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Revisional surgery results after sleeve gastrectomy. A retrospective cohort study surveying 2nd stage BPD/DS

Zvi H Perry, MD, PhD, Mohammed Al Abri, MD, Olivier Court, MD, Amin Andalib, MD, MPH, Sebastian Demyttenaere, MD. Center for Bariatric Surgery, Division of General Surgery, Department of Surgery, McGill University, Montreal, Quebec

Introduction: Sleeve gastrectomy is becoming the most popular bariatric procedure in the world. However, there is ongoing debate as to the appropriate surgical procedure after failed sleeve gastrectomy. In this study, we aimed to evaluate patients who underwent prior sleeve surgery who subsequently underwent biliopancreatic diversion with duodenal switch (BPD/DS).

Methods: A retrospective analysis of a prospectively maintained database of laparoscopic sleeve gastrectomies (LSG) was performed between January 2006 and March 2018. Data analyzed included age, weight loss, postoperative complications and long-term outcomes.

Results: 173 patients were enlisted in our database as having lap BPD/DS. Of these patients, 91 subsequently had revisional surgery to (BPD/DS). Of the 91 patients 56 (61.5%) were female. Mean follow up time was 5.5 (±2.7) years. Mean time between the sleeve and the revisional surgery was 21.5 (±16) months. The mean age upon the sleeve procedure was 41.8 (±10.5), while the mean age upon the revisional duodenal switch was 43.7 (± 10.6). Pre-sleeve mean body mass index (BMI) was 63.5 (±9.7) kg/m2. Pre-BPD mean BMI was 46.3 (±7.7) kg/m2 and at the end of the follow up period the mean BMI was 39.5 (±7.8) kg/m2. Differences between pre-op BMI and pre-revision, pre-revision and end of follow-up BMI, as well as between pre-op BMI and end of the follow-up were all significant (p<0.001). 20 patients suffered from a complication (22%), with the most common being leak (9 patients, 9.9%), and infection (6 patients, 6.6%). No death occurred.

Discussion and Conclusions: Controversy exists regarding technical aspects of revisional LSG. In our study, we have seen that post-sleeve duodenal switch had substantial weight loss, with a satisfactory complication profile. Longer follow up is needed to determine if this improvement in weight loss remains in the long term.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 92035

Program Number: P196

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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