Indications and short-term outcomes of revisional surgery after failed or complicated sleeve gastrectomy

Sleeve gastrectomy (SG) is an upcoming primary treatment modality for morbid obesity. The aim of this study was to report the indications for and the outcomes of revisional surgery after SG.

Four hundred sixteen individuals underwent a SG between August 2006 and July 2010 with a minimum follow-up of 12 months. The patients that needed revision were identified from our prospective registry. Patients were subdivided in a first group undergoing revision as part of a two-step procedure, a second group with failure of a secondary SG, and a third group with failure of a primary SG.

Twenty-three patients (5.5%) had an unplanned revision. Fourteen (3.4%) had a two-step procedure because of super obesity. A significant additional weight loss was achieved after revision; no complications occurred in this group. Five patients with failure of a secondary SG had no significant additional weight loss after revision. Reflux disease was cured. Eighteen patients in the third group showed significant additional weight loss and remission of diabetes and hypertension. Both reflux disease and dysphagia did not heal in all affected patients after revision. The early complication rate in the whole cohort was 23.4%; staple line leakage was 5.4%, and bleeding was 8.1%. Revision-related mortality was 0%.

In a large series of sleeve gastrectomies, the unplanned revision rate was 5.5%. Revision of a sleeve gastrectomy is feasible in patients that do not achieve sufficient weight loss and in those patients developing complications after the initial sleeve gastrectomy.