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

Kermansaravi, Mohammad; Parmar, Chetan; Chiappetta, Sonja; Shikora, Scott A.; Aminian, Ali; Abbas, Syed Imran; Angrisani, Luigi; Bashir, Ahmad; Behrens, Estuardo; Bhandari, Mohit; Clapp, Benjamin; Cohen, Ricardo; Dargent, J.; Dilemans, Bruno; Luca, Maurizio De; 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; Corvalá, Juan Antonio López; Miller, Karl; Musella, Mario; Nimeri, Abdelrahman; Noe͏̈l, Patrick; Palermo, Mariano; Poggi, Luis; Poghosyan, Tigran; Prager, Gerhard; Prasad, Arun; Alqahtani, Aayad; Rheinwalt, Karl Peter; Ribeiro, Rui; Shabbir, Asim; Torres, Antonio; Villalonga, R; Wang, Cunchuan; Mahawar, Kamal; Zundel, Natán

doi:10.1007/s00464-023-09879-x

Cited by 25 publications

(23 citation statements)

References 55 publications

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“…Moreover, 9/11 patients with GERD improved, which may be promising for revisional procedure for GERD. However, the latest Delphi consensus does not recommend SASI as a revisional procedure after SG for GERD symptoms [ 14 ]. Due to the small number of people analysed, further work is needed to assess the efficacy of SASI as a revisional surgery.…”

Section: Discussionmentioning

confidence: 99%

Single anastomosis sleeve ileal (SASI) bypass as a primary and revisional procedure: a single-centre experience.

Dowgiałło-Gornowicz,

Waczyński,

Waczyńska

et al. 2023

Videosurgery and Other Miniinvasive Techniques

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Introduction To achieve effective weight loss and remission of comorbidities, various surgical methods are used in the treatment of obesity. The most common procedures performed worldwide are followed by the newest ones. Aim To present the results of the first group of patients from a high-volume bariatric centre in central Europe and to compare single anastomosis sleeve ileal (SASI) as a primary and revisional procedure. Material and methods We retrospectively analysed patients who underwent SASI for obesity from December 2018 to June 2022 by the same team of surgeons. There were 2 groups of patients. The first group consisted of patients who underwent SASI as their first bariatric procedure (primary group – PG). The second group consisted of patients who underwent SASI after previous SG procedure due to weight regain and/or symptoms of gastroesophageal reflux disease (GERD) (revisional group – RG). Results There were 15 patients (80% female) in the PG, and 14 patients (88% female) in the RG. In the PG, %TWL 12 and 36 months after surgery was 37.8% and 43.9% respectively. In the RG, %TWL 12 and 24 months after surgery was 13.8% and 20.9%, respectively. Most patients had complete remission of T2D and HT after surgery. In the RG, 9 (81.8%) patients had remission of GERD. The worsening of GERD was reported in 4 (40%) patients in the PG. Conclusions SASI may be an effective and safe method of treatment of obesity. SASI may be an effective method of revisional bariatric surgery performed for GERD, but not for weight regain.

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Section: Discussionmentioning

confidence: 99%

Single anastomosis sleeve ileal (SASI) bypass as a primary and revisional procedure: a single-centre experience.

Dowgiałło-Gornowicz,

Waczyński,

Waczyńska

et al. 2023

Videosurgery and Other Miniinvasive Techniques

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“…Musella et al [22] reported a multi-central retrospective anaylsis of patients undergoing OAGB after failed restrictive procedures and showed a 74.5% excess BMI loss at 20.8 months follow-up with 8.6% overall complication rate. In an expert's modified Delphi consensus on the best approach for redo surgeries after SG, OAGB was agreed by 84.7% of the committee to be an acceptable procedure after SG [23].…”

Section: Discussionmentioning

confidence: 99%

Revision of restrictive bariatric procedures in elderly patients: results at a 5-year follow-up

Abu-Abeid,

Gosher,

Shnell

et al. 2024

Updates Surg

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Revisional Bariatric Surgery (RBS) is increasing in popularity. Elderly patients (> 65 years old) are sometimes referred for RBS evaluation. The aim of this study is to evaluate outcomes of elderly patients undergoing RBS. A retrospective analysis of a cohort from a single–tertiary bariatric center. All elderly patients undergoing RBS after restrictive procedures between 2012 and 2022 were included. Thirty Nine patients undergoing RBS were included in the comparative analysis − 23 patients (57.5%) after adjustable gastric banding (s/p LAGB) and 16 patients (40%) after Sleeve Gastrectomy (s/p SG). The mean age and body mass index (BMI) of patients were comparable (67.2 ± 2.8 years and 38.3 ± 7.4, respectively). There was no difference in associated medical problems except reflux which was higher in s/p SG (68% vs. 13%; p < 0.001). The mean time interval between surgeries was 8.7 ± 5.1 years. The surgeries included One anastomosis gastric bypass (n = 22), SG (n = 8) and Roux-en-y gastric bypass (n = 9). Early major complication rates were comparable (4.3% and 12.5%; p = 0.36), and readmission rate was higher in patients s/p SG (p = 0.03). Ninety percent of patients were available to a follow-up of 59.8 months. The mean BMI and total weight loss was 29.2 and 20.3%, respectively with no difference between groups. The rate of patients with associated medical problems at last follow-up was significantly reduced. Five patients (12.5%) underwent revisional surgery due to complications during follow-up. In conclusion, RBS in the elderly is associated with a reasonable complication rate and is effective in terms of weight loss and improvement of associated medical problems in a 5-year follow-up.

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“…44 The most recent expert-modified Delphi consensus on revisions after SG recommended an algorithmic approach with medical therapy first prior to considering RYGB. 45 Staple line leak and bleeding can be devastating complications after SG, and several adjuncts have been proposed to reduce this risk. These include staple-line reinforcement with buttress material, oversewing of the staple lines, and application of fibrin glue.…”

Section: Sleeve Gastrectomymentioning

confidence: 99%

“…44 The most recent expert-modified Delphi consensus on revisions after SG recommended an algorithmic approach with medical therapy first prior to considering RYGB. 45…”

Section: Sleeve Gastrectomymentioning

confidence: 99%

Updates in Bariatric Surgery

Hsu,

Farrell

2023

The American Surgeon™

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Bariatric surgery is currently the most effective long-term treatment for morbid obesity as well as type-2 diabetes mellitus. The field of metabolic and bariatric surgery has seen tremendous growth over the past decade with dramatically reduced risks. This article aims to provide an update on bariatric surgery, highlighting the latest outcomes, improvements, and challenges in the field. Recently, the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) released a major update to the indications for bariatric surgery at BMI ≥35 kg/m2 regardless of co-morbidities and 30-34.9 kg/m2 with obesity-related comorbidities. Sleeve gastrectomy has emerged as the most popular bariatric procedure in the last 10 years with its remarkable efficacy and safety profile. The implementation of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) and Enhanced Recovery After Surgery (ERAS) protocols have significantly improved the quality of care for all bariatric patients. The recent introduction and FDA approval of Glucagon-Like Peptide-1 (GLP-1) agonists for chronic obesity has garnered significant media coverage and popularity, but no guidelines exist regarding its use in relation to bariatric surgery. This update underscores the need for tailored approaches, ongoing research, and the integration of evidence-based medicine and innovations to enhance patient care.

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

Cited by 25 publications

References 55 publications

Single anastomosis sleeve ileal (SASI) bypass as a primary and revisional procedure: a single-centre experience.

Single anastomosis sleeve ileal (SASI) bypass as a primary and revisional procedure: a single-centre experience.

Revision of restrictive bariatric procedures in elderly patients: results at a 5-year follow-up

Updates in Bariatric Surgery

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