Abstract Background Endoscopic sleeve gastroplasty (ESG) is a recognized minimally invasive approach for weight management, with growing adoption in selected patients. However, in some cases, weight loss outcomes may be suboptimal, and revisional surgery may be considered. Revising ESG can present technical challenges due to altered anatomy and residual sutures. This case highlights the feasibility and short-term success of a robotic-assisted sleeve gastrectomy (RASG) following ESG, focusing on the technical advantages of robotic platforms in revisional bariatric procedures. Case description A 41-year-old female (BMI 54) with multiple comorbidities—including type 2 diabetes mellitus, polycystic ovary syndrome, Crohn’s disease, and depression—presented with weight regain and limited metabolic improvement following ESG (performed 5 years prior). Preoperative upper endoscopy showed intact residual endoscopic sutures and normal anatomy. She underwent robotic-assisted sleeve gastrectomy using a four-port robotic configuration and epigastric liver retraction. Intraoperative findings included mild fatty liver and visible ESG sutures. Dissection of the greater curvature was carried out starting 4 cm from the pylorus to the angle of His. A 38 Fr bougie-guided sleeve was fashioned using robotic staplers (5 blue and 1 white cartridge), and the staple line was oversewn with V-Loc sutures. ICG leak test was negative. The procedure was completed without complications. Outcome The patient had an uneventful recovery and was discharged on postoperative day 2. At 8 weeks, she had achieved a weight loss of 20 kg—substantially greater than the peak 5 kg loss achieved following ESG over the previous 5 years. There was excellent tolerance to dietary progression, and comorbidities remained under active management. Conclusion Robotic-assisted sleeve gastrectomy following ESG is a feasible and safe revisional approach in select patients. The robotic platform provides enhanced precision and control during dissection in previously altered anatomy. This case demonstrates that surgical conversion, when clinically indicated, can yield effective outcomes with minimal morbidity.
Ramar et al. (Thu,) studied this question.