Other options if laparoscopic sleeve gastrectomy fails to reduce the weight. Review of literature. Obesity, BAROS, BMI,

1. What should be the approach when
laparoscopic sleeve gastrectomy fails
to reduce the weight?
A review of literature
Dr. Abdul Qadeer Memon
MBBS; FCPS; FICS
Assistant Professor in Surgery
& Consultant General Surgeon
King Faisal University College of Medicine
Kingdom of Saudi Arabia

2. Obesity
■ Metabolic disorder
■ Associated with:
Diabetes mellitus
Hypertension
Heart diseases
Infertility
Cancer

3. Anti-obesity drugs
■ Amphetamine based drugs
■ Appetite suppressors
■ Block cannabinoid receptors
■ Examples: Orlistat (Xanical),
Rimonabant (Acomplia),
Sibutramine (Meridia)
■ Not promising effect
■ Side effects

4. Anti-obesity surgery
Restrictive
■ Gastric banding
■ Sleeve gastrectomy
■ Roux-en-Y gastric
bypass
Malabsorptive
■ Bilio-pancreatic
diversion
■ Duodenal switch

10. ■ None of the surgical procedure is without
complications
■ Newer techniques:
NOTES
Single incision technique
Transoral gastroplasty (TOGA)
Primary obesity surgery endoluminal (POSE)
Endobarrier

11. Methodology
■ Online search of Pubmed
■ Abstracts & full articles to find the most suitable
revision procedure after failed LSG
■ Seven studies, which included 296 cases,
selected online were reviewed

12. Criterion for failure
■ Insufficient weight loss or
■ Weight regain
■ Criteria are:
Bariatric Analysis and Reporting Outcome
System (BAROS)
Reinhold criteria (>25% EWL)

14. %EWL at
24 months
%EWL at
18 months
%EWL at
12 months
%EWL at
6 months
%EWL at
3 months
ProcedureName of study
48
44
75
58
48
NA
60
68
65
37
48
NA
27
50
NA
LGBP*
LReSG*
OSI*
Cheung D et al
(n=218)
51.6±14.848.6±2149.3±19.837.2±12.426.8±12LMGBP-OL*
(%EBL*)
Moszkowicz D et
al (n=19)
NANA56.8±12.4NANALReSG*Giovanni C et al
(n=11)
NANA29.1NANALReSG*Rebibo et al
(n=15)
61.7NANANANARYGBP*Gautier T et al
(n=9)
28NANANANARYGBP*Langer FB et al
(n=5)
80±40
65.5±34
NANANANABPD-DS*
RYGBP*
Carmeli I et al
(n=19)
LGBP = Laparscopic gastric bypass, LReSG = Laparoscopic re-sleeve gastrectomy RYGBP = Roux-en-Y
gastric bypass, LMGBP-OL = Laparoscopic mini-gasric bypass-Omega loop, BPD-DS = Bilio-pancreatic
diversion-Duodenal switch,

15. 0
10
20
30
40
50
60
70
80
12345
Cheung D et al
(n=218)
LGBP* LReSG* OSI*

16. Study by Prof. Hamed A. Al-Wadaani
■ Mini-gastrectomy with bypass has been conducted by Prof. Dr. Hamed A. Al-
Wadaani
■ It is about to be published
■ 23 patients have been operated so far
■ 85% EWL has been reduced
■ Negligible complications

17. Conclusion
■ None of the procedures is without complications
■ Selection of the procedure may very according to the patients
■ Re-sleeve gastrectomy is good option for dilated stomach pouch
■ Gastric bypass is better choice in failure of sleeve gastrectomy without dilatation
of stomach for selective patients
■ Mini-gastrectomy with by-pass is the better choice for re-do surgery with
promising results of 85% EWL and negligible complications
■ Weight loss is significant in BPD-DS if the patient is strictly compliant of post-
operative instructions to have micronutrients, vitamins and excessive proteins;
otherwise can be fatal