title: Revised sleeve gastrectomy (re-sleeve).
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) has rapidly become increasingly popular in bariatric surgery. However, in the long-term follow-up, weight loss failure and intractable severe reflux after primary LSG can necessitate further surgical interventions.
  
  
  OBJECTIVE
  To evaluate the safety and the efficiency of revisional sleeve gastrectomy (ReSG).
  
  
  METHODS
  Private hospital.
  
  
  METHODS
  From October 2008 to October 2014, 61 patients underwent ReSG. All patients with failure after primary LSG underwent radiologic evaluation, and an algorithm of treatment was proposed.
  
  
  RESULTS
  Sixty-one patients (54 women, 7 men; mean age 40.8 yr) with a body mass index (BMI) of 39.4 kg/m² underwent ReSG. The primary LSG was performed for mean BMI of 46.2 kg/m² (range 35.4-77.9). The mean interval time from the primary LSG to ReSG was of 37.5 months (9-80 mo). The indication for ReSG was insufficient weight loss in 28 patients (45.9%), weight regain in 29 patients (47.5%), and gastroesophageal reflux disease (GERD) in 4 patients. In 42 patients the gastrografin swallow results were interpreted as primary dilation and in the remaining 19 cases as secondary dilation. The computed tomography (CT) scan volumetry was obtained in 38 patients with mean gastric volume of 436.3 cc (275-1056 cc). All cases were completed by laparoscopy with no intraoperative incidents. The mean operative time was 39 minutes (range 29-70 min) and the mean hospital stay was 3.5 days (range 3-16 d). One perigastric hematoma and 2 cases of gastric stenosis were recorded. The mean BMI decreased to 29.2 kg/m(2) (range 20.2-37.5); the mean percentage of excess weight loss (%EWL) was 58.5% (±25.3) (P<.0004) for a mean follow-up of 20 months (range 6-56 mo).
  
  
  CONCLUSIONS
  The ReSG may be a valid option for failure of primary LSG. Further prospective clinical trials are required to compare the outcomes of ReSG with those of laparoscopic Roux-en-Y gastric bypass or duodenal switch for weight loss failure after LSG.
authors.affiliation: Hôpital Prive La Casamance, Aubagne, France; Centre Hospitalier Universitaire Strasbourg, France. Electronic address: nedelcu.marius@gmail.com.
authors.forename: Marius
authors.initials: M
authors.lastname: Nedelcu
authors.affiliation: Hôpital Prive La Casamance, Aubagne, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Noel
authors.affiliation: Hôpital Archet, Université de Nice, France.
authors.forename: Antonio
authors.initials: A
authors.lastname: Iannelli
authors.affiliation: Hôpital Du Sacre Cœur, Montréal, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Gagner
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology*
keywords: Primary dilation; Revised sleeve gastrectomy; Secondary dilation