Kamal K Mahawar1, Jacques M Himpens2, Scott A Shikora3, Almino C Ramos4, Antonio Torres5, Shaw Somers6, Bruno Dillemans7, Luigi Angrisani8, Jan Willem M Greve9,10, Jean-Marc Chevallier11, Pradeep Chowbey12, Maurizio De Luca13, Rudolf Weiner14, Gerhard Prager15, Ramon Vilallonga16, Marco Adamo17, Nasser Sakran18, Lilian Kow19, Mufazzal Lakdawala20, Jerome Dargent21, Abdelrahman Nimeri22, Peter K Small23. 1. Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK. kmahawar@gmail.com. 2. St Pierre University Hospital, Brussels, Belgium. 3. Brigham and Women's Hospital, Harvard Medical School, Boston, USA. 4. Gastro-Obeso-Center Metabolic Optimisation Institute, Sao Paulo, Brazil. 5. Hospital Clinico San Carlos, Complutense University, Madrid, Spain. 6. Portsmouth Hospitals NHS Trust, Portsmouth, UK. 7. AZ Sint Jan AV, Bruges, Oostend, Belgium. 8. Department of Public Health, University of Naples "Federico II", Naples, Italy. 9. Zuyderland Medical Center, Heerlen, The Netherlands. 10. The Netherlands and Maastricht University (MUMC+), Maastricht, The Netherlands. 11. Université Paris 5, Paris, France. 12. Max Institute of Minimal Access Metabolic and Bariatric Surgery, Max Hospital, Saket, New Delhi, India. 13. Castelfranco and Montebelluna Hospitals, Treviso, Italy. 14. Clinic Obesity Surgery, Sana-Klinikum Offenbach, Offenbach, Germany. 15. Medical University of Vienna, Vienna, Austria. 16. Universitary Hospital Vall Hebron, Barcelona, Spain. 17. University College London Hospital, London, UK. 18. Emek Medical Center, Afula, Israel. 19. Flinders Private Hospital, Adelaide, Australia. 20. Digestive Health Institute, Saifee Hospital, Mumbai, India. 21. Polyclinique Lyon Nord, Lyon, France. 22. Bariatric & Metabolic Institute (BMI), Abu Dhabi, United Arab Emirates. 23. Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK.
Abstract
BACKGROUND: Revisional bariatric surgery (RBS) constitutes a possible solution for patients who experience an inadequate response following bariatric surgery or significant weight regain following an initial satisfactory response. This paper reports results from the first modified Delphi consensus-building exercise on RBS. METHODS: We created a committee of 22 recognised opinion-makers with a special interest in RBS. The committee invited 70 RBS experts from 27 countries to vote on 39 statements concerning RBS. An agreement amongst ≥ 70.0% experts was regarded as a consensus. RESULTS: Seventy experts from twenty-seven countries took part. There was a consensus that the decision for RBS should be individualised (100.0%) and multi-disciplinary (92.8%). Experts recommended a preoperative nutritional (95.7%) and psychological evaluation (85.7%), endoscopy (97.1%), and a contrast series (94.3%). Experts agreed that Roux-Y gastric bypass (RYGB) (94.3%), One anastomosis gastric bypass (OAGB) (82.8%), and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) (71.4%) were acceptable RBS options after gastric banding (84.3%). OAGB (84.3%), bilio-pancreatic diversion/duodenal switch (BPD/DS) (81.4%), and SADI-S (88.5%) were agreed as consensus RBS options after sleeve gastrectomy. lengthening of bilio-pancreatic limb was the only consensus RBS option after RYGB (94.3%) and OAGB (72.8%). CONCLUSION: Experts achieved consensus on a number of aspects of RBS. Though expert opinion can only be regarded as low-quality evidence, the findings of this exercise should help improve the outcomes of RBS while we develop robust evidence to inform future practice.
BACKGROUND: Revisional bariatric surgery (RBS) constitutes a possible solution for patients who experience an inadequate response following bariatric surgery or significant weight regain following an initial satisfactory response. This paper reports results from the first modified Delphi consensus-building exercise on RBS. METHODS: We created a committee of 22 recognised opinion-makers with a special interest in RBS. The committee invited 70 RBS experts from 27 countries to vote on 39 statements concerning RBS. An agreement amongst ≥ 70.0% experts was regarded as a consensus. RESULTS: Seventy experts from twenty-seven countries took part. There was a consensus that the decision for RBS should be individualised (100.0%) and multi-disciplinary (92.8%). Experts recommended a preoperative nutritional (95.7%) and psychological evaluation (85.7%), endoscopy (97.1%), and a contrast series (94.3%). Experts agreed that Roux-Y gastric bypass (RYGB) (94.3%), One anastomosis gastric bypass (OAGB) (82.8%), and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) (71.4%) were acceptable RBS options after gastric banding (84.3%). OAGB (84.3%), bilio-pancreatic diversion/duodenal switch (BPD/DS) (81.4%), and SADI-S (88.5%) were agreed as consensus RBS options after sleeve gastrectomy. lengthening of bilio-pancreatic limb was the only consensus RBS option after RYGB (94.3%) and OAGB (72.8%). CONCLUSION: Experts achieved consensus on a number of aspects of RBS. Though expert opinion can only be regarded as low-quality evidence, the findings of this exercise should help improve the outcomes of RBS while we develop robust evidence to inform future practice.
Entities:
Keywords:
Band to bypass; Band to sleeve; Bariatric surgery; Conversion; Gastric banding; Obesity surgery; One anastomosis gastric bypass; Revisional bariatric surgery; Roux-en-Y gastric bypass; Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy; Sleeve gastrectomy; Sleeve to bypass; Weight regain
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