Endoscopic sleeve gastroplasty (ESG) is a new obesity control modality. Limited data are available to describe post ESG findings and approaches to surgically revise this procedure. Two female patients with persistent obesity despite multiple ESG procedures underwent laparoscopic sleeve gastrectomy (LSG). Pre- and post-ESG, LSG body mass index (BMI), weight, and excess weight loss percentage (EWL%) were recorded. Endoscopic findings and revisional LSG technique were carefully documented. Pre-ESG BMI of the patients were 44 and 52 kg/m. Pre-LSG BMI were 44.6 and 50 kg/m. Pre-LSG gastroscopy and laparoscopy revealed complete dehiscence of ESG sutures with full-thickness invasion of these sutures and titanium clips through the gastric wall and some intraperitoneal adhesions. At 7-month follow-up, BMI are 40.3 and 35.7 kg/m and EWL% are 39 and 43%, respectively. This is the first study reporting LSG following failed ESG. ESG can lead to significant complications. LSG is achievable post-ESG and has superior results to it.
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