Re-sleeve gastrectomy: single-center insight into controversial territory.

BACKGROUND

Re-sleeve gastrectomy (ReSG) has emerged as a revisional option for patients with inadequate weight loss or weight regain after primary sleeve gastrectomy (SG). Despite increasing utilization, its role remains controversial due to limited data on outcomes and safety.

OBJECTIVES

To evaluate weight loss outcomes, safety, and impact on gastroesophageal reflux disease (GERD) in patients undergoing ReSG after SG.

SETTING

High-volume tertiary bariatric surgery center in the United States.

METHODS

A retrospective review was performed of patients who underwent ReSG between 2017 and 2023 for weight regain or insufficient weight loss following SG, with radiographic and/or endoscopic evidence of sleeve dilation. Data collected included demographics, comorbidities, perioperative outcomes, complications, and weight loss. Primary outcomes were percentage of excess weight loss (%EWL) and percentage of total weight loss (%TWL) at 1-, 2-, and 3-year follow-up. Secondary outcomes included 30-day morbidity, GERD symptoms, and medication use.

RESULTS

A total of 101 patients underwent ReSG. Thirty-day outcomes were available for all patients. After excluding early conversions, 95 individuals were included in the long-term follow-up. The mean operative time was 96.5 minutes, with a mean length of stay of 1.7 day. The 30-day readmission, reoperation, and complication rates were 9.9% (10), 7.9% (8), and 7.9% (8), respectively. Staple line leak occurred in 5.9% (6) of patients within 30 days of surgery, with most managed surgically. Three patients had early conversion due to staple line leak (2) or severe gastric stenosis (1). No mortalities occurred. Although GERD medication use significantly increased after ReSG, reflux symptoms were well controlled, and an initial decline in GERD symptoms was observed. BMI significantly decreased over time compared to baseline SG and ReSG (P < .05). Of the patients eligible for long-term follow-up, 84.6% (77/91), 78.8% (41/52), and 71.4% (20/28) had available data at 1, 2, and 3 years, respectively. Mean %EWL was 63.7%, 61.4%, and 62.8%; mean %TWL was 31.0%, 30.3%, and 30.9%.

CONCLUSIONS

ReSG is a safe and effective revisional procedure after SG for weight recurrence or insufficient weight loss, offering sustained weight loss and symptom improvement with acceptable morbidity.