title: Approach to Poor Weight Loss After Laparoscopic Sleeve Gastrectomy: Re-sleeve Vs. Gastric Bypass.
abstract: Laparoscopic sleeve gastrectomy (LSG) is increasing worldwide; however, long-term follow-up results included insufficient weight loss and weight regain. This study aims at assessing the outcomes of converting LSG to laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic re-sleeve gastrectomy (LRSG).
  
  
  
  A total of 1300 patients underwent LSG from 2009 to 2012, of which 12 patients underwent LRYGB and 24 patients underwent LRSG in Al-Amiri Hospital alone. Data included length of stay, percentage excessive weight loss (EWL%), and body mass index (BMI).
  
  
  
  Twenty-four patients underwent conversion from LSG to LRSG, and 12 patients underwent conversion from LSG to LRYGB due to insufficient weight loss and weight regain. Eighty-five percent were females. The mean weight and BMI prior to LSG for the LRYGB and LRSG patients were 136.5 kg and 52, and 134 kg and 50, respectively. The EWL% after the initial LSG was 37.9 and 43 %, for LRYGB and LRSG, respectively. There were no complications recorded. Results of conversion of LSG to LRYGB involved a mean EWL% 61.3 % after 1 year (p value 0.009). Results of LRSG involved a mean EWL% of 57 % over interval of 1 year (p value 0.05). Comparison of the EWL% of LRYGB and LRSG for failed primary LSG was not significant (p value 0.097).
  
  
  
  Following our algorithm, revising an LSG with an LRSG or LRYGB for poor weight loss is feasible with good outcomes. Larger and longer follow-up studies are needed to verify our results.
authors.affiliation: Al-Amiri Hospital, Kuwait City, Kuwait. salman.k.alsabah@gmail.com.
authors.forename: Salman
authors.identifier: 0000-0002-8081-8544
authors.initials: S
authors.lastname: AlSabah
authors.affiliation: Al-Amiri Hospital, Kuwait City, Kuwait.
authors.forename: Nourah
authors.initials: N
authors.lastname: Alsharqawi
authors.affiliation: Al-Amiri Hospital, Kuwait City, Kuwait.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Almulla
authors.affiliation: Al-Amiri Hospital, Kuwait City, Kuwait.
authors.forename: Shehab
authors.initials: S
authors.lastname: Akrof
authors.affiliation: Al-Amiri Hospital, Kuwait City, Kuwait.
authors.forename: Khaled
authors.initials: K
authors.lastname: Alenezi
authors.affiliation: Al-Amiri Hospital, Kuwait City, Kuwait.
authors.forename: Waleed
authors.initials: W
authors.lastname: Buhaimed
authors.affiliation: Al-Amiri Hospital, Kuwait City, Kuwait.
authors.forename: Saud
authors.initials: S
authors.lastname: Al-Subaie
authors.affiliation: Al-Amiri Hospital, Kuwait City, Kuwait.
authors.forename: Mohanned
authors.initials: M
authors.lastname: Al Haddad
mesh_terms: D000328:Adult; D000465:Algorithms; D015992:Body Mass Index; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods*; D015391:Gastroplasty / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D015431:Weight Loss
keywords: Conversion; Laparoscopic Roux-en-Y gastric bypass; Laparoscopic re-sleeve gastrectomy; Laparoscopic sleeve gastrectomy; Malabsorptive procedures; Redo; Revisional; Weight loss; Weight regain