Technical aspects of revisional surgery following endoscopic sleeve gastroplasty

Less invasive endoscopic bariatric procedures have become established for the management of obesity disease, and the evidence supporting their impact on future bariatric surgery are limited in literature.

The purpose of our study was to assess the technical aspects and early complication rate (within 30 days) of revisional bariatric surgery following an endoscopic sleeve gastroplasty (ESG).

Private hospital, France.

From January 2019 to December 2024, all consecutive patients who underwent revisional surgery following ESG were retrospectively reviewed. Data on patient demographic characteristics, case history, intraoperative findings, technique, and adverse events were reviewed.

Fifty-eight patients (51 women, 87.9%; mean age 37.2 years [20-63]; mean body mass index 37.4 ± 4.3) underwent bariatric surgery after a previous ESG, including 37 laparoscopic sleeve gastrectomy (63.8%) and 21 Roux-en-Y gastric bypass (36.2%). The preoperative upper endoscopy analyzed for 42 patients found a complete undo of plication in 19 cases (45.2%), some cinches with the stitch in place in 17 cases (40.5%), and an intact plication in 6 cases (10.3%). Different intraoperative additional techniques were used in 39 cases: fluoroscopic control in 28 cases, intraoperative endoscopy in 6 cases, or opening of the greater curvature in 5 cases. There were 4 intraoperative incidents and 2 postoperative adverse events (1 bleeding; 1 leak). No conversion to open surgery and no mortality was recorded.

The revisional bariatric surgery following ESG is safe, but several technical points are important, and the team should be familiar with additional needed tools. Preoperative endoscopy is mandatory, but the endoscopic removal of anchors is not necessary.