Conversion of one-anastomosis gastric bypass (OAGB) to Roux-en-Y gastric bypass (RYGB) for gastroesophageal reflux disease (GERD): who is more at risk? A multicenter study.

BACKGROUND: Although gastroesophageal reflux disease (GERD) affects 0.6% to 10% of patients operated on for one-anastomosis gastric bypass (OAGB), only about 1% require surgery to convert to Roux-en-Y gastric bypass (RYGB) [3-5]. The aim of the present study was to analyze the characteristics of OAGB patients converted to RYGB for GERD not responding to medical treatment. METHODS: This retrospective multicenter study included patients who underwent conversion from OAGB to RYGB for severe GERD. The conversion was performed with resection of the previous gastro-jejunal anastomosis and the use of the afferent loop as a new biliary loop. RESULTS: A total of 126 patients were included in the study. Of these patients, 66 (52.6%) had a past medical history of bariatric restrictive surgery (gastric banding, sleeve gastrectomy). A hiatal hernia (HH) was present in 56 patients (44.7%). The association between previous restrictive surgery and HH was recorded in 33 (26.2%) patients. Three-dimensional gastric computed tomography showed an average gastric pouch volume of 242.4 ± 55.1 cm3. Conversion to RYGB was performed on average 60 ± 35.6 months after OAGB. Seven patients (5.5%) experienced an early postoperative complication (4 patients grade IIIb and 3 grade IIb), and 3 (2.4%) a late complication. Patients showed further weight loss after RYGB conversion and an average of 24.8 ± 21.7 months after surgery, with a mean % of total weight loss (%TWL) of 6.9 ± 13.6 kg. From a clinical point of view, the problem of GERD was definitively solved in more than 90% of patients. CONCLUSIONS: Situations that weaken the esogastric junction appear to be highly frequent in patients operated on for OAGB and converted to RYGB for severe reflux. Similarly, the correct creation of the gastric pouch could play an important role in reducing the risk of conversion to RYGB for GERD.

Endoscopic Revisional Gastroplasty After Bariatric Surgery with a Single-Channel Endoscope.

BACKGROUND: Less invasive endoscopic bariatric procedures are under development for the management of recurrence of obesity. The purpose of the current manuscript was to evaluate the safety of the endoscopic revisional gastroplasty (ERG) for patients with recurrence of weight gain following different bariatric procedures. MATERIALS AND METHODS: This is a retrospective single-center study over 22 patients using the ERG between January 2020 to July 2022 at Bouchard Private Hospital (Marseille, France). The demographic data, past surgical history, obesity complications, time interval between the surgical and endoscopic procedures, and intra and postoperative parameters and outcomes were analyzed. RESULTS: A total of 22 patients underwent ERG: 19 female (86.4%) with a mean age of 34.2 years and a mean BMI of 32.9 kg/m2 (± 3.4). Average time between the revisional bariatric surgery and ERG was 14.4 months (range 5-36). There were 14 cases of LSG (77.8%), 9 cases of RYGBP (19.4%), and 3 cases with previous gastric band. All procedures were completed by endoscopy with no complication and a mean length of hospital stay of 1.1 days (± 0.9). The weight loss results at 1-year follow-up were available for 17 of the 22 patients: two patients were lost to follow-up (4%) and 3 patients had less than a 1-year follow-up from the ERG. The mean BMI, 1 year after ERG, was 28.7 kg/m2 (± 7.4); the mean BMI loss and %EWL were, respectively, 4.2 kg/m2 (± 4.7) and 53.1% (± 17). CONCLUSION: Endoscopic revisional gastroplasty represents a safe minimal invasive approach that can be considered an effective and well-tolerated procedure for patients with previous bariatric surgery.

One-Anastomosis Gastric Bypass and Hiatal Hernia: Nissen Fundoplication with the Excluded Stomach to Decrease the Risk of Postoperative Gastroesophageal Reflux.

INTRODUCTION: The realization of an antireflux valve according to the Nissen technique during the operation of one-anastomosis gastric bypass (OAGB) may theoretically decrease the incidence of postoperative reflux in patients with hiatal hernia (HH). MATERIAL AND METHODS: In this retrospective study, we included all patients operated on between January 2015 and January 2019 for an OAGB associated with the creation of an antireflux Nissen valve (360-degree wrap). The patients included had type II or type III HH that had been diagnosed preoperatively or discovered intraoperatively. RESULTS: Twenty-two patients were operated on during the period considered. The mean preoperative BMI was 40 ± 14 kg/m2. Five patients (22.7%) had a history of bariatric surgery. Typical symptoms of gastroesophageal reflux disease (GERD) were preoperatively present in four patients (18%), and HH was revealed preoperatively only in four patients; for all the other patients, the diagnosis of HH was made intraoperatively. The rate of early and/or late postoperative complications was 0%. The mean duration of follow-up was 23 ± 15 months. No dysphagia was reported during follow-up. Three patients presented with symptomatic GERD postoperatively, including one de novo. Mean BMI at the end of follow-up was 24 ± 3 kg/m2, and the % of total weight loss was 108 ± 30%. CONCLUSIONS: OAGB with a Nissen antireflux valve seems to be a safe and effective surgical technique and it could be an extra arrow in the surgeon's quiver in the presence of HH in a patient scheduled for OAGB.

The Utility of Video Recording in Assessing Bariatric Surgery Complications.

INTRODUCTION: Recording every procedure could diminish the postoperative complication rates in bariatric surgery. The aim of our study was to evaluate the correlation between recording every bariatric surgery and their postoperative analysis in relation to the early or late postoperative complications. METHODS: Seven hundred fifteen patients who underwent a bariatric procedure between January 2018 and December 2019 were included in a retrospective analysis. There were: 589 laparoscopic sleeve gastrectomies (LSGs); 110 Roux-en-Y bypasses (RYGBs) and 16 gastric bands (LAGBs). The video recording was systematically used, and all patients were enrolled in the IFSO registry. RESULTS: There were 15 patients (2.1%) with surgical postoperative complications: 5 leaks, 8 hemorrhages and 2 stenosis. Most complications were consequent to LSG, except for two, which occurred after RYGB. In four cases a site of active bleeding was identified. After reviewing the video, in three cases the site was correlated with an event which occurred during the initial procedure. Three out of five cases of leak following sleeve were treated purely endoscopically, and no potential correlated mechanism was identified. Two other possible benefits were observed: a better evaluation of the gastric pouch for the treatment of the ulcer post bypass and the review of one per operative incident. Two negative diagnostic laparoscopies were performed. The benefit of the systematic video recording was singled out in eight cases. All the other cases were completed by laparoscopy with no conversion. CONCLUSION: To record every bariatric procedure could help in understanding the mechanism of certain complications, especially when the analysis is performed within the team. Still, recording the procedure did not prevent the negative diagnostic laparoscopy, but it could play a significant role for the medico-legal aspect in the future.

Revisional Surgery from Vertical Banded Gastroplasty to Roux-en-Y Gastric Bypass with Gastric Resection.

Introduction: Vertical banded gastroplasty (VBG) was a common bariatric procedure by laparotomy and or at the beginning of the laparoscopy, but nowadays it is almost an abandoned procedure. However, the young generation of bariatric surgeons should be aware about this procedure especially for revisional cases. Roux-en-Y gastric bypass (RYGB) is considered the procedure of choice for the revision of VBG. Materials and Methods: The evolution of revisional surgery to RYGB has known several technical steps. At the beginning, the procedure was performed with no gastric resection. Then a limited resection of the ancient staple line along with the fibrous tissue under the previous band or mesh was performed. The purpose of this article is to describe a simplified operative technique to simultaneously resect the ancient staple line and the calibration band. Results: After the initial viscrerolysis, an attempt to distinguish the course of the ancient section line of the stomach during the VBG is done. The dissection can become extremely challenging, with too much fibrosis and nonanatomical planes of dissection. At this point, we counsel to abandon the anterior direct dissection of the upper part of the stomach and to switch to a posterior dissection with the approach of greater curvature. Driven by the potential advantages (no risk of mucocele or gastrogastric fistula), for the past several years, we have changed the technique from resecting only the ancient staple line to perform a partial gastrectomy. The gastrectomy is larger and includes the complete resection of the gastric fundus, ancient staple line, the region with the mesh inside, and part of the gastric body. Once the stomach is extracted, the subsequent steps are similar to those of a primary RYGB. Conclusion: The procedure of choice for the revision of VBG is represented by RYGBP. Associating an atypical gastrectomy of the previous staple line with the region of mesh migration is a safe approach, eliminating the risk of mucocele.

Single Anastomosis Duodeno-ileal Bypass As a Revisional Procedure Following Sleeve Gastrectomy: Review of the Literature.

Laparoscopic sleeve gastrectomies (LSGs) can experience weight-loss failure and conversion to another bariatric procedure. An analysis of the bariatric literature concerning the single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) as revisional surgery after LSG in terms of safety and efficacy identified 607 studies. Fifty-nine studies were analyzed for full content review and 9 primary studies (398 patients) were included. Revisional single anastomosis duodeno-ileal bypass (SADI) was performed in 294 patients at a mean interval of 37.7 months (range 11-179). Total weight loss (%) varies from 20.5% to 46.2%. Early complications after surgery occurred in 4.1% surgeries including leak (7 cases -1.9%). Mortality was nil. SADI after LSG, after failed sleeve gastrectomy or as a sequential procedure, offers a satisfactory weight loss result. Both early and late term complications are acceptable.

Leak After Sleeve Gastrectomy: Updated Algorithm of Treatment.

INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) is currently the most common procedure performed worldwide, and still the leak is considered the main limitation. After an initial enthusiasm for stents, the endoscopic treatment evolved including in the current management the septotomy with balloon dilatation and pigtails insertions. The aim of this study was to evaluate the updated algorithm of endoscopic treatment of leak following LSG including septotomy and balloon dilatation. METHODS: All consecutive patients treated by endoscopy between January 2018 and March 2020 for leak following LSG were included in the current study. After recording the demographic and the leak history, we have analyzed the number of endoscopic sessions, the duration of treatment, and the healing rate of endoscopic treatment for 3 groups: A, small orifice (< 10 mm); B, large orifice (> 10 mm) and acute leak; and group C with large orifice and late leak. RESULTS: A total of 53 patients received endoscopic treatment for leak following LSG. The leaks achieved complete healing after average duration of 3.2 months (range 1-7 months), 2.3 months for group A, 4.2 months for group B, and 3.7 months for group C. The average number of endoscopic procedures was 2.8 (range 2-6) and was required for general population: for group A, 2.3 sessions; in group B, 3.4 sessions; and in group C, 2.7 sessions. Two out of 53 patients (3.8%) required additional treatment outside of the current algorithm, one in group A and another in group B. One patient was transferred for pulmonary abscess, and for another patient, the leak was considered chronic after a total of 14 months, and a laparoscopic fistula-jejunostomy was performed with favorable outcomes. CONCLUSIONS: Although there is still no consensus for endoscopic management of leaks after LSG, the benefits of pigtails and the septotomy are undeniable, and it should be included in the armamentarium of any bariatric endoscopic service.

Bariatric surgery in patients with previous COVID-19 infection.

BACKGROUND: The process of reintroducing bariatric surgery to our communities in a COVID-19 environment was particular to each country. Furthermore, no clear recommendation was made for patients with a previous COVID-19 infection and a favorable outcome who were seeking bariatric surgery. OBJECTIVES: To analyze the risks of specific complications for patients with previous COVID-19 infection who were admitted for bariatric surgery. SETTING: Eight high-volume private centers from 5 countries. METHODS: All patients with morbid obesity and previous COVID-19 infection admitted for bariatric surgery were included in the current study. Patients were enrolled from 8 centers and 5 countries, and their electronic health data were reviewed retrospectively. The primary outcome was to identify early (<30 d) specific complications related to COVID-19 infection following bariatric surgery, and the secondary outcome was to analyze additional factors from work-ups that could prevent complications. RESULTS: Thirty-five patients with a mean age of 40 years (range, 21-68 yr) and a mean body mass index of 44.3 kg/m2 (±7.4 kg/m2) with previous COVID-19 infection underwent different bariatric procedures: 23 cases of sleeve (65.7 %), 7 cases of bypass, and 5 other cases. The symptomatology of the previous COVID-19 infection varied: 15 patients had no symptoms, 12 had fever and respiratory signs, 5 had only fever, 2 had digestive symptoms, and 1 had isolated respiratory signs. Only 5 patients (14.2 %) were hospitalized for COVID-19 infection, for a mean period of 8.8 days (range, 6-15 d). One patient was admitted to an intensive care unit and needed invasive mechanical ventilation. The mean interval time from COVID-19 infection to bariatric surgery was 11.3 weeks (3-34 wk). The mean hospital stay was 1.7 days (±1 d), and all patients were clinically evaluated 1 month following the bariatric procedure. There were 2 readmissions and 1 case of complication: that case was of a gastric leak treated with laparoscopic drainage and a repeated pigtail drain, with a favorable outcome. No cases of other specific complications or mortality were recorded. CONCLUSION: Minor and moderate COVID-19 infections, especially the forms not complicated with invasive mechanical ventilation, should not preclude the indication for bariatric surgery. In our experience, a prior COVID-19 infection does not induce additional specific complications following bariatric surgery.

Is It Safe to Combine a Fundoplication to Sleeve Gastrectomy? Review of Literature.

Background and Objectives: The rising numbers of laparoscopic sleeve gastrectomy (LSG) procedures now being performed worldwide will likely be followed by an increasing number of patients experiencing gastro-esophageal reflux disease (GERD). The purpose of the current review was to analyze in terms of safety different techniques of fundoplication used to treat GERD associated with LSG. Methods: An online search was performed in PubMed/MEDLINE in December 2020 to identify articles reporting LSG and fundoplication. The following term combination was used: (sleeve, fundoplication), (sleeve, Nissen), (sleeve, Rossetti), (sleeve, Toupet) and (sleeve, Dor). The extracted information included details of the methods (e.g., retrospective case series), demographic characteristics (e.g., age, gender), clinical characteristics, number of patients, rate of conversion, and postoperative outcomes. Results: A total of 154 studies were identified and after an assessment of title according to our exclusion criteria, 116 articles were removed. Of the 38 studies analyzed for full content review, a total of seven primary studies (487 patients) were identified with all inclusion criteria. Analyzing the different types of fundoplication used, we have identified: 236 cases of Nissen-Sleeve, 220 cases with modified Rossetti fundoplication, 31 cases of Dor fundoplication, and no case of Toupet fundoplication. The overall postoperative complication rate was 9.4%, with the most common reported complication being gastric perforation, 15 cases-3.1%. The second most common complication was bleeding identified in nine cases (1.8%) followed by gastric stenosis in six cases (1.2%). The mortality was nil. Conclusions: Different types of fundoplication associated with LSG appear to be a safe surgical technique with an acceptable early postoperative complication rate. Any type of fundoplication associated with LSG to decrease GERD should be evaluated cautiously while prospective clinical randomized trials are needed.

Aortic Injuries Following Stent Deployments in Bariatric Surgery-Review of Literature.

Introduction: Consecutive to an increase in the number of bariatric surgeries worldwide, the number of articles reporting complications have also increased. The most dreadful bariatric complication is represented by the leak, and the endoscopic stent is still the standard treatment for some bariatric teams despite the poor quality of life and associated complications. The purpose of this review was to identify the very rare cases of aortic injuries associated with stent use in bariatric surgery. Methods: Aortic injuries related to stent use was the main criteria to summarize the literature by a careful assessment of PubMed/MEDLINE databases. Leak characteristics, primary endoscopic treatment, and the outcome of endoscopic complication were retrieved and categorized from each eligible article. Results: Thirty-five articles were selected for analysis. After abstract analysis, 22 studies were excluded, and 13 articles were reviewed in full-text version. Four articles were confirmed with aortic injury following stent use for complications after different bariatric procedures. These contained one retrospective case series and three retrospective case reports. There were 4 patients involved with complications following bariatric surgery: Roux-en-Y Gastric Bypass-3 cases and laparoscopic sleeve gastrectomy-1 case. The reported mortality of the aorto-esophageal fistula was 50%. Conclusions: Using stents in the treatment of leaks following bariatric surgery could be an efficient treatment, despite the poor quality of life and the stent migration. Even though it is rare, the aortic injury is a dreaded complication related to stent use and associated with high mortality rates.

Management of Leak after Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy.

The single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has been introduced in the past few years for the treatment of morbid obesity. SADI-S has shown good results in terms of long-term results and short-term complications. However, the management of patients undergoing SADI-S and suffering from a leak is a great challenge for surgeons. We present an extensive review of the currently available literature on the management of leak after SADI in morbid obese (MO) patients. We aim at providing objective information regarding the optimal management, including diagnosis, technical options for the different strategies that have been proposed, to facilitate the selection of the best individual approach for each MO patient.

The evolution of surgical treatment for chronic leak following sleeve.

BACKGROUND: Leak is estimated to be the most severe complication of laparoscopic sleeve gastrectomy (LSG), with sporadic failure of endoscopic techniques. In such cases, an aggressive management with surgical reconstructive procedures can be proposed to patients in whom all the conservative endoscopic techniques failed. OBJECTIVES: The purpose of the present study was to report our experience with surgical approach for the treatment of chronic leak after LSG. SETTING: University hospital, France. METHODS: Between January 2013-December 2019, 21 consecutive patients underwent reconstructive surgery for the treatment of chronic leak after LSG. The initial intervention, the endoscopic approach, and the definitive surgical repair were carefully reviewed. RESULTS: Twenty-one patients (17 women) with a mean (standard deviation [SD]) age of 42.7 years (9.81) and a mean (SD) body mass index (BMI) of 27.3 (5.2) kg/m2 underwent reconstructive surgery for persistent fistula. Seventeen patients (81%) had their early LSG performed in another hospital. Endoscopic treatment was represented by the pigtail drain or stent in 9 cases each, ovesco in 8 cases, and glue for 2 patients. The reconstructive surgery was performed within 6 months in 8 cases; between 6-12 months in 6 cases; between 1-3 years in 4 cases, and >3 years in 3 cases. There were 14 fistulo-jejunostomy (66.7%), 5 Roux-en-Y gastric bypass (23.8%), and 2 total gastrectomies (9.5%). The operative time was between 99 minutes and 5.5 hours (mean = 216.2, median = 225 min). The hospital stay ranged from 5-30 days (mean = 12.67, median = 11 d) and the surgical reintervention rate was 23.8% (5/21 patients), including 1 case of recurrent hemorrhage requiring 3 surgical operations over 1 month of postoperative follow-up. No postoperative mortality was recorded. CONCLUSIONS: Surgery should be considered in case of failure of the endoscopic treatment of chronic leak after LSG. Further research is needed to clearly identify the appropriate treatment, but in our experience the fistulo-jejunostomy approach shows a low morbidity rate. (Surg Obes Relat Dis 2020;17:278-283.) © 2020 American Society for Metabolic and Bariatric Surgery. All rights reserved.

Aortic injuries following stents in bariatric surgery: our experience.

BACKGROUND: Due to the large number of laparoscopic sleeve gastrectomy (LSG) performed over the last decade, the management of the leak following LSG has been increasingly reported. The role of covered Self Expandable Metal Stents (cSEMS) for the treatment of the leak is still controversial because of the poor tolerance and high risk of complications. OBJECTIVES: The aim of the present study was to analyze the foregut wall perforation and aorta injuries, a very rare but potentially fatal complication, related to the treatment of the leak following LSG using cSEMS. SETTING: Private hospital, France. METHODS: An audit was conducted in 2 French tertiary bariatric endoscopic centers focusing on aortic injuries after cSEMS use for leak. We examined and classified the initial procedure, leak characteristics, primary endoscopic treatment, and outcome of endoscopic complication for each eligible case. RESULTS: A total of 5 patients were identified with foregut wall perforation and aorta injuries. All stents were deployed for staple line leak following LSG. The recorded mortality in case of esophageal-aortic injuries related to cSEMS use was 80%. CONCLUSION: cSEMS are potentially effective tools for the management of foregut leaks in bariatric surgery. The biggest challenges with this approach are stent migration and poor quality of life. Caution is required due to the risk of fatal complications such as foregut wall perforation and aortic injury.

Roux-en-Y Gastric Bypass for the Treatment of Leak Following Sleeve Gastrectomy.

PURPOSE: Laparoscopic sleeve gastrectomy (LSG) is estimated to be its most severe complication. An aggressive management with surgical reconstructive procedures can be proposed in patients in whom all the conservative endoscopic techniques fail. The purpose of the present study was to report our experience with Roux-en-Y gastric bypass (RYGBP) as treatment for the chronic leak after LSG. METHODS: Between January 2013 and July 2019, 17 consecutive patients underwent RYGBP for the treatment of chronic leak after LSG. The initial intervention, the endoscopic approach and the definitive surgical repair were carefully reviewed. RESULTS: Seventeen patients (13 women) with a median age of 39 years (24-67) with a median body mass index (BMI) of 40 kg/m2 (30-52) underwent RYGBP for persistent fistula. Sixteen patients had their early LSG performed in another hospital. Eleven patients had an initial endoscopic treatment by pigtail drains following laparoscopic drainage and 6 other patients had the endoscopic stent as the first-choice line treatment. The overall average fistula diagnosis was done at 7.7 months (2-49 months) for 12 patients. For the rest of five patients, the procedure was performed almost in the acute setting (< 30 days). All procedures were performed by laparotomy but one. Five patients had a gastrojejunal anastomosis leak diagnosed by salivary flow in the drainage, but all patients were treated conservatively. No post-operative mortality was recorded. CONCLUSIONS: Surgery should be considered in case of failure of the endoscopic treatment of chronic leak after LSG. Further research is needed to clearly identify the appropriate treatment, but in our experience, RYGBP approach including the leak site offers a low morbidity rate.

Revised Sleeve Gastrectomy: Our Experience.

Introduction: Laparoscopic sleeve gastrectomy (LSG) has rapidly become increasingly popular in bariatric surgery. However, in the long-term follow-up, weight loss failure and intractable severe acid reflux after primary LSG can necessitate further interventions. The purpose of this study was to evaluate our initial case series regarding the complications and short-term weight loss results of the ReSleeve Gastrectomy (ReSG). Methods: From January 2010 to February 2016, all patients who underwent ReSG were included in this study. From a retrospective database, the demographic data, surgical history, comorbidities, American Society of Anaesthesiologists (ASA) score, time interval between the two procedures, and intra- and postoperative parameters and outcomes were analyzed. Results: ReSG was performed for 25 patients (7 men) with a mean age of 49 years (±11). Indications for ReSG were weight loss insufficiency for 1 patient (4%), weight regain for 23 patients (92%), and an acute dysphagia due to a residual fundic pouch for 1 patient (4%). Mean reoperation time before ReSG was 2.9 years (±1.5). The mean body mass index (BMI) for ReSG was 43.9 kg/m2 (±9.4). The first 4 patients (16%) had a barium swallow and the next 21 (84%) patients a computed tomography scan volumetry with a mean gastric volume of 526.7 cc (±168). All procedures were completed by laparoscopy with no intraoperative complication. An additional procedure was carried out for 3 patients (12%), including 1 cholecystectomy and 2 hiatal hernia repairs. Mean length of hospital stay was 5.2 days (±4.2), with no postoperative death. The complication rate was 60% (n = 15) including a Dindo-Clavien grade 2 complication for 7 patients (28%) and grade 3 for 8 patients (32%). One patient was lost to follow-up (4%). The mean BMI before RSG was 43.9 kg/m2 (±9.4). At a mean follow-up after ReSG of 37.3 months (range 6-80), the mean BMI and percentage of excess weight loss were, respectively, 35 kg/m2 (±6.7) and 38.2% (±19). Conclusions: ReSG should be proposed only for well-selected cases. This study has led us to change our habits by selecting only patients with a large gastric pouch ≥500 mL or with unresected fundus. Further prospective clinical trials are required to compare the outcomes of ReSG with those of laparoscopic Roux-en-Y gastric bypass or duodenal switch for weight loss failure after LSG.

Evaluating the impact of the antrum size following laparoscopic sleeve gastrectomy: a randomized multicenter study.

BACKGROUND: The effect of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) remains discordant and highly related to the surgical technique. GERD and weight regain are probably understudied by prospective clinical studies depending on different technical factors. OBJECTIVES: The purpose of this article is to evaluate the effect of extent to which the antrum is resected on GERD following LSG but also on early complications and short-term weight loss results. SETTING: University Hospital, France. METHODS: Patients were randomly assigned in group A (172 patients), LSG with antral resection, or group B (174 patients), LSG with antral preservation. The baseline characteristics collected were demographic characteristics and anthropometric data (age, sex, body mass index), presence of GERD clinical characteristics, ± pH-metry, postoperative complications, or gastrin level. RESULTS: A total of 279 patients underwent LSG and they were included in the final analysis. The GERD analyzed at 3 months postoperatively by pH-metry was observed for 57.8% in group A and for 52.4% of patients in group B (P = .4819). There was no statistically significant difference (P = .3755) between the 2 groups at 1 year after surgery (group A, 49.5% versus group B, 43.6%). The gastrin serum level was analyzed 1 year after surgery for a total of 107 patients. For group A, the mean gastrin level was 97.4 ± 85.9 pg/mL, which was inferior compared with group B (150.6 ± 152.4 pg/mL) with no statistical difference (P = .067). The recorded excess weight loss for group A was 79.67% (± 28.88) with no statistically significant difference with group B 74.46% (± 36.61) (P = .3678). The mortality rate was nil. We recorded 5 cases of staple line leakage (3 in group A and 2 in group B); 11 patients presented bleeding (3 in group A and 8 group B), and 4 patients presented with gastric stenosis (2 in group A and 2 in group B). CONCLUSIONS: The antrum preservation has no significant difference in terms of reflux, weight loss, or complications at 3 or 12 months following LSG. The only significant difference was achieved for nausea and vomiting symptoms, which were more significant for the antrum resection group. Further clinical trials with newer procedures will indicate the factors that can diminish the reflux following LSG. Furthermore, the conservation of a large part of the antrum may be helpful to convert the sleeve to another bariatric procedure (transit bipartition).

Laparoscopic Banded Resleeve Gastrectomy.

Introduction: The recurrence of the morbid obesity disease after laparoscopic sleeve gastrectomy is a well-known complication. The banded resleeve gastrectomy (ReSG) is considered an innovative procedure and an alternative restrictive option to other malabsorptive procedures. Materials and Methods: We present an edited video on the placement of a MIDCAL™ (MID, Dardilly, France) ring during a revised sleeve gastrectomy with the main steps of the procedure. The subject is a male patient with a body mass index of 44 kg/m2. After the fundus resection, the MIDCAL is placed and fixed to the stomach by two sutures. Results: We present the steps of the operation. The intervention is performed by posterior approach using a three-port technique. The dissection of the previous staple line of the sleeve was continued upward with the visualization of the left crura. The gastric tube was calibrated with a 36F bougie. The restapling of the previous sleeve was carried out by respecting the incisura angularis. The dissection of the pars flaccida allowed the posterior passage of the MIDCAL ring, which was locked and then fixed to the gastric wall with two nonabsorbable sutures. The operative outcome was favorable. The total body weight loss was 9% at 1 month and 27% at 2 years follow-up. Conclusion: Banded ReSG is a safe procedure with acceptable results at short term. Other comparative studies are suitable to provide with long-term follow-up results.