The first consensus statement on revisional bariatric surgery using a modified Delphi approach

Kamal K. Mahawar; Jacques M. Himpens; Scott A. Shikora; Almino C. Ramos; Antonio Torres; Shaw Somers; Bruno Dillemans; Luigi Angrisani; Jan Willem M. Greve; Jean-Marc Chevallier; Pradeep Chowbey; Maurizio De Luca; Rudolf Weiner; Gerhard Prager; Ramon Vilallonga; Marco Adamo; Nasser Sakran; Lilian Kow; Mufazzal Lakdawala; Jerome Dargent; Abdelrahman Nimeri; Peter K. Small

doi:10.1007/s00464-019-06937-1

The first consensus statement on revisional bariatric surgery using a modified Delphi approach

Kamal K. Mahawar, Jacques M. Himpens, Scott A. Shikora, Almino C. Ramos, Antonio Torres, Shaw Somers, Bruno Dillemans, Luigi Angrisani, Jan Willem M. Greve, Jean-Marc Chevallier, Pradeep Chowbey, Maurizio De Luca, Rudolf Weiner, Gerhard Prager, Ramon Vilallonga, Marco Adamo, Nasser Sakran, Lilian Kow, Mufazzal Lakdawala, Jerome DargentAbdelrahman Nimeri, Peter K. Small

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

63 Citations (Scopus)

Abstract

Background: Revisional bariatric surgery (RBS) constitutes a possible solution for patients who experience an inadequate response following bariatric surgery or significant weight regain following an initial satisfactory response. This paper reports results from the first modified Delphi consensus-building exercise on RBS.

Methods: We created a committee of 22 recognised opinion-makers with a special interest in RBS. The committee invited 70 RBS experts from 27 countries to vote on 39 statements concerning RBS. An agreement amongst ≥ 70.0% experts was regarded as a consensus.

Results: Seventy experts from twenty-seven countries took part. There was a consensus that the decision for RBS should be individualised (100.0%) and multi-disciplinary (92.8%). Experts recommended a preoperative nutritional (95.7%) and psychological evaluation (85.7%), endoscopy (97.1%), and a contrast series (94.3%). Experts agreed that Roux-Y gastric bypass (RYGB) (94.3%), One anastomosis gastric bypass (OAGB) (82.8%), and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) (71.4%) were acceptable RBS options after gastric banding (84.3%). OAGB (84.3%), bilio-pancreatic diversion/duodenal switch (BPD/DS) (81.4%), and SADI-S (88.5%) were agreed as consensus RBS options after sleeve gastrectomy. lengthening of bilio-pancreatic limb was the only consensus RBS option after RYGB (94.3%) and OAGB (72.8%).

Conclusion: Experts achieved consensus on a number of aspects of RBS. Though expert opinion can only be regarded as low-quality evidence, the findings of this exercise should help improve the outcomes of RBS while we develop robust evidence to inform future practice.

Original language	English
Pages (from-to)	1648-1657
Number of pages	10
Journal	Surgical Endoscopy
Volume	34
Issue number	4
Early online date	19 Jun 2019
DOIs	https://doi.org/10.1007/s00464-019-06937-1
Publication status	Published - Apr 2020
Externally published	Yes

Keywords

Band to bypass
Band to sleeve
Bariatric surgery
Conversion
Gastric banding
Obesity surgery
One anastomosis gastric bypass
Revisional bariatric surgery
Roux-en-Y gastric bypass
Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy
Sleeve gastrectomy
Sleeve to bypass
Weight regain

UN SDGs

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

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Mahawar, K. K., Himpens, J. M., Shikora, S. A., Ramos, A. C., Torres, A., Somers, S., Dillemans, B., Angrisani, L., Greve, J. W. M., Chevallier, J.-M., Chowbey, P., De Luca, M., Weiner, R., Prager, G., Vilallonga, R., Adamo, M., Sakran, N., Kow, L., Lakdawala, M., ... Small, P. K. (2020). The first consensus statement on revisional bariatric surgery using a modified Delphi approach. Surgical Endoscopy, 34(4), 1648-1657. https://doi.org/10.1007/s00464-019-06937-1

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title = "The first consensus statement on revisional bariatric surgery using a modified Delphi approach",

abstract = "Background: Revisional bariatric surgery (RBS) constitutes a possible solution for patients who experience an inadequate response following bariatric surgery or significant weight regain following an initial satisfactory response. This paper reports results from the first modified Delphi consensus-building exercise on RBS. Methods: We created a committee of 22 recognised opinion-makers with a special interest in RBS. The committee invited 70 RBS experts from 27 countries to vote on 39 statements concerning RBS. An agreement amongst ≥ 70.0% experts was regarded as a consensus. Results: Seventy experts from twenty-seven countries took part. There was a consensus that the decision for RBS should be individualised (100.0%) and multi-disciplinary (92.8%). Experts recommended a preoperative nutritional (95.7%) and psychological evaluation (85.7%), endoscopy (97.1%), and a contrast series (94.3%). Experts agreed that Roux-Y gastric bypass (RYGB) (94.3%), One anastomosis gastric bypass (OAGB) (82.8%), and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) (71.4%) were acceptable RBS options after gastric banding (84.3%). OAGB (84.3%), bilio-pancreatic diversion/duodenal switch (BPD/DS) (81.4%), and SADI-S (88.5%) were agreed as consensus RBS options after sleeve gastrectomy. lengthening of bilio-pancreatic limb was the only consensus RBS option after RYGB (94.3%) and OAGB (72.8%). Conclusion: Experts achieved consensus on a number of aspects of RBS. Though expert opinion can only be regarded as low-quality evidence, the findings of this exercise should help improve the outcomes of RBS while we develop robust evidence to inform future practice.",

keywords = "Band to bypass, Band to sleeve, Bariatric surgery, Conversion, Gastric banding, Obesity surgery, One anastomosis gastric bypass, Revisional bariatric surgery, Roux-en-Y gastric bypass, Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy, Sleeve gastrectomy, Sleeve to bypass, Weight regain",

author = "Mahawar, {Kamal K.} and Himpens, {Jacques M.} and Shikora, {Scott A.} and Ramos, {Almino C.} and Antonio Torres and Shaw Somers and Bruno Dillemans and Luigi Angrisani and Greve, {Jan Willem M.} and Jean-Marc Chevallier and Pradeep Chowbey and {De Luca}, Maurizio and Rudolf Weiner and Gerhard Prager and Ramon Vilallonga and Marco Adamo and Nasser Sakran and Lilian Kow and Mufazzal Lakdawala and Jerome Dargent and Abdelrahman Nimeri and Small, {Peter K.}",

year = "2020",

month = apr,

doi = "10.1007/s00464-019-06937-1",

language = "English",

volume = "34",

pages = "1648--1657",

journal = "Surgical Endoscopy",

issn = "0930-2794",

publisher = "Springer-Verlag",

number = "4",

}

Mahawar, KK, Himpens, JM, Shikora, SA, Ramos, AC, Torres, A, Somers, S, Dillemans, B, Angrisani, L, Greve, JWM, Chevallier, J-M, Chowbey, P, De Luca, M, Weiner, R, Prager, G, Vilallonga, R, Adamo, M, Sakran, N, Kow, L, Lakdawala, M, Dargent, J, Nimeri, A & Small, PK 2020, 'The first consensus statement on revisional bariatric surgery using a modified Delphi approach', Surgical Endoscopy, vol. 34, no. 4, pp. 1648-1657. https://doi.org/10.1007/s00464-019-06937-1

TY - JOUR

T1 - The first consensus statement on revisional bariatric surgery using a modified Delphi approach

AU - Mahawar, Kamal K.

AU - Himpens, Jacques M.

AU - Shikora, Scott A.

AU - Ramos, Almino C.

AU - Torres, Antonio

AU - Somers, Shaw

AU - Dillemans, Bruno

AU - Angrisani, Luigi

AU - Greve, Jan Willem M.

AU - Chevallier, Jean-Marc

AU - Chowbey, Pradeep

AU - De Luca, Maurizio

AU - Weiner, Rudolf

AU - Prager, Gerhard

AU - Vilallonga, Ramon

AU - Adamo, Marco

AU - Sakran, Nasser

AU - Kow, Lilian

AU - Lakdawala, Mufazzal

AU - Dargent, Jerome

AU - Nimeri, Abdelrahman

AU - Small, Peter K.

PY - 2020/4

Y1 - 2020/4

N2 - Background: Revisional bariatric surgery (RBS) constitutes a possible solution for patients who experience an inadequate response following bariatric surgery or significant weight regain following an initial satisfactory response. This paper reports results from the first modified Delphi consensus-building exercise on RBS. Methods: We created a committee of 22 recognised opinion-makers with a special interest in RBS. The committee invited 70 RBS experts from 27 countries to vote on 39 statements concerning RBS. An agreement amongst ≥ 70.0% experts was regarded as a consensus. Results: Seventy experts from twenty-seven countries took part. There was a consensus that the decision for RBS should be individualised (100.0%) and multi-disciplinary (92.8%). Experts recommended a preoperative nutritional (95.7%) and psychological evaluation (85.7%), endoscopy (97.1%), and a contrast series (94.3%). Experts agreed that Roux-Y gastric bypass (RYGB) (94.3%), One anastomosis gastric bypass (OAGB) (82.8%), and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) (71.4%) were acceptable RBS options after gastric banding (84.3%). OAGB (84.3%), bilio-pancreatic diversion/duodenal switch (BPD/DS) (81.4%), and SADI-S (88.5%) were agreed as consensus RBS options after sleeve gastrectomy. lengthening of bilio-pancreatic limb was the only consensus RBS option after RYGB (94.3%) and OAGB (72.8%). Conclusion: Experts achieved consensus on a number of aspects of RBS. Though expert opinion can only be regarded as low-quality evidence, the findings of this exercise should help improve the outcomes of RBS while we develop robust evidence to inform future practice.

AB - Background: Revisional bariatric surgery (RBS) constitutes a possible solution for patients who experience an inadequate response following bariatric surgery or significant weight regain following an initial satisfactory response. This paper reports results from the first modified Delphi consensus-building exercise on RBS. Methods: We created a committee of 22 recognised opinion-makers with a special interest in RBS. The committee invited 70 RBS experts from 27 countries to vote on 39 statements concerning RBS. An agreement amongst ≥ 70.0% experts was regarded as a consensus. Results: Seventy experts from twenty-seven countries took part. There was a consensus that the decision for RBS should be individualised (100.0%) and multi-disciplinary (92.8%). Experts recommended a preoperative nutritional (95.7%) and psychological evaluation (85.7%), endoscopy (97.1%), and a contrast series (94.3%). Experts agreed that Roux-Y gastric bypass (RYGB) (94.3%), One anastomosis gastric bypass (OAGB) (82.8%), and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) (71.4%) were acceptable RBS options after gastric banding (84.3%). OAGB (84.3%), bilio-pancreatic diversion/duodenal switch (BPD/DS) (81.4%), and SADI-S (88.5%) were agreed as consensus RBS options after sleeve gastrectomy. lengthening of bilio-pancreatic limb was the only consensus RBS option after RYGB (94.3%) and OAGB (72.8%). Conclusion: Experts achieved consensus on a number of aspects of RBS. Though expert opinion can only be regarded as low-quality evidence, the findings of this exercise should help improve the outcomes of RBS while we develop robust evidence to inform future practice.

KW - Band to bypass

KW - Band to sleeve

KW - Bariatric surgery

KW - Conversion

KW - Gastric banding

KW - Obesity surgery

KW - One anastomosis gastric bypass

KW - Revisional bariatric surgery

KW - Roux-en-Y gastric bypass

KW - Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy

KW - Sleeve gastrectomy

KW - Sleeve to bypass

KW - Weight regain

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U2 - 10.1007/s00464-019-06937-1

DO - 10.1007/s00464-019-06937-1

M3 - Article

C2 - 31218425

AN - SCOPUS:85067785280

SN - 0930-2794

VL - 34

SP - 1648

EP - 1657

JO - Surgical Endoscopy

JF - Surgical Endoscopy

IS - 4

ER -

The first consensus statement on revisional bariatric surgery using a modified Delphi approach

Abstract

Keywords

UN SDGs

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