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Even though long-term results support the consideration of sleeve gastrectomy as a standard-alone procedure, when weight loss failure (insufficient weight loss or weight regain) occurs, or complications such as de novo GERD appear, a reversal procedure must be considered. There is no consensus on the procedure of choice for LSG reversal. Weight loss after revisional procedures tends to be modest and decision making must consider not only morphological aspects but also other patient-related factors such as resolution of comorbidities, dietary habits, or the presence of sleeve-related sequelae. Therefore, several options such as re-sleeve, RYGBP, banded sleeve, BPD, SADI-S or OAGB can be offered not only to add weight loss but also to improve both metabolic results and procedure-related complications. Current evidence suggests that in the presence of GERD, conversion from SG to RYGBP could regarded as the procedure of choice.
