Re-sleeve Gastrectomy

Re-sleeve gastrectomy is indicated in selected patients with weight regain after primary sleeve gastrectomy when objective evaluation demonstrates sleeve dilation, particularly enlargement of the gastric fundus or body, without severe gastroesophageal reflux disease. Pre-operative endoscopy and upper gastrointestinal contrast studies are essential to confirm increased gastric capacity and to exclude functional or anatomical contraindications. The main advantage of re-sleeve gastrectomy is restoration of the restrictive component while preserving normal gastrointestinal continuity and avoiding the malabsorptive risks of bypass procedures. Compared with Roux-en-Y or one-anastomosis gastric bypass, re-sleeve is technically less complex and maintains more physiological digestion. However, re-sleeve gastrectomy carries a higher technical difficulty than primary sleeve due to adhesions and distorted anatomy, and the risk of staple-line leak may be increased. In addition, re-sleeve does not address reflux or metabolic failure as effectively as bypass procedures. Therefore, careful patient selection is critical to achieve durable weight loss and acceptable outcomes.