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The safety of bariatric surgical revision after Endoscopic sleeve gastroplasty (ESG) is unknown. There are concerns that the presence of indwelling needles and cinches within the gastric wall might cause failure of the surgical stapling.


A systematic literature review was performed in Cochrane Database, Embase, Medline, PubMed, and Scopus electronic databases using terms 'endoscopic sleeve gastroplasty' and 'revision' to identify pertinent articles. The initial search yielded 300 studies which were manually reviewed. Eight articles met the inclusion criteria with a total of 27 cases reported. These articles were reviewed for the intraoperative technical challenges along with the complications following these revisions.


the revisional surgery was laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y Gastric Bypass (LRYGB) in 25 (93%) and 2 (7%) patients respectively. Only 1 (3%) patient had an intraoperative complication of staple line misfiring during LSG; which was dealt with appropriately during the surgery without any postoperative clinical consequences. In 24 (89%) a single stage endoscopic-laparoscopic removal of the pre-existing sutures was done concomitant to LSG. Whereas pre-operative endoscopic suture removal was done in the remaining 3 cases. LRYGB was used instead of LSG in 2 cases to minimize the necessity of removing sutures.


Surgical bariatric revision is feasible after ESG. Both LSG and LRYGB can be safely done after the endoscopic sutures and prior adhesions are managed adequately. As ESG gaining popularity, more data is needed about the surgical revisional options.