Limitations
weight loss
MINOR, SECONDARY
This study had some limitations, such as the lack of data on the first operation or the postoperative stomach volume at three months since all the patients were referred from other clinics. For example, calibrations of the LSG procedure, how the follow-up was done, guidance and therapy from the multi-disciplinary team, and how the weight loss in that period went were unknown. Moreover, the cause of either primary or secondary sleeve pouch dilatation was unclear, even with the MDCT volumetry, so we did not correlate this data with the weight loss before and after the re-LSG. Another limitation is the relatively short 2-year follow-up time, which may be insufficient for a proper conclusion of outcomes between the two groups. At the same time, the differences after three or more years could be significant in favor of one of the groups. Moreover, nine of 59 patients were lost to follow-up. This may be explained by a lack of interest in follow-up after successful revision surgery, mainly since the patients were referred from other centers. We did not measure any quality of life questionnaires pre-revision and follow-up. This could have been with added value and must be included in new studies as an outcome measure.We recommend studying the effect of successful or failed LSG on stomach volume in future cohorts, focusing on the cut-off values for dilatation vs. volume vs. weight regain. Finally, this study was powered to detect only a large effect size corresponding to approximately 8% differences in %EWL between both re-sleeve groups; if there are medium or minor differences in %EWL between the two re-sleeve groups, a larger sample would be required to detect such differences.