Contributors: Jeremy Slawin and George Fielding
Revisional surgery after laparoscopic sleeve gastrectomy (LSG) is sometimes needed to manage complications of the procedure, in particular, weight loss failure. Several surgical options exist for revision including repeat sleeve gastrectomy (“re-sleeve”), placement of an adjustable gastric band around the sleeve, conversion to Roux-en-Y gastric bypass or conversion to biliopancreatic diversion-duodenal switch. The loop duodenal switch is a modification of the duodenal switch procedure whereby a malabsorptive component is added to improve weight loss but the procedure is simplified by having only one intestinal anastomosis.
The patient presented is a 63-year-old male with a past medical history of coronary artery disease, diabetes mellitus type II, hyperlipidemia and morbid obesity. He had undergone LSG over a 36 French bougie at an outside institution two years prior. His past surgical history was also notable for previous laparoscopic ventral hernia repair and laparoscopic transabdominal inguinal hernia repair. The patient had lost weight after his LSG but had regained a significant amount, with worsening of his diabetes. His Body Mass Index (BMI) at revision is 37.7kg/m2.