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Page 6 of 7 Aktokmakyan et al. Mini-invasive Surg 2020;4:23 I http://dx.doi.org/10.20517/2574-1225.2019.72

of the three bleeding cases were followed conservatively and they were discharged without any problem.
Re-laparoscopy was performed when stabilization could not be achieved despite four units of blood
replacement in only one bleeding case, but no bleeding focus could be detected and the bleeding had
stopped. Only the hematoma was removed and the drain was replaced.

In up to 30% of cases, revision surgery is necessary for causes which include inadequate weight loss, weight
[17]
re-gain, and/or the progress of severe upper gastrointestinal symptoms . Traditionally, conversion to DS
after failed GS or more commonly to RYGB has been standard. The recently popular mini gastric bypass
technique stands out in revision sleeve gastrectomies. It is important not only in revision of SG but also in
[18]
revision of adjustable gastric banding .
However, the discovery of a possible dilation of the remnant stomach or the presence of a remaining
gastric fundus led to changes in the approach of a failed LSG and the application of a re-LSG emerged with
[19]
the reason of re-sizing the sleeve when the expansion is present on the imaginary modalities . We do
not recommend LSG as a revision surgery since two of our three leakage cases developed after re-sleeve
operation. When re-sleeve is applied, we try to prevent narrowing by applying separate staplers between the
antrum and the incisura angularis, without touching the incisura angularis, and on the dilated stomach.

CONCLUSION
We describe the tips and tricks for the sleeve gastrectomy technique. We also discuss the controversial
subjects in this technique. Further prospective large studies would help to define optimal techniques.
Standardizing this surgical technique as much as possible is important so most teams work using
homologous methods, as well as in view of performing systematic reviews, consensus conferences, and
long-term multicenter studies. We will see in time whether the fate of sleeve gastrectomy, which has been
popular for the last 20 years, will follow that of the adjustable gastric band.

DECLARATIONS
Authors’ contributions
Conception and design: Aktokmakyan TV
Administrative support: Sumer A
Provision of study materials or patients: Aktokmakyan TV, Gungor O, Sumer A
Collection and assembly of data: Aktokmakyan TV
Data analysis and interpretation: Gungor O
Manuscript writing: Aktokmakyan TV, Gungor O, Sumer A
Final approval of manuscript: Aktokmakyan TV, Gungor O, Sumer A

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.