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. 2023 Mar;37(3):1617-1628.
doi: 10.1007/s00464-023-09879-x. Epub 2023 Jan 24.

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

Mohammad Kermansaravi  1 , Chetan Parmar  2 , Sonja Chiappetta  3 , Scott Shikora  4 , Ali Aminian  5 , Syed Imran Abbas  6 , Luigi Angrisani  7 , Ahmad Bashir  8 , Estuardo Behrens  9 , Mohit Bhandari  10 , Benjamin Clapp  11 , Ricardo Cohen  12 , Jerome Dargent  13 , Bruno Dilemans  14 , Maurizio De Luca  15 , Ashraf Haddad  8 , Khaled Gawdat  16 , Mohamed Hayssam Elfawal  17 , Jaques Himpens  18 , Chih-Kun Huang  19 , Farah Husain  20 , Kazunori Kasama  21 , Radwan Kassir  22 , Amir Khan  23 , Lilian Kow  24 , Matthew Kroh  25 , Muffazal Lakdawala  26 , Juan Antonio Lopez Corvala  27 , Karl Miller  28 , Mario Musella  29 , Abdelrahman Nimeri  30 , Patrick Noel  31 , Mariano Palermo  32 , Luis Poggi  33 , Tigran Poghosyan  34 , Gerhard Prager  35 , Arun Prasad  36 , Aayad Alqahtani  37 , Karl Rheinwalt  38 , Rui Ribeiro  39 , Asim Shabbir  40 , Antonio Torres  41 , Ramon Villalonga  42 , Cunchuan Wang  43 , Kamal Mahawar  44 , Natan Zundel  45
Affiliations

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

Mohammad Kermansaravi et al. Surg Endosc. 2023 Mar.

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.

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