How to Manage Sleeve Complications: The Unresponsive Sleeve

This chapter describes the standards in Laparoscopic Sleeve Gastrectomy (LSG) and potential errors in the treatment of obesity. The inadequate (poor) weight loss can be caused by several factors, like insufficient gastric volume reduction for nutritional uptake (restriction) and/or mistakes in daily nutrition. The diagnostic algorithm with on-invasive tools were described. The treatment of the unresponsive sleeve based on the diagnostic findings. Most common cause of missed effective weight loss is the lack of restriction. The pyloric function plays an important role. The re-sleeve is an efficient revisional surgery option for insufficient weight loss after primary gastric sleeve in a short- and medium-term follow-up. The long-term results are poor. In the situation of a proper sleeve, the conversion to a malabsorptive procedure is the solution for long-term success in weight loss. Beside the classic BPD-DS, SADI, MGB/OAGB, SASI and many other variations can be offered.