
Laparoscopic re-sleeve gastrectomy as a treatment of weight regain after sleeve gastrectomy
Giovanni Cesana, Matteo Uccelli, Francesca Ciccarese, Domenico Carrieri, Giorgio Castello, Stefano Olmi
Giovanni Cesana, Matteo Uccelli, Francesca Ciccarese, Domenico Carrieri, Giorgio Castello, Stefano Olmi, Department of General and Oncologic Surgery, Centre of Laparoscopic and Bariatric Surgery, Istituti Ospedalieri Bergamaschi-Policlinico San Marco, 24040 Zingonia-Osio Sotto, Italy
Author contributions: Cesana G, Ciccarese F and Olmi S performed the interventions; Uccelli M, Carrieri D and Castello G provided the collection and the analysis of the data; Cesana G designed the study and wrote the manuscript; Olmi S edited the manuscript.
Correspondence to: Dr. Giovanni Cesana, Department of General and Oncologic Surgery, Centre of Laparoscopic and Bariatric Surgery, Istituti Ospedalieri Bergamaschi-Policlinico San Marco, Corso Europa 7, 24040 Zingonia-Osio Sotto, Italy. giovanni.cesana@gmail.com
Telephone: +39-331-6526615 Fax: +39-35-885789
Received: December 2, 2013
Revised: April 17, 2014
Accepted: May 28, 2014
Published online: June 27, 2014
Abstract

AIM: To evaluate laparoscopic re-sleeve gastrectomy as a treatment of weight regain after Sleeve.

METHODS: Laparoscopic sleeve gastrectomy is a common bariatric procedure. Weight regain after long-term follow-up is reported. Patients were considered for laparoscopic re-sleeve gastrectomy when we observed progressive weight regain and persistence of comorbidities associated with evidence of dilated gastric fundus and/or antrum on upper gastro-intestinal series. Follow-up visits were scheduled at 1, 3, 6 and 12 mo after surgery and every 6 mo thereafter. Measures of change from baseline at different times were analyzed with the paired samples t test.

RESULTS: We observed progressive weight regain after sleeve in 11 of the 201 patients (5.4%) who had a mean follow-up of 21.1 ± 9.7 mo (range 6-57 mo). Three patients started to regain weight after 6 mo following Sleeve, 5 patients after 12 mo, 3 patients after 18 m. Re-sleeve gastrectomy was always performed by laparoscopy. The mean time of intervention was 55.8 ± 29.1 min. In all cases, neither intra-operative nor post-operative complications occurred. After 1 year follow-up we observed a significant (P < 0.05) mean body mass index reduction (-6.6 ± 2.7 kg/m2) and mean % excess weight loss (%EWL) increase (+31.0% ± 15.8%). An important reduction of antihypertensive drugs and hypoglycemic agents was observed after re-sleeve in those patients affected by hypertension and diabetes. Joint problems and sleep apnea syndrome improved in all 11 patients.

CONCLUSION: Laparoscopic re-sleeve gastrectomy is a feasible and effective intervention to correct weight regain after sleeve.

Keywords: Obesity, Bariatric surgery, Laparoscopic surgery, Stomach stapling, Gastrectomy, Surgery, Repeat

Core tip: Laparoscopic sleeve gastrectomy is gaining an important role in bariatric surgery because it may have similar results to gastric by-pass and duodenal switch, without problems of malabsorption and digestive anastomosis. However, weight regain after a long-term follow-up is reported. In this paper we show that re-sleeve gastrectomy is a valid and effective intervention to correct weight regain after sleeve.