Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus

Mohammad Kermansaravi; Chetan Parmar; Sonja Chiappetta; Scott Shikora; Ali Aminian; Syed Imran Abbas; Luigi Angrisani; Ahmad Bashir; Estuardo Behrens; Mohit Bhandari; Benjamin Clapp; Ricardo Cohen; Jerome Dargent; Bruno Dilemans; Maurizio De Luca; Ashraf Haddad; Khaled Gawdat; Mohamed Hayssam Elfawal; Jaques Himpens; Chih-Kun Huang; Farah Husain; Kazunori Kasama; Radwan Kassir; Amir Khan; Lilian Kow; Matthew Kroh; Muffazal Lakdawala; Juan Antonio Lopez Corvala; Karl Miller; Mario Musella; Abdelrahman Nimeri; Patrick Noel; Mariano Palermo; Luis Poggi; Tigran Poghosyan; Gerhard Prager; Arun Prasad; Aayad Alqahtani; Karl Rheinwalt; Rui Ribeiro; Asim Shabbir; Antonio Torres; Ramon Villalonga; Cunchuan Wang; Kamal Mahawar; Natan Zundel

doi:10.1007/s00464-023-09879-x

Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus

Mohammad Kermansaravi, Chetan Parmar, Sonja Chiappetta, Scott Shikora, Ali Aminian, Syed Imran Abbas, Luigi Angrisani, Ahmad Bashir, Estuardo Behrens, Mohit Bhandari, Benjamin Clapp, Ricardo Cohen, Jerome Dargent, Bruno Dilemans, Maurizio De Luca, Ashraf Haddad, Khaled Gawdat, Mohamed Hayssam Elfawal, Jaques Himpens, Chih-Kun HuangFarah Husain, Kazunori Kasama, Radwan Kassir, Amir Khan, Lilian Kow, Matthew Kroh, Muffazal Lakdawala, Juan Antonio Lopez Corvala, Karl Miller, Mario Musella, Abdelrahman Nimeri, Patrick Noel, Mariano Palermo, Luis Poggi, Tigran Poghosyan, Gerhard Prager, Arun Prasad, Aayad Alqahtani, Karl Rheinwalt, Rui Ribeiro, Asim Shabbir, Antonio Torres, Ramon Villalonga, Cunchuan Wang, Kamal Mahawar, Natan Zundel

Research output: Contribution to journal › Article › peer-review

27 Citations (Scopus)

Abstract

Background: Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgical (MBS) procedure worldwide. Despite the desired effect of SG on weight loss and remission of obesity-associated medical problems, there are some concerns regarding the need to do revisional/conversional surgeries after SG. This study aims to make an algorithmic clinical approach based on an expert-modified Delphi consensus regarding redo-surgeries after SG, to give bariatric and metabolic surgeons a guideline that might help for the best clinical decision.

Methods: Forty-six recognized bariatric and metabolic surgeons from 25 different countries participated in this Delphi consensus study in two rounds to develop a consensus on redo-surgeries after SG. An agreement/disagreement ≥ 70.0% on statements was considered to indicate a consensus.

Results: Consensus was reached for 62 of 72 statements and experts did not achieve consensus on 10 statements after two rounds of online voting. Most of the experts believed that multi-disciplinary team evaluation should be done in all redo-procedures after SG and there should be at least 12 months of medical and supportive management before performing redo-surgeries after SG for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD). Also, experts agreed that in case of symptomatic GERD in the presence of adequate weight loss, medical treatment for at least 1 to 2 years is an acceptable option and agreed that Roux-en Y gastric bypass is an appropriate option in this situation. There was disagreement consensus on efficacy of omentopexy in rotation and efficacy of fundoplication in the presence of a dilated fundus and GERD.

Conclusion: Redo-surgeries after SG is still an important issue among bariatric and metabolic surgeons. The proper time and procedure selection for redo-surgery need careful considerations. Although multi-disciplinary team evaluation plays a key role to evaluate best options in these situations, an algorithmic clinical approach based on the expert's consensus as a guideline can help for the best clinical decision-making.

Original language	English
Pages (from-to)	1617-1628
Number of pages	12
Journal	Surgical Endoscopy
Volume	37
Issue number	3
Early online date	24 Jan 2023
DOIs	https://doi.org/10.1007/s00464-023-09879-x
Publication status	Published - Mar 2023
Externally published	Yes

Keywords

Bariatric surgery
Consensus
Conversion
GERD
Revision
Sleeve gastrectomy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s00464-023-09879-xLicence: In Copyright

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Cite this

Kermansaravi, M., Parmar, C., Chiappetta, S., Shikora, S., Aminian, A., Abbas, S. I., Angrisani, L., Bashir, A., Behrens, E., Bhandari, M., Clapp, B., Cohen, R., Dargent, J., Dilemans, B., De Luca, M., Haddad, A., Gawdat, K., Elfawal, M. H., Himpens, J., ... Zundel, N. (2023). Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus. Surgical Endoscopy, 37(3), 1617-1628. https://doi.org/10.1007/s00464-023-09879-x

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title = "Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus",

abstract = "Background: Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgical (MBS) procedure worldwide. Despite the desired effect of SG on weight loss and remission of obesity-associated medical problems, there are some concerns regarding the need to do revisional/conversional surgeries after SG. This study aims to make an algorithmic clinical approach based on an expert-modified Delphi consensus regarding redo-surgeries after SG, to give bariatric and metabolic surgeons a guideline that might help for the best clinical decision. Methods: Forty-six recognized bariatric and metabolic surgeons from 25 different countries participated in this Delphi consensus study in two rounds to develop a consensus on redo-surgeries after SG. An agreement/disagreement ≥ 70.0% on statements was considered to indicate a consensus. Results: Consensus was reached for 62 of 72 statements and experts did not achieve consensus on 10 statements after two rounds of online voting. Most of the experts believed that multi-disciplinary team evaluation should be done in all redo-procedures after SG and there should be at least 12 months of medical and supportive management before performing redo-surgeries after SG for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD). Also, experts agreed that in case of symptomatic GERD in the presence of adequate weight loss, medical treatment for at least 1 to 2 years is an acceptable option and agreed that Roux-en Y gastric bypass is an appropriate option in this situation. There was disagreement consensus on efficacy of omentopexy in rotation and efficacy of fundoplication in the presence of a dilated fundus and GERD. Conclusion: Redo-surgeries after SG is still an important issue among bariatric and metabolic surgeons. The proper time and procedure selection for redo-surgery need careful considerations. Although multi-disciplinary team evaluation plays a key role to evaluate best options in these situations, an algorithmic clinical approach based on the expert's consensus as a guideline can help for the best clinical decision-making.",

keywords = "Bariatric surgery, Consensus, Conversion, GERD, Revision, Sleeve gastrectomy",

author = "Mohammad Kermansaravi and Chetan Parmar and Sonja Chiappetta and Scott Shikora and Ali Aminian and Abbas, {Syed Imran} and Luigi Angrisani and Ahmad Bashir and Estuardo Behrens and Mohit Bhandari and Benjamin Clapp and Ricardo Cohen and Jerome Dargent and Bruno Dilemans and {De Luca}, Maurizio and Ashraf Haddad and Khaled Gawdat and Elfawal, {Mohamed Hayssam} and Jaques Himpens and Chih-Kun Huang and Farah Husain and Kazunori Kasama and Radwan Kassir and Amir Khan and Lilian Kow and Matthew Kroh and Muffazal Lakdawala and Corvala, {Juan Antonio Lopez} and Karl Miller and Mario Musella and Abdelrahman Nimeri and Patrick Noel and Mariano Palermo and Luis Poggi and Tigran Poghosyan and Gerhard Prager and Arun Prasad and Aayad Alqahtani and Karl Rheinwalt and Rui Ribeiro and Asim Shabbir and Antonio Torres and Ramon Villalonga and Cunchuan Wang and Kamal Mahawar and Natan Zundel",

year = "2023",

month = mar,

doi = "10.1007/s00464-023-09879-x",

language = "English",

volume = "37",

pages = "1617--1628",

journal = "Surgical Endoscopy",

issn = "0930-2794",

publisher = "Springer-Verlag",

number = "3",

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Kermansaravi, M, Parmar, C, Chiappetta, S, Shikora, S, Aminian, A, Abbas, SI, Angrisani, L, Bashir, A, Behrens, E, Bhandari, M, Clapp, B, Cohen, R, Dargent, J, Dilemans, B, De Luca, M, Haddad, A, Gawdat, K, Elfawal, MH, Himpens, J, Huang, C-K, Husain, F, Kasama, K, Kassir, R, Khan, A, Kow, L, Kroh, M, Lakdawala, M, Corvala, JAL, Miller, K, Musella, M, Nimeri, A, Noel, P, Palermo, M, Poggi, L, Poghosyan, T, Prager, G, Prasad, A, Alqahtani, A, Rheinwalt, K, Ribeiro, R, Shabbir, A, Torres, A, Villalonga, R, Wang, C, Mahawar, K & Zundel, N 2023, 'Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus', Surgical Endoscopy, vol. 37, no. 3, pp. 1617-1628. https://doi.org/10.1007/s00464-023-09879-x

TY - JOUR

T1 - Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus

AU - Kermansaravi, Mohammad

AU - Parmar, Chetan

AU - Chiappetta, Sonja

AU - Shikora, Scott

AU - Aminian, Ali

AU - Abbas, Syed Imran

AU - Angrisani, Luigi

AU - Bashir, Ahmad

AU - Behrens, Estuardo

AU - Bhandari, Mohit

AU - Clapp, Benjamin

AU - Cohen, Ricardo

AU - Dargent, Jerome

AU - Dilemans, Bruno

AU - De Luca, Maurizio

AU - Haddad, Ashraf

AU - Gawdat, Khaled

AU - Elfawal, Mohamed Hayssam

AU - Himpens, Jaques

AU - Huang, Chih-Kun

AU - Husain, Farah

AU - Kasama, Kazunori

AU - Kassir, Radwan

AU - Khan, Amir

AU - Kow, Lilian

AU - Kroh, Matthew

AU - Lakdawala, Muffazal

AU - Corvala, Juan Antonio Lopez

AU - Miller, Karl

AU - Musella, Mario

AU - Nimeri, Abdelrahman

AU - Noel, Patrick

AU - Palermo, Mariano

AU - Poggi, Luis

AU - Poghosyan, Tigran

AU - Prager, Gerhard

AU - Prasad, Arun

AU - Alqahtani, Aayad

AU - Rheinwalt, Karl

AU - Ribeiro, Rui

AU - Shabbir, Asim

AU - Torres, Antonio

AU - Villalonga, Ramon

AU - Wang, Cunchuan

AU - Mahawar, Kamal

AU - Zundel, Natan

PY - 2023/3

Y1 - 2023/3

N2 - Background: Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgical (MBS) procedure worldwide. Despite the desired effect of SG on weight loss and remission of obesity-associated medical problems, there are some concerns regarding the need to do revisional/conversional surgeries after SG. This study aims to make an algorithmic clinical approach based on an expert-modified Delphi consensus regarding redo-surgeries after SG, to give bariatric and metabolic surgeons a guideline that might help for the best clinical decision. Methods: Forty-six recognized bariatric and metabolic surgeons from 25 different countries participated in this Delphi consensus study in two rounds to develop a consensus on redo-surgeries after SG. An agreement/disagreement ≥ 70.0% on statements was considered to indicate a consensus. Results: Consensus was reached for 62 of 72 statements and experts did not achieve consensus on 10 statements after two rounds of online voting. Most of the experts believed that multi-disciplinary team evaluation should be done in all redo-procedures after SG and there should be at least 12 months of medical and supportive management before performing redo-surgeries after SG for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD). Also, experts agreed that in case of symptomatic GERD in the presence of adequate weight loss, medical treatment for at least 1 to 2 years is an acceptable option and agreed that Roux-en Y gastric bypass is an appropriate option in this situation. There was disagreement consensus on efficacy of omentopexy in rotation and efficacy of fundoplication in the presence of a dilated fundus and GERD. Conclusion: Redo-surgeries after SG is still an important issue among bariatric and metabolic surgeons. The proper time and procedure selection for redo-surgery need careful considerations. Although multi-disciplinary team evaluation plays a key role to evaluate best options in these situations, an algorithmic clinical approach based on the expert's consensus as a guideline can help for the best clinical decision-making.

AB - Background: Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgical (MBS) procedure worldwide. Despite the desired effect of SG on weight loss and remission of obesity-associated medical problems, there are some concerns regarding the need to do revisional/conversional surgeries after SG. This study aims to make an algorithmic clinical approach based on an expert-modified Delphi consensus regarding redo-surgeries after SG, to give bariatric and metabolic surgeons a guideline that might help for the best clinical decision. Methods: Forty-six recognized bariatric and metabolic surgeons from 25 different countries participated in this Delphi consensus study in two rounds to develop a consensus on redo-surgeries after SG. An agreement/disagreement ≥ 70.0% on statements was considered to indicate a consensus. Results: Consensus was reached for 62 of 72 statements and experts did not achieve consensus on 10 statements after two rounds of online voting. Most of the experts believed that multi-disciplinary team evaluation should be done in all redo-procedures after SG and there should be at least 12 months of medical and supportive management before performing redo-surgeries after SG for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD). Also, experts agreed that in case of symptomatic GERD in the presence of adequate weight loss, medical treatment for at least 1 to 2 years is an acceptable option and agreed that Roux-en Y gastric bypass is an appropriate option in this situation. There was disagreement consensus on efficacy of omentopexy in rotation and efficacy of fundoplication in the presence of a dilated fundus and GERD. Conclusion: Redo-surgeries after SG is still an important issue among bariatric and metabolic surgeons. The proper time and procedure selection for redo-surgery need careful considerations. Although multi-disciplinary team evaluation plays a key role to evaluate best options in these situations, an algorithmic clinical approach based on the expert's consensus as a guideline can help for the best clinical decision-making.

KW - Bariatric surgery

KW - Consensus

KW - Conversion

KW - GERD

KW - Revision

KW - Sleeve gastrectomy

UR - http://www.scopus.com/inward/record.url?scp=85146820196&partnerID=8YFLogxK

U2 - 10.1007/s00464-023-09879-x

DO - 10.1007/s00464-023-09879-x

M3 - Article

C2 - 36693918

AN - SCOPUS:85146820196

SN - 0930-2794

VL - 37

SP - 1617

EP - 1628

JO - Surgical Endoscopy

JF - Surgical Endoscopy

IS - 3

ER -

Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus

Abstract

Keywords

UN SDGs

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