Revisional surgery after laparoscopic sleeve gastrectomy

Since laparoscopic sleeve gastrectomy (LSG) is the most frequently performed bariatric surgery, the absolute number of revisional surgeries performed after it is extremely high. There are three main reasons as indications for revisional surgeries after LSG. The first is the occurrence of «de novo» gastroesophageal reflux or worsening of its symptoms. In such cases, the most common revisional surgeries performed are cruroraphy and diaphragmatic hernia repair, or reconstructive surgeries, primarily Roux-en-Y gastric bypass. The second reason is various surgical complications, such as postoperative bleeding and leakage, gastric fistula, and gastric stenosis. In these situations, depending on the type of complication, surgeries aimed directly at eliminating the cause of the complication or interventions supplemented with a reconstructive component are performed. The third main reason for revisional surgery after LSG is the ineffectiveness of the primary procedure in terms of weight management and metabolic disorders. In these clinical situations, two main strategies are currently accepted: performing a re-sleeve gastrectomy or performing some type of reconstructive revisional surgery. At the same time, it should be noted that the issue of revisional surgery after LSG remains a significant challenge in modern surgery. Many researchers emphasize the need for further research, with the central objectives being the choice of the most effective revisional surgery technique and improving its safety by reducing the rate of complications.