Weight Regain After Gastric Plication: Reoperative Sleeve Gastrectomy or Roux-en-Y Gastric Bypass?-Analysis of 116 Consecutive Cases

Abstract

Purpose: In France, laparoscopic gastric plication (GP) has rarely been utilized as a weight loss procedure. Although relatively safe and efficient, its long-term results are still controversial. The goal of this study is to assess the indications and outcomes of revisional surgery post-GP.

Materials and methods: Between February 2010 and September 2017, patient characteristics undergoing GP were prospectively collected from our database. Failure of conservative treatment or presence of anatomical anomaly explaining weight loss insufficiency was an indication for revisional surgery (RS).

Results: A total of 300 patients were included, 41 patients were lost to follow-up (13.7%), 124 patients (41.3%) had total weight loss (TWL) > 30%, and 116 patients (38.7%) underwent RS. Revisional procedures were laparoscopic Roux-en-Y gastric bypass (RYGB) in 72 patients (62.1%) and sleeve gastrectomy (SG) in 44 patients (37.9%). The median interval to RS was 29 months. The mean operative time was 60 min for the SG and 125 min for the RYGB (p < 0.0001). Mortality was nil. Significant morbidity occurred in eight patients (6.9%) including 4 non-abdominal complications, 1 gastric leak, 1 case of hemorrhage, 1 case of hematoma, and 1 intra-abdominal abscess. The mean length of hospital stay (LOS) was 2.9 days (range, 1-11) for the SG group vs 3.2 days (range, 2-8) for the RYGB group (p = 0.608).

Conclusion: GP is associated with a relatively high rate of weight regain or insufficient weight loss. When compared to SG, RYGB seems to be the safer revisional procedure with fewer surgical complications.