Laparoscopic Conversion of Sleeve Gastrectomy to One Anastomosis Gastric Bypass in a Hostile Abdomen.

purposeFailure of weight loss is the most common indication for revisional surgery following sleeve gastrectomy (SG) as reported by Guan et al. (Obes Surg. 2019; 29:1965-1975). Recent evidence suggests that the revision rates for SG can be up to 10% when patients are followed up for more than 3 years and as high as 22% after 10 years as reported by Guan et al. (Obes Surg. 2019; 29:1965-1975). Options for revisional surgery following a SG include Roux-en-Y gastric bypass (RYGB), one anastomosis gastric bypass (OAGB), and re-sleeve as the commonest procedures. There is good evidence supporting revisional surgery following failure of weight loss post-primary surgery as reported by Guan et al. (Obes Surg. 2019; 29:1965-1975); Cheung et al. (Obes Surg. 2014; 24:1757-1763); Shimizu et al. (Obes Surg. 2013; 23:1766-1773); and Mora Oliver et al. (Cirugia Espanola. 2019; 97:568-574). However, at the same time, retrospective studies suggest higher complication rates following revisional surgery with a major complication rate up to 10% as reported by Yilmaz et al. (Obes Surg. 2017; 27:2855-2860); Fulton et al. (Can J Surg J Can Chir. 2017; 60:205-211); and Abdelgawad et al. (Obes Surg. 2016; 26:2144-2149). Additionally, the durability of weight loss and morbidity reduction in re-operated patients is still debated and overall high-quality evidence in the field is lacking as discussed by Abdelgawad et al. (Obes Surg. 2016; 26:2144-2149). Aim of this educational video is to demonstrate a revisional bariatric procedure which was technically difficult due to extensive intra-abdominal adhesions and explain the available surgical options and the decision-making process adopted by the surgeons. MATERIALS AND

methodsThe video describes a laparoscopic conversion of a SG to OAGB in a 37-year-old female patient due to weight regain. Her primary bariatric procedure was planned to be a RYGB but due to extensive intra-abdominal adhesions discovered at the time of primary surgery, a SG was performed. Pre-primary procedure weight was 134kg with a BMI of 52.3kg/m

resultsExtensive adhesiolysis followed by OAGB were performed successfully with an uneventful post-operative course. The patient was discharged on the second post-operative day. Excess BMI loss was 58% at 1-year follow-up.

conclusionRevisional surgery can be a challenging especially in the context of extensive surgical history. OAGB can be used as an alternative to RYGB.