Computed Tomography-Derived Gastric Sleeve Volumetry as an Adjunctive Tool for Planning Revisional Single Anastomosis Duodeno-ileal Bypass in Patients with Suboptimal Weight Loss After Sleeve Gastrectomy.

INTRODUCTION: Single-anastomosis duodeno-ileal bypass (SADI) is an effective revision procedure for patients with suboptimal weight loss after sleeve gastrectomy (SG). However, the clinical value of concomitant revisional SG (ReSG) during revisional SADI remains unclear. This study evaluated the outcomes of revisional SADI with selective ReSG guided by preoperative computed tomography (CT) volumetry. METHODS: This single-center retrospective study analyzed prospectively collected data of patients who underwent revisional SADI following SG between 2019 and 2023. Preoperative CT volumetry was used to measure gastric tube, antral, and total sleeve volumes. ReSG was selectively performed based on CT-derived volumetric findings and intraoperative assessments. Perioperative outcomes, complications, and weight-loss parameters were reviewed. RESULTS: Twenty-three female patients underwent revisional SADI and completed at least 12 months of follow-up. The mean interval between primary SG and revision was 41.3 ± 21.6 months. ReSG was performed in 20 patients, whereas three underwent SADI only. The mean follow-up duration after revision was 21.4 ± 9.0 months. The mean percent total weight loss (%TWL) after revisional SADI was 40.2 ± 5.4%, an additional 27.4 ± 8.8% compared with SG only. The postoperative complications were manageable, including one thromboembolic event and two malnutrition cases, one of which required reversal surgery. CONCLUSION: Revisional SADI was associated with substantial additional weight reduction in patients with suboptimal weight loss after SG. Concurrent ReSG may be considered in select patients with enlarged gastric sleeve segments. Preoperative CT sleeve volumetry may provide adjunctive surgical planning support, with approximately 110 ml serving as the exploratory reference point.