The Sleeve Gastrectomy and How and Why it can Fail?

Weight recidivism after primary bariatric procedures is an important issue and concern for many bariatric patients. Regardless of the specific type of bariatric surgery, long term weight regain will occur to a small but significant proportion of patients [1]. Weight regain is especially prevalent in the restrictive bariatric procedures, operations that limit the amount of oral intake compared to malabsorptive procedures [2]. The Sleeve Gastrectomy (SG) is still a newer primary bariatric surgery, formerly being the first step in a staged procedure for higher risk bariatric patients [3]. SG, considered mainly a restrictive procedure, removes the greater curvature of the stomach, thereby reducing the size of the stomach to 60-80mL in capacity and modifying its shape to be more tubular in nature [4,5]. It has gained popularity as a standalone bariatric surgery due to its relative operational simplicity, lack of foreign body implantation and with an undisrupted gastrointestinal tract, it lacksthe dumping syndrome and nutrient deficiencies seen with the malabsorptive operations [6-8]. However due to its relative infancy, data on the long term complication of weight recidivism with it being a primary procedure is still unknown [7,9]. Furthermore, anypast data on significant weight regain following SG, as a staged procedure, was not highlighted as a second, planned surgery was still being scheduled to compensate [9]. In this paper, we review the literature for weight regain following the Sleeve Gastrectomy, theorize why this complication can occur and recommend strategy options for dealing with this feared complication.