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

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

Affiliation

Rasool E Akram Hospital; Whittington Hospital; Ospedale Evangelico Betania; Brigham and Women's Hospital; Iranian Hospital; Federico II University of Naples; Jordan Hospital; New Life Center; Mohak Bariatrics and Robotics Center; Texas Tech HSC Paul Foster School of Medicine; Oswaldo Cruz German Hospital; Polyclinique Lyon Nord; AZ Sint Jan Brugge-Oostende; Rovigo Hospital; Ain Shams University; Makassed General Hospital; Bariatric Surgery Unit, Delta Chirec Hospital; Body Science and Metabolic Disorders International Medical Center; Medical University Hospital; University of Arizona College of Medicine; Yotsuya Medical Cube; CHU Félix Guyon; Walsall Healthcare NHS Trust; Flinders Medical Centre; Cleveland Clinic; Sir H N Reliance Foundation Hospital; Hospital Ángeles Tijuana Mexico; Diakonissen Wehrle Private Hospital; "Federico II" University; Atrium Health; Clinique Bouchard; University of Buenos Aires; Universidad Nacional Mayor de San Marcos; Hôpital Bichât; Medical University of Vienna; Apollo Hospital; King Saud University; St. Franziskus Hospital; Hospital Lusíadas Amadora e Lisbon; National University of Singapore; Hospital Clínico San Carlos; University Hospital Vall Hebron; The First Affiliated Hospital of Jinan University; South Tyneside and Sunderland Foundation NHS Trust; State University of New York

Publication date

2023-03

Subject

Surgery

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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.

Citation

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 CK, 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. Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus. Surg Endosc. 2023 Mar;37(3):1617-1628.

Type

Article