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.

• Authors: 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
• Journal: Surgical endoscopy (Surg Endosc) Vol. 37 Issue 3 Pg. 1617-1628 (03 2023) ISSN: 1432-2218 [Electronic] Germany
• PMID: 36693918 (Publication Type: Journal Article)
• Copyright: © 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Topics

• Humans
• Delphi Technique
• Reoperation (methods)
• Gastric Bypass (methods)
• Gastrectomy (methods)
• Gastroesophageal Reflux (etiology, surgery)
• Weight Loss
• Obesity, Morbid (surgery)
• Retrospective Studies
• Treatment Outcome