Gastric Reservoir Necrosis Post Gastro-jejunal Bypass. the Importance of Clinical Evaluation in the Decision Making Progress: Case Report

later returned referring the capacity of eating a larger volume and weight regain. His new BMI was 34,5. Given this clinical scenario were requested abdominal ultrasound, oral contrasted esophagus, stomach and duodenum and upper gastrointestinal endoscopy (Figure 1A). FIGURE 1 – A) Contrasted esophagus, stomach and duodenum demonstrating moderate fundus dilatation; B) surgical specimen of re-sleeve (12 cm of gastric fundus) Laparoscopic cholecystectomy with cholangiography was performed and also a partial gastric fundus re-sleeve (Figure 1B) was executed using articulated linear stapler and load-blue clips and reinforcement over suture with polidioxanone 3-0. Surgery obtain great results and without any intraoperative and postperative complications. Patient stayed in hospital for 48 h. After six months of the procedure he had no complication, 12 kg weight loss and stopped all medications. He presented a change in BMI=8%, excess BMI loss (%EBMIL) of 84.21% and percent of total weight loss (%TWL) of 12.37%. DISCUSSION Literature present few publications describing re-sleeve gastrectomy. None of them in the Latin-America and none reporting MLSG as the primary bariatric procedure. In 2006, Baltasar A, et al. reported two patients that were submitted to laparoscopic sleeve gastrectomy and when they regained weight, laparoscopic re-sleeve gastrectomy and duodenal switch were performed and reduced patients BMI after 3-4 months 1. However, duodenal switch is a best indication for a super-super-obesity and a very malabsorptive technique. Re-sleeve is a good way to approach cases which patient´s need to loss the great part of weight which regained without other problems. In 2009, Iannelli A, et al. performed a feasibility study of revision of laparoscopic sleeve gastrectomy. They recruited 13 patients with weight regain or insufficient weight loss. They followed their patients in the 1 st , 6 th and 12 th months after revision in laparoscopic sleeve gastrectomy. Before surgery the mean BMI was 44.6 kg/m 2 ; one month after surgery the mean BMI was 32.3 kg/m 2 ; six months after surgery the mean BMI was 32 kg/m 2 and 12 months mean BMI was 27.5 kg/m 2. They concluded that for one year after revision of laparoscopic sleeve gastrectomy the procedure was safe and effective 3. Rebibo L et al. compared repeat sleeve gastrectomy with primary sleeve gastrectomy. They found that repeated sleeve gastrectomy can generate similar weight loss then primary sleeve, but can be associated with an increased risk of complications, such as gastric fistula 5. In 2014 Cesana …