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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 . Weight regain is especially prevalent in the restrictive bariatric procedures, operations that limit the amount of oral intake compared to malabsorptive procedures . 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 . 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 . The Royal Alexandra Hospital in Edmonton, Alberta, Canada, recently opened dedicated weight recidivism after bariatric surgery clinic, specific for pre-operatively patient selection, in order to determine which patients would benefit from revisional surgery. This inevitably will become the model clinic for tertiary bariatric centers across the world. Repeating a second SG, named a Â“re-sleeveÂ” gastrectomy, is another option. This procedure is usually indicated in the event of insufficient weight loss or weight regain due to isolated gastric dilatation. Iannelli et al. reported EWL of 46.5% in their patients with a re-do SG, in a described Â“technically relatively easyÂ” operation. The operator must take into consideration important surgical revision complications when advising their patient for this option, which include increased risk of leakage at the Angle of His and risk of injury to the splenic vein . It is important to remember, however, that repeating a SG does not protect the patient from are occurrence of gastric dilation and long-term weight regains Weight regains following the Sleeve Gastrectomy is a concern. Due to its relative infancy, there exists limited information on long-term outcomes following this procedure. The role of gastric dilatation and long term circulating ghrelin levels in causing weight regain needs to be further clarified. The management options for significant weight regain are emerging and include conversion to a malabsorptive procedure, performing a re-sleeve or adding an adjustable band. The safety of these procedures remains concerning and involving an experienced bariatric surgeon at a tertiary care hospital is of the utmost importance.
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