Revision after gastric sleeve and gastric bypass for weight re-gain: Emphasis on biliopancreatic limb length across procedures

Abstract Introduction: This report describes a series of gastric sleeve revision procedures stemming from the common indications of weight re-gain, diabetes mellitus (T2) and gastro-oesophageal reflux disease. The aim is to report the outcomes of a revisional strategy emphasising the lengthening of the biliopancreatic (BP) limb as a central principle and assessing its efficacy in achieving weight loss and remission of obesity-related conditions. Patients and Methods: Revisional procedures were conducted from 2019 to 2022, encompassing 19 laparoscopic Roux-en-Y gastric bypass (LRYGB), 40 limb distalisation with lengthening of the BP limb and 95 Single Anastomosis Duodenal Switch (SADI) cases. A standardised approach maintained a 300 cm common channel and a minimum 375 cm alimentary length while adding 100 cm or more of BP limb length. Monitoring included weight loss, comorbidity resolution and complications. Data were collected from the patient charts. Results: Reduction in body mass index (BMI) at 6-month follow-up was 18.7% for LRYGB, 21.8% for SADI and 11.1% for BP patients. Single-factor ANOVA showed statistical significance for BMI change in all three groups (LRYGB P = 0.01; SADI P = 0.006 and BP P = 0.02). Three SADI patients required reoperation; meanwhile, 2 LRYGB, 2 BP and 5 SADI patients experienced post-operative vitamin deficiencies. Conclusion: Revisional bariatric surgery demonstrates substantial weight and BMI reduction with relatively few complications. SADI procedures exhibited the greatest BMI reduction at 6 months. The emphasis on lengthening the BP limb may provide a structured framework for successful revision surgery decisions, potentially contributing to the standardisation of care across procedures in this context.