Key result
Revisional laparoscopic one anastomosis gastric bypass resulted in significantly higher excess weight loss compared to ReSleeve gastrectomy (MD 28.881) in patients with failed primary sleeve gastrectomy.
Why the study?
Selecting a revisional bariatric procedure after primary laparoscopic sleeve gastrectomy failure in the presence of gastric tube dilation is challenging, with unclear guidance on which procedure best suits which patient.
Does revisional laparoscopic one anastomosis gastric bypass improve weight loss compared to ReSleeve gastrectomy in patients with failed primary sleeve gastrectomy with dilated gastric tube?
Cohort (n=52)
No
Does revisional laparoscopic one anastomosis gastric bypass improve weight loss compared to ReSleeve gastrectomy in patients with failed primary sleeve gastrectomy with dilated gastric tube?
Mean Difference: 28.881 (95% CI 21.941–35.822)
Absolute Event Rate: 83.7% vs 60.3%
p-value: p=<0.001
Revisional laparoscopic one anastomosis gastric bypass provides superior weight loss compared to ReSleeve gastrectomy in patients with failed primary sleeve gastrectomy and dilated gastric tube.
May support RLOAGB over ReLSG for weight loss after failed sleeve; leaves open need for RCTs.
BACKGROUND: Revisional bariatric surgery (RBS) has been increasingly performed due to weight loss failure (WLF). Many revisional procedures have been proposed after primary laparoscopic sleeve gastrectomy (pLSG) failure, including ReSleeve gastrectomy (ReLSG), and laparoscopic one anastomosis gastric bypass (LOAGB). Choosing the RBS post-pLSG failure represents a challenge. WLF without gastric tube (GT) dilation is undoubtedly converted to a malabsorptive procedure, but the presence of GT dilation makes it more difficult to select a RBS. This study aimed to compare two relatively simple revisional procedures after pLSG failure with dilated GT to help decision making on which procedure better done to which patient. METHODS: Data of 52 patients who completed one year follow-up (FU) after their RBS (ReLSG: 27 or LOAGB: 25) for their failed pLSG were collected, assessed, correlated to weight loss (WL) and compared. RESULTS: Mean operative time was 97 ± 18.4 min. with revisional LOAGB (RLOAGB) and 62 ± 11 min. with ReLSG. Six patients (11.5%) had seven postoperative procedure-specific complications. Significant hemorrhage occurred in three patients. Two cases of leakage were encountered with each procedure. LOAGB Patients had lower mean final weight (76.2 ± 10.5 vs 85.3 ± 13), lower mean Final BMI (26.4 ± 2.5 vs 29.7 ± 2.9) and higher mean percentage of excess weight loss (EWL%) (83.6 ± 13.5% vs 60.29 ± 14.6%). All RLOAGB patients and 77.8% of ReLSG patients had EWL% > 50%. RLOAGB patients had higher EWL% compared to ReLSG (p < 0.001). Insufficient WL (IWL) patients had higher EWL% compared to weight regain (WR) patients (p = 0.034). CONCLUSION: Both procedures (RLOAGB and ReLSG) were relatively safe and effective in terms of WL. RLOAGB led to higher WL compared to ReLSG in all types of patients despite higher Caloric intake. IWL patients had more WL compared to WR patients. WL was not related to GT dilation type. Large-scale longer-FU studies are still needed. TRIAL REGISTRATION: PACTR202310644487566 (retrospectively registered).
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Gerges et al. (2023) conducted a cohort in Failed primary sleeve gastrectomy with dilated gastric tube (n=52). Revisional laparoscopic one anastomosis gastric bypass (RLOAGB) vs. Laparoscopic ReSleeve (ReLSG) was evaluated on Percentage of excess weight loss (EWL%) (MD 28.881, 95% CI 21.941-35.822, p=<0.001). Revisional laparoscopic one anastomosis gastric bypass resulted in significantly higher excess weight loss compared to ReSleeve gastrectomy (MD 28.881) in patients with failed primary sleeve gastrectomy.
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