Conversion and revisional surgery: Sleeve gastrectomy

Sleeve gastrectomy (SG) was initially conceived as a component of a biliopancreatic diversion and duodenal switch operation. Later, noting significant weight loss with the gastric sleeve alone, the paradigm shifted toward SG as the first stage of a two-stage biliopancreatic diversion and duodenal switch and eventually gained significant popularity as a stand-alone bariatric operation. Thus SG has always been a revisable procedure. Numerous indications for revision of a prior SG exist, with an equal number of possible operative conversion. Generally SG revisional surgery addresses complications of a SG, most notably either staple-line leak or stenosis, mechanical issues related to sleeve construction, and development of treatments of new comorbid conditions, failure to lose weight, or weight recidivism. In other cases SG revision is pre-planned as a second operation in patients with super-morbid obesity. Consideration of the indication for revision commonly directs the surgeon to the most reasonable revisional operation.