Metabolic and Bariatric Surgery in Patients with Obesity Class V (BMI > 60 kg/m2): a Modified Delphi Study

Guillermo Ponce de Leon-Ballesteros; Sjaak Pouwels; Gustavo Romero-Velez; Ali Aminian; Luigi Angrisani; Mohit Bhandari; Wendy Brown; Catalin Copaescu; Maurizio De Luca; Mathias Fobi; Omar M. Ghanem; Till Hasenberg; Miguel F. Herrera; Johnn H. Herrera-Kok; Jacques Himpens; Lilian Kow; Matthew Kroh; Marina Kurian; Mario Musella; Mahendra Narwaria; Patrick Noel; Juan P. Pantoja; Jaime Ponce; Gerhard Prager; Almino Ramos; Rui Ribeiro; Elena Ruiz-Ucar; Paulina Salminen; Scott Shikora; Peter Small; Christine Stier; Safwan Taha; Eren Halit Taskin; Antonio Torres; Carlos Vaz; Ramon Vilallonga; Sergio Verboonen; Carlos Zerrweck; Natan Zundel; Chetan Parmar

doi:10.1007/s11695-023-06990-9

Metabolic and Bariatric Surgery in Patients with Obesity Class V (BMI > 60 kg/m²): a Modified Delphi Study

Guillermo Ponce de Leon-Ballesteros, Sjaak Pouwels, Gustavo Romero-Velez, Ali Aminian, Luigi Angrisani, Mohit Bhandari, Wendy Brown, Catalin Copaescu, Maurizio De Luca, Mathias Fobi, Omar M. Ghanem, Till Hasenberg, Miguel F. Herrera, Johnn H. Herrera-Kok, Jacques Himpens, Lilian Kow, Matthew Kroh, Marina Kurian, Mario Musella, Mahendra NarwariaPatrick Noel, Juan P. Pantoja, Jaime Ponce, Gerhard Prager, Almino Ramos, Rui Ribeiro, Elena Ruiz-Ucar, Paulina Salminen, Scott Shikora, Peter Small, Christine Stier, Safwan Taha, Eren Halit Taskin, Antonio Torres, Carlos Vaz, Ramon Vilallonga, Sergio Verboonen, Carlos Zerrweck, Natan Zundel, Chetan Parmar

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

5 Citations (Scopus)

Abstract

Background: Metabolic and bariatric surgery (MBS) is the preferred method to achieve significant weight loss in patients with Obesity Class V (BMI > 60 kg/m²). However, there is no consensus regarding the best procedure(s) for this population. Additionally, these patients will likely have a higher risk of complications and mortality. The aim of this study was to achieve a consensus among a global panel of expert bariatric surgeons using a modified Delphi methodology.

Methods: A total of 36 recognized opinion-makers and highly experienced metabolic and bariatric surgeons participated in the present Delphi consensus. 81 statements on preoperative management, selection of the procedure, perioperative management, weight loss parameters, follow-up, and metabolic outcomes were voted on in two rounds. A consensus was considered reached when an agreement of ≥ 70% of experts’ votes was achieved.

Results: A total of 54 out of 81 statements reached consensus. Remarkably, more than 90% of the experts agreed that patients should be notified of the greater risk of complications, the possibility of modifications to the surgical procedure, and the early start of chemical thromboprophylaxis. Regarding the choice of the procedure, SADI-S, RYGB, and OAGB were the top 3 preferred operations. However, no consensus was reached on the limb length in these operations.

Conclusion: This study represents the first attempt to reach consensus on the choice of procedures as well as perioperative management in patients with obesity class V. Although overall consensus was reached in different areas, more research is needed to better serve this high-risk population. Graphical Abstract: (Figure presented.)

Original language	English
Pages (from-to)	790-813
Number of pages	24
Journal	Obesity Surgery
Volume	34
Issue number	3
Early online date	19 Jan 2024
DOIs	https://doi.org/10.1007/s11695-023-06990-9
Publication status	Published - Mar 2024
Externally published	Yes

Keywords

Bariatric surgery
BMI > 60
Metabolic surgery
Severe obesity

UN SDGs

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

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10.1007/s11695-023-06990-9Licence: In Copyright

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Cite this

Ponce de Leon-Ballesteros, G., Pouwels, S., Romero-Velez, G., Aminian, A., Angrisani, L., Bhandari, M., Brown, W., Copaescu, C., De Luca, M., Fobi, M., Ghanem, O. M., Hasenberg, T., Herrera, M. F., Herrera-Kok, J. H., Himpens, J., Kow, L., Kroh, M., Kurian, M., Musella, M., ... Parmar, C. (2024). Metabolic and Bariatric Surgery in Patients with Obesity Class V (BMI > 60 kg/m²): a Modified Delphi Study. Obesity Surgery, 34(3), 790-813. https://doi.org/10.1007/s11695-023-06990-9

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title = "Metabolic and Bariatric Surgery in Patients with Obesity Class V (BMI > 60 kg/m2): a Modified Delphi Study",

abstract = "Background: Metabolic and bariatric surgery (MBS) is the preferred method to achieve significant weight loss in patients with Obesity Class V (BMI > 60 kg/m2). However, there is no consensus regarding the best procedure(s) for this population. Additionally, these patients will likely have a higher risk of complications and mortality. The aim of this study was to achieve a consensus among a global panel of expert bariatric surgeons using a modified Delphi methodology. Methods: A total of 36 recognized opinion-makers and highly experienced metabolic and bariatric surgeons participated in the present Delphi consensus. 81 statements on preoperative management, selection of the procedure, perioperative management, weight loss parameters, follow-up, and metabolic outcomes were voted on in two rounds. A consensus was considered reached when an agreement of ≥ 70% of experts{\textquoteright} votes was achieved. Results: A total of 54 out of 81 statements reached consensus. Remarkably, more than 90% of the experts agreed that patients should be notified of the greater risk of complications, the possibility of modifications to the surgical procedure, and the early start of chemical thromboprophylaxis. Regarding the choice of the procedure, SADI-S, RYGB, and OAGB were the top 3 preferred operations. However, no consensus was reached on the limb length in these operations. Conclusion: This study represents the first attempt to reach consensus on the choice of procedures as well as perioperative management in patients with obesity class V. Although overall consensus was reached in different areas, more research is needed to better serve this high-risk population. Graphical Abstract: (Figure presented.)",

keywords = "Bariatric surgery, BMI > 60, Metabolic surgery, Severe obesity",

author = "{Ponce de Leon-Ballesteros}, Guillermo and Sjaak Pouwels and Gustavo Romero-Velez and Ali Aminian and Luigi Angrisani and Mohit Bhandari and Wendy Brown and Catalin Copaescu and {De Luca}, Maurizio and Mathias Fobi and Ghanem, {Omar M.} and Till Hasenberg and Herrera, {Miguel F.} and Herrera-Kok, {Johnn H.} and Jacques Himpens and Lilian Kow and Matthew Kroh and Marina Kurian and Mario Musella and Mahendra Narwaria and Patrick Noel and Pantoja, {Juan P.} and Jaime Ponce and Gerhard Prager and Almino Ramos and Rui Ribeiro and Elena Ruiz-Ucar and Paulina Salminen and Scott Shikora and Peter Small and Christine Stier and Safwan Taha and Taskin, {Eren Halit} and Antonio Torres and Carlos Vaz and Ramon Vilallonga and Sergio Verboonen and Carlos Zerrweck and Natan Zundel and Chetan Parmar",

year = "2024",

month = mar,

doi = "10.1007/s11695-023-06990-9",

language = "English",

volume = "34",

pages = "790--813",

journal = "Obesity Surgery",

issn = "0960-8923",

publisher = "Springer ",

number = "3",

}

Ponce de Leon-Ballesteros, G, Pouwels, S, Romero-Velez, G, Aminian, A, Angrisani, L, Bhandari, M, Brown, W, Copaescu, C, De Luca, M, Fobi, M, Ghanem, OM, Hasenberg, T, Herrera, MF, Herrera-Kok, JH, Himpens, J, Kow, L, Kroh, M, Kurian, M, Musella, M, Narwaria, M, Noel, P, Pantoja, JP, Ponce, J, Prager, G, Ramos, A, Ribeiro, R, Ruiz-Ucar, E, Salminen, P, Shikora, S, Small, P, Stier, C, Taha, S, Taskin, EH, Torres, A, Vaz, C, Vilallonga, R, Verboonen, S, Zerrweck, C, Zundel, N & Parmar, C 2024, 'Metabolic and Bariatric Surgery in Patients with Obesity Class V (BMI > 60 kg/m²): a Modified Delphi Study', Obesity Surgery, vol. 34, no. 3, pp. 790-813. https://doi.org/10.1007/s11695-023-06990-9

TY - JOUR

T1 - Metabolic and Bariatric Surgery in Patients with Obesity Class V (BMI > 60 kg/m2)

T2 - a Modified Delphi Study

AU - Ponce de Leon-Ballesteros, Guillermo

AU - Pouwels, Sjaak

AU - Romero-Velez, Gustavo

AU - Aminian, Ali

AU - Angrisani, Luigi

AU - Bhandari, Mohit

AU - Brown, Wendy

AU - Copaescu, Catalin

AU - De Luca, Maurizio

AU - Fobi, Mathias

AU - Ghanem, Omar M.

AU - Hasenberg, Till

AU - Herrera, Miguel F.

AU - Herrera-Kok, Johnn H.

AU - Himpens, Jacques

AU - Kow, Lilian

AU - Kroh, Matthew

AU - Kurian, Marina

AU - Musella, Mario

AU - Narwaria, Mahendra

AU - Noel, Patrick

AU - Pantoja, Juan P.

AU - Ponce, Jaime

AU - Prager, Gerhard

AU - Ramos, Almino

AU - Ribeiro, Rui

AU - Ruiz-Ucar, Elena

AU - Salminen, Paulina

AU - Shikora, Scott

AU - Small, Peter

AU - Stier, Christine

AU - Taha, Safwan

AU - Taskin, Eren Halit

AU - Torres, Antonio

AU - Vaz, Carlos

AU - Vilallonga, Ramon

AU - Verboonen, Sergio

AU - Zerrweck, Carlos

AU - Zundel, Natan

AU - Parmar, Chetan

PY - 2024/3

Y1 - 2024/3

N2 - Background: Metabolic and bariatric surgery (MBS) is the preferred method to achieve significant weight loss in patients with Obesity Class V (BMI > 60 kg/m2). However, there is no consensus regarding the best procedure(s) for this population. Additionally, these patients will likely have a higher risk of complications and mortality. The aim of this study was to achieve a consensus among a global panel of expert bariatric surgeons using a modified Delphi methodology. Methods: A total of 36 recognized opinion-makers and highly experienced metabolic and bariatric surgeons participated in the present Delphi consensus. 81 statements on preoperative management, selection of the procedure, perioperative management, weight loss parameters, follow-up, and metabolic outcomes were voted on in two rounds. A consensus was considered reached when an agreement of ≥ 70% of experts’ votes was achieved. Results: A total of 54 out of 81 statements reached consensus. Remarkably, more than 90% of the experts agreed that patients should be notified of the greater risk of complications, the possibility of modifications to the surgical procedure, and the early start of chemical thromboprophylaxis. Regarding the choice of the procedure, SADI-S, RYGB, and OAGB were the top 3 preferred operations. However, no consensus was reached on the limb length in these operations. Conclusion: This study represents the first attempt to reach consensus on the choice of procedures as well as perioperative management in patients with obesity class V. Although overall consensus was reached in different areas, more research is needed to better serve this high-risk population. Graphical Abstract: (Figure presented.)

AB - Background: Metabolic and bariatric surgery (MBS) is the preferred method to achieve significant weight loss in patients with Obesity Class V (BMI > 60 kg/m2). However, there is no consensus regarding the best procedure(s) for this population. Additionally, these patients will likely have a higher risk of complications and mortality. The aim of this study was to achieve a consensus among a global panel of expert bariatric surgeons using a modified Delphi methodology. Methods: A total of 36 recognized opinion-makers and highly experienced metabolic and bariatric surgeons participated in the present Delphi consensus. 81 statements on preoperative management, selection of the procedure, perioperative management, weight loss parameters, follow-up, and metabolic outcomes were voted on in two rounds. A consensus was considered reached when an agreement of ≥ 70% of experts’ votes was achieved. Results: A total of 54 out of 81 statements reached consensus. Remarkably, more than 90% of the experts agreed that patients should be notified of the greater risk of complications, the possibility of modifications to the surgical procedure, and the early start of chemical thromboprophylaxis. Regarding the choice of the procedure, SADI-S, RYGB, and OAGB were the top 3 preferred operations. However, no consensus was reached on the limb length in these operations. Conclusion: This study represents the first attempt to reach consensus on the choice of procedures as well as perioperative management in patients with obesity class V. Although overall consensus was reached in different areas, more research is needed to better serve this high-risk population. Graphical Abstract: (Figure presented.)

KW - Bariatric surgery

KW - BMI > 60

KW - Metabolic surgery

KW - Severe obesity

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U2 - 10.1007/s11695-023-06990-9

DO - 10.1007/s11695-023-06990-9

M3 - Article

C2 - 38238640

AN - SCOPUS:85182420013

SN - 0960-8923

VL - 34

SP - 790

EP - 813

JO - Obesity Surgery

JF - Obesity Surgery

IS - 3

ER -