{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T15:46:11Z","timestamp":1769010371811,"version":"3.49.0"},"reference-count":31,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,4,20]],"date-time":"2023-04-20T00:00:00Z","timestamp":1681948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Although the technical simplicity of laparoscopic sleeve gastrectomy is relatively well understood, many parts of the procedure differ according to bariatric surgeons. These technical variations may impact postoperative weight loss or the treatment of comorbidities and lead to qualification for redo procedures. Materials and Methods: A multicenter, observational, retrospective study was conducted among patients undergoing revision procedures. Patients were divided into three groups based on the indications for revisional surgery (insufficient weight loss or obesity-related comorbidities treatment, weight regain and development of complications). Results: The median bougie size was 36 (32\u201340) with significant difference (p = 0.04). In 246 (51.57%) patients, the resection part of sleeve gastrectomy was started 4 cm from the pylorus without significant difference (p = 0.065). The number of stapler cartridges used during the SG procedure was six staplers in group C (p = 0.529). The number of procedures in which the staple line was reinforced was the highest in group A (29.63%) with a significant difference (0.002). Cruroplasty was performed in 13 patients (p = 0.549). Conclusions: There were no differences between indications to redo surgery in terms of primary surgery parameters such as the number of staplers used or the length from the pylorus to begin resection. The bougie size was smaller in the group of patients with weight regain. Patients who had revision for insufficient weight loss were significantly more likely to have had their staple line oversewn. A potential cause could be a difference in the size of the removed portion of the stomach, but it is difficult to draw unequivocal conclusions within the limitations of our study.<\/jats:p>","DOI":"10.3390\/medicina59040799","type":"journal-article","created":{"date-parts":[[2023,4,20]],"date-time":"2023-04-20T03:25:11Z","timestamp":1681961111000},"page":"799","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Differences in Technical Aspects of Primary Sleeve Gastrectomy Prior to Redo Bariatric Surgery\u2014A Multicenter Cohort Study (PROSS Study)"],"prefix":"10.3390","volume":"59","author":[{"given":"Piotr","family":"Zarzycki","sequence":"first","affiliation":[{"name":"Department of Medical Education, Jagiellonian University Medical College, 30-688 Krakow, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justyna","family":"Rymarowicz","sequence":"additional","affiliation":[{"name":"2nd Department of General Surgery, Jagiellonian University Medical College, 30-688 Krakow, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piotr","family":"Ma\u0142czak","sequence":"additional","affiliation":[{"name":"2nd Department of General Surgery, Jagiellonian University Medical College, 30-688 Krakow, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8936-1977","authenticated-orcid":false,"given":"Magdalena","family":"Pisarska-Adamczyk","sequence":"additional","affiliation":[{"name":"Department of Medical Education, Jagiellonian University Medical College, 30-688 Krakow, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rafa\u0142","family":"Mulek","sequence":"additional","affiliation":[{"name":"EuroMediCare Specialist Hospital and Clinic, 54-144 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Artur","family":"Binda","sequence":"additional","affiliation":[{"name":"Department of General, Oncological and Digestive Tract Surgery, Centre of Postgraduate Medical Education, Or\u0142owski Hospital, 00-416 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2204-5088","authenticated-orcid":false,"given":"Natalia","family":"Dowgia\u0142\u0142o-Gornowicz","sequence":"additional","affiliation":[{"name":"Department of General, Minimally Invasive and Elderly Surgery, Collegium Medicum, University of Warmia and Mazury, 10-045 Olsztyn, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6552-7979","authenticated-orcid":false,"given":"Piotr","family":"Major","sequence":"additional","affiliation":[{"name":"2nd Department of General Surgery, Jagiellonian University Medical College, 30-688 Krakow, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"PROSS Collaborative Study Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,20]]},"reference":[{"key":"ref_1","unstructured":"American Society for Metabolic and Bariatric Surgery (2022, May 19). Estimate of Bariatric Surgery Numbers, 2011\u20132019. Available online: https:\/\/asmbs.org\/resources\/estimate-of-bariatric-surgery-numbers."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2339","DOI":"10.1007\/s11695-018-3163-6","article-title":"Which Bariatric Procedure Is the Most Popular in the World? A Bibliometric Comparison","volume":"28","author":"Ozsoy","year":"2018","journal-title":"Obes. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"626","DOI":"10.3389\/fendo.2019.00626","article-title":"Metabolic and Endocrine Consequences of Bariatric Surgery","volume":"10","author":"Tinahones","year":"2019","journal-title":"Front. Endocrinol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"295","DOI":"10.4174\/astr.2014.86.6.295","article-title":"Causes and outcomes of revisional bariatric surgery: Initial experience at a single center","volume":"86","author":"Park","year":"2014","journal-title":"Ann. Surg. Treat. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2789","DOI":"10.1007\/s11695-018-3245-5","article-title":"Revisional Bariatric Surgery for Weight Regain and Refractory Complications in a Single MBSAQIP Accredited Center: What Are We Dealing with?","volume":"28","author":"Qiu","year":"2018","journal-title":"Obes. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2744","DOI":"10.1007\/s11695-022-06129-2","article-title":"Banded Sleeve Gastrectomy vs Non-banded Sleeve Gastrectomy: A Systematic review and Meta-analysis","volume":"32","author":"Gupta","year":"2022","journal-title":"Obes. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1097\/SLE.0000000000000597","article-title":"Omentopexy in Sleeve Gastrectomy Reduces Early Gastroesophageal Reflux Symptoms","volume":"29","author":"Filho","year":"2019","journal-title":"Surg. Laparosc. Endosc. Percutaneous Tech."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1007\/s11695-017-2576-y","article-title":"Omentectomy in Addition to Bariatric Surgery\u2014A 5-Year Follow-up","volume":"27","author":"Andersson","year":"2017","journal-title":"Obes. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e9699","DOI":"10.1097\/MD.0000000000009699","article-title":"Different surgical approaches in laparoscopic sleeve gastrectomy and their influence on metabolic syndrome: A retrospective study","volume":"97","author":"Hady","year":"2018","journal-title":"Medicine"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"61","author":"Altman","year":"2008","journal-title":"J. Clin. Epidemiol."},{"key":"ref_11","unstructured":"Lee, J.H., and Park, D.J. (2013). Bariatric and Metabolic Surgery, Springer."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"15217","DOI":"10.1038\/s41598-021-94716-1","article-title":"Promising effects of 33 to 36 Fr. bougie calibration for laparoscopic sleeve gastrectomy: A systematic review and network meta-analysis","volume":"11","author":"Chang","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1590\/S0102-6720201500S100018","article-title":"TECHNICAL ASPECTS OF LAPAROSCOPIC SLEEVE GASTRECTOMY","volume":"28","author":"Ramos","year":"2015","journal-title":"Arq. Bras. Cir. Dig. ABCD"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1186\/s13063-021-05734-3","article-title":"Impact of the calibration bougie diametre during laparoscopic sleeve gastrectomy on the rate of postoperative staple-line leak (BOUST): Study protocol for a multicentre randomized prospective trial","volume":"22","author":"Gaillard","year":"2021","journal-title":"Trials"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/j.ijsu.2014.02.008","article-title":"Long term predictors of success after laparoscopic sleeve gastrectomy","volume":"12","author":"Ellatif","year":"2014","journal-title":"Int. J. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s13037-020-00270-6","article-title":"The role of the surgical resection distance from the pylorus after laparoscopic sleeve gastrectomy: A prospective cohort study from an academic medical center in Egypt","volume":"14","author":"Hussein","year":"2020","journal-title":"Patient Saf. Surg."},{"key":"ref_17","first-page":"30","article-title":"Laparoscopic Sleeve Gastrectomy: 2 cm versus 6 cm Distance from the Pylorus","volume":"4","author":"Maklad","year":"2021","journal-title":"SVU-Int. J. Med. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2731","DOI":"10.1007\/s11695-019-03923-3","article-title":"Effect of Resection Distance from Pylorus on Weight Loss Outcomes in Laparoscopic Sleeve Gastrectomy","volume":"29","author":"Avlanmis","year":"2019","journal-title":"Obes. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"88","DOI":"10.5114\/wiitm.2017.70197","article-title":"More stapler firings increase the risk of perioperative morbidity after laparoscopic sleeve gastrectomy","volume":"13","author":"Major","year":"2018","journal-title":"Videosurg. Other Miniinvasive Tech."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.1007\/s11695-022-05950-z","article-title":"Staple Line Reinforcement During Laparoscopic Sleeve Gastrectomy: Systematic Review and Network Meta-analysis of Randomized Controlled Trials","volume":"32","author":"Aiolfi","year":"2022","journal-title":"Obes. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1007\/s11695-015-1580-3","article-title":"Minimizing Hemorrhagic Complications in Laparoscopic Sleeve Gastrectomy\u2014A Randomized Controlled Trial","volume":"25","author":"Sroka","year":"2015","journal-title":"Obes. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1016\/j.soard.2013.10.018","article-title":"Comparative use of different techniques for leak and bleeding prevention during laparoscopic sleeve gastrectomy: A multicenter study","volume":"10","author":"Gentileschi","year":"2014","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1089\/lap.2013.0137","article-title":"Outcome of Laparoscopic Sleeve Gastrectomy with and without Staple Line Oversewing in Morbidly Obese Patients: A Randomized Study","volume":"23","author":"Aggarwal","year":"2013","journal-title":"J. Laparoendosc. Adv. Surg. Tech."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2709","DOI":"10.1007\/s11695-021-05327-8","article-title":"Laparoscopic Sleeve Gastrectomy with Omentopexy: Is It Really a Promising Method?\u2014A Systematic Review with Meta-analysis","volume":"31","author":"Zarzycki","year":"2021","journal-title":"Obes. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1111\/j.1572-0241.2005.41703.x","article-title":"Obesity Is an Independent Risk Factor for GERD Symptoms and Erosive Esophagitis","volume":"100","author":"Graham","year":"2005","journal-title":"Am. J. Gastroenterol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"102415","DOI":"10.1016\/j.amsu.2021.102415","article-title":"Cruroplasty added to laparoscopic sleeve gastrectomy; does it decrease postoperative incidence of de-novo acid reflux?: A randomised controlled trial","volume":"66","author":"Shahraki","year":"2021","journal-title":"Ann. Med. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"hcab097.015","DOI":"10.1093\/qjmed\/hcab097.015","article-title":"Efficiency of Cruroplasty as a Treatment of Gastro-Esophageal Reflux Disease in Morbid Obese Patients with Hiatus Hernia during SleeveGastrectomy","volume":"114","author":"Sabry","year":"2021","journal-title":"Qjm Int. J. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1962","DOI":"10.1007\/s11605-019-04355-1","article-title":"Long-Term Results After Laparoscopic Sleeve Gastrectomy with Concomitant Posterior Cruroplasty: 5-Year Follow-up","volume":"24","author":"Boru","year":"2019","journal-title":"J. Gastrointest. Surg."},{"key":"ref_29","first-page":"1","article-title":"Hiatal hernia repair during laparoscopic sleeve gastrectomy: Systematic review and meta-analysis on gastroesophageal reflux disease symptoms changes","volume":"93","author":"Zarzycki","year":"2021","journal-title":"Ann. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3905","DOI":"10.1007\/s11695-021-05545-0","article-title":"Effect of Concomitant Laparoscopic Sleeve Gastrectomy and Hiatal Hernia Repair on Gastroesophageal Reflux Disease in Patients with Obesity: A Systematic Review and Meta-analysis","volume":"31","author":"Chen","year":"2021","journal-title":"Obes. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"575","DOI":"10.2147\/DMSO.S295162","article-title":"Revisional Surgeries of Laparoscopic Sleeve Gastrectomy","volume":"14","author":"Li","year":"2021","journal-title":"Diabetes Metab. Syndr. Obes. Targets Ther."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/4\/799\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:19:31Z","timestamp":1760123971000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/4\/799"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,20]]},"references-count":31,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["medicina59040799"],"URL":"https:\/\/doi.org\/10.3390\/medicina59040799","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,20]]}}}