Revisional Surgery: LSG to OAGB

Laparoscopic Sleeve Gastrectomy (LSG) is the most commonly performed bariatric operation worldwide; this is not surprising given its shorter operating time and relative safety. Patients may experience early or late complications, de novo symptoms, worsening of pre-operative symptoms, inadequate weight loss, weight regain or unsatisfactory improvement in comorbidities after any bariatric procedure. Some patients do not achieve a satisfactory response following primary bariatric surgery, and a significant other group experience a gradual waning of satisfactory initial response. It is inevitable that many of these patients will seek Revisional Bariatric Surgery (RBS) for further weight loss or co-morbidity resolution. Presently there is no consensus on the best RBS following LSG. Roux-en-Y gastric bypass (RYGB), One-anastomosis gastric bypass (OAGB), Biliopancreatic diversion/duodenal switch (BPD-DS) and Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) are options used by surgeons around the world after LSG for further weight loss or metabolic benefit. Interestingly, in spite of OAGB’s relatively recent mainstream utilisation as a primary procedure, in a recent survey of practicing revisional bariatric surgeons, it was the second most commonly utilised RBS option after RYGB for these patients. This chapter will explore outcomes with conversion of LSG to OAGB.