Weight regain after laparoscopic sleeve gastrectomy
Dr. Antonio Torres, the former president of IFSO and clinical professor in Hospital Clínico San Carlos of Computense University (Madrid) gave this speech during the IV IFSO online symposium, in the virtual learning academy.
He talked about the treatment options for weight regain after laparoscopic sleeve gastrectomy (LSG).
In his experience LSG accounts for the 49% of all obesity surgical procedures, and its performance has been increasing in number worldwide.
According to the quality standards of weight loss, the percentage of excess body mass index (BMI) or weight loss (EWL) should be over 50% one year after surgery. In patients who do not meet this goal, both due to lack of weight loss or due to weight regain, revisional surgery is proposed.
Many options are included, such as re-sleeve, laparoscopic Roux-en-Y gastric bypass (LRYGB), one anastomosis gastric bypass (OAGB) or single anastomosis duodeno-ileal bypass (SADI).
Dr. Torres focuses on the results of SADI after LSG. This surgery adds malabsorption and a greater metabolic effect, with good long-term results regarding EWL, which according to some series is above 70% . Dr. Torres presents the results of his team, registered from 2007 to 2017, and including 33 patients submitted to SADI after LSG.
The total revision rate for insufficient weight loss in their experience is performed in 9.8% of the cases. The mean time to second step is 33 months and the resulting EWL is 72%.
Regarding the metabolic evolution of these patients, 92% of previously diabetic patients are off therapy after SADI. Nevertheless, more need of supplementation is found compared to LSG, as well as more abnormalities in the laboratory findings.
In conclusion, SADI is a safe, simple, versatile and reproducible procedure, with a low complication rate. Better results are found when performing SADI after LSG than after LRYGB. In the other hand, it seems to be more physiologic than gastric bypass and has fewer side effects than standard duodenal switch.
As Dr. Torres wonders, could it become the gold standard after failed LSG?
After the conference Dr. Torres answers some questions and a debate is held among experienced surgeons in obesity surgery (M. Gagner, J.M. Chevallier, R. Rosenthal, M. Lakdawala, A. Ramos) to discuss technical and conceptual aspects regarding the alternatives after a failure in weight loss or a weight regain after obesity surgery.