One anastomosis gastric bypass vs sleeve gastrectomy as a revisional bariatric surgery for weight loss failure after primary restrictive procedure

Abstract

AbstractIntroductionWeight loss failure after restrictive bariatric procedures initiated the debate about the choice of an adequate revisional intervention, a question still unanswered. While many surgeons went for a conversion to gastric bypass, others opted for re‐trying a revisional restrictive procedure to avoid the side effects of gastric bypass. The objective of our study was to compare weight loss outcome between revisional laparoscopic sleeve gastrectomy (re‐LSG) and revisional one anastomosis gastric bypass (re‐OAGB) for insufficient weight loss or weight regain following primary restrictive bariatric surgery.Materials and MethodsWe included 20 obese patients, with a history of weight regain or insufficient weight loss after primary restrictive surgery, who underwent re‐LSG (eight patients) or re‐OAGB (12 patients) between January 2018 and January 2021. Patients were followed up 2 years after their revisional intervention. Statistics were performed using IBM® SPSS® software for Windows version 21.ResultsIn the re‐LSG group, the average body mass index (BMI) before primary restrictive procedure was 43.7 kg/m2. The average period between the primary and revisional surgery was 12.6 years. Patients had a nadir BMI of 33.2 kg/m2 during that period and reached a mean BMI of 40.6 kg/m2 before re‐LSG. Two years after re‐LSG, the average BMI was 31.5 kg/m2 with a percent of excess weight loss (%EWL) of 54% and percent of excess BMI loss (%EBMIL) of 66.6%. In the re‐OAGB group, the average BMI before primary restrictive procedure was 39 kg/m2. The average period between the primary and revisional surgery was 10.7 years. Patients had a nadir BMI of 30.5 kg/m2 during that period and reached a mean BMI of 36.5 kg/m2 before re‐OAGB. Two years after re‐OAGB, the average BMI was 27 kg/m2 with a %EWL of 86.7% and %EBMIL of 92.6%.ConclusionFor patients with insufficient weight loss or weight regain following primary restrictive bariatric surgery, re‐OAGB has a better effectiveness in weight reduction compared with re‐LSG after a 2‐year follow up.