Background

Insufficient weight loss or anatomic complications following laparoscopic sleeve gastrectomy (LSG) occasionally leads to revisional surgery. Few single institution studies have examined the efficacy and safety of redo-LSG, with mixed results. The purpose of this study is to evaluate the 30-day outcomes of redo-LSG.

Methods

The 2020 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Registry was used to evaluate patients undergoing redo-LSG. 30-day outcomes including anastomotic leaks and gastric stricture were evaluated using univariate analysis and multivariable logistic regression.

Results

A total of 104,440 patients were reviewed; 658(0.6%) underwent redo LSG and 103,782(99.4%) underwent initial LSG. Redo-LSG patients were older (45.4±10.9 vs 43.1±11.9), predominantly female (86.2% vs 80.5%), with lower BMI (kg/m2) 407.7 vs 44.97.7, and fewer comorbidities. Univariate outcomes demonstrated higher complications and reinterventions for Redo-LSG (Figure 1, all p<0.001). On multivariable analysis, Redo-LSG was independently associated with increased risk of anastomotic leak (OR 11.26, p<0.001) and stenosis (OR 4.43, p=0.012), more reinterventions (OR 3.14, p=0.001), and more reoperations (OR 1.95, p=0.044). There was no difference in 30-day mortality.

Conclusions

In this national database study, redo laparoscopic sleeve gastrectomy is associated with increased rates of anastomotic leak, gastric stricture, reinterventions, and reoperations compared to primary LSG. While these results are concerning further studies are required to examine long term outcomes.