Michel Gagner1, Colleen Hutchinson2, Raul Rosenthal3. 1. Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Department of Surgery, Hopital du Sacre Coeur, Montreal, Quebec, Canada. 2. Cleveland Clinic Florida, Weston, Florida. 3. Cleveland Clinic Florida, Weston, Florida. Electronic address: rosentr@ccf.org.
Abstract
BACKGROUND: For the purpose of building best practice guidelines, an international expert panel was surveyed in 2014 and compared with the 2011 Sleeve Gastrectomy Consensus and with survey data culled from a general surgeon audience. OBJECTIVES: To measure advancement on aspects of laparoscopic sleeve gastrectomy and identify current best practices. SETTING: International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) 2014, Fifth International Summit for Laparoscopic Sleeve Gastrectomy, Montréal, Canada. METHODS: In August 2014, expert surgeons (based on having performed>1000 cases) completed an online anonymous survey. Identical survey questions were then administered to general surgeon attendees. RESULTS: One hundred twenty bariatric surgeons completed the expert survey, along with 103 bariatric surgeons from IFSO 2014 general surgeon audience. The following indications were endorsed: as a stand-alone procedure (97.5%); in high-risk patients (92.4%); in kidney and liver transplant candidates (91.6%); in patients with metabolic syndrome (83.8%); body mass index 30-35 with associated co-morbidities (79.8%); in patients with inflammatory bowel disease (87.4%); and in the elderly (89.1%). Significant differences existed between the expert and general surgeons groups in endorsing several contraindications: Barrett's esophagus (80.0% versus 31.3% [P<.001]), gastroesophageal reflux disease (23.3% versus 52.5% [P<.001]), hiatal hernias (11.7% versus 54.0% [P<.001]), and body mass index>60 kg/m(2) (5.0% versus 28.0% [P<.001]). Average reported weight loss outcomes 5 years postoperative were significantly higher for the expert surgeons group (P = .005), as were reported stricture (P = .001) and leakage (P = .005) rates. The following significant differences exist between 2014 and 2011 expert surgeons: Patients with gastroesophageal reflux disease should have pH and manometry study pre-laparoscopic sleeve gastrectomy (32.8% versus 50.0%; P = .033); it is important to take down the vessels before resection (88.1% versus 81.8%; P = .025); it is acceptable to buttress (81.4% versus 77.3%; P<.001); the smaller the bougie size and tighter the sleeve, the higher the incidence of leaks (78.8% versus 65.2%; P = .006). CONCLUSION: This study highlights areas of new and improved best practices on various aspects of laparoscopic sleeve gastrectomy performance among experts from 2011 and 2014 and among the current general surgeon population.
BACKGROUND: For the purpose of building best practice guidelines, an international expert panel was surveyed in 2014 and compared with the 2011 Sleeve Gastrectomy Consensus and with survey data culled from a general surgeon audience. OBJECTIVES: To measure advancement on aspects of laparoscopic sleeve gastrectomy and identify current best practices. SETTING: International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) 2014, Fifth International Summit for Laparoscopic Sleeve Gastrectomy, Montréal, Canada. METHODS: In August 2014, expert surgeons (based on having performed>1000 cases) completed an online anonymous survey. Identical survey questions were then administered to general surgeon attendees. RESULTS: One hundred twenty bariatric surgeons completed the expert survey, along with 103 bariatric surgeons from IFSO 2014 general surgeon audience. The following indications were endorsed: as a stand-alone procedure (97.5%); in high-risk patients (92.4%); in kidney and liver transplant candidates (91.6%); in patients with metabolic syndrome (83.8%); body mass index 30-35 with associated co-morbidities (79.8%); in patients with inflammatory bowel disease (87.4%); and in the elderly (89.1%). Significant differences existed between the expert and general surgeons groups in endorsing several contraindications: Barrett's esophagus (80.0% versus 31.3% [P<.001]), gastroesophageal reflux disease (23.3% versus 52.5% [P<.001]), hiatal hernias (11.7% versus 54.0% [P<.001]), and body mass index>60 kg/m(2) (5.0% versus 28.0% [P<.001]). Average reported weight loss outcomes 5 years postoperative were significantly higher for the expert surgeons group (P = .005), as were reported stricture (P = .001) and leakage (P = .005) rates. The following significant differences exist between 2014 and 2011 expert surgeons: Patients with gastroesophageal reflux disease should have pH and manometry study pre-laparoscopic sleeve gastrectomy (32.8% versus 50.0%; P = .033); it is important to take down the vessels before resection (88.1% versus 81.8%; P = .025); it is acceptable to buttress (81.4% versus 77.3%; P<.001); the smaller the bougie size and tighter the sleeve, the higher the incidence of leaks (78.8% versus 65.2%; P = .006). CONCLUSION: This study highlights areas of new and improved best practices on various aspects of laparoscopic sleeve gastrectomy performance among experts from 2011 and 2014 and among the current general surgeon population.
Authors: 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 Journal: Surg Endosc Date: 2019-06-19 Impact factor: 4.584
Authors: Neal Mehta; Andrew T Strong; Tyler Stevens; Kevin El-Hayek; Alfred Nelson; Adeyinka Owoyele; Ahmed Eltelbany; Prabhleen Chahal; Maged Rizk; Carol A Burke; John McMichael; Rocio Lopez; Joseph Veniero; John Vargo; Matthew Kroh; Amit Bhatt Journal: Surg Endosc Date: 2018-10-23 Impact factor: 4.584