The first consensus statement on revisional bariatric surgery using a modified Delphi approach

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

doi:10.1007/s00464-019-06937-1

The first consensus statement on revisional bariatric surgery using a modified Delphi approach

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 DargentAbdelrahman Nimeri, Peter K Small

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Pages (from-to)	1648-1657
Number of pages	10
Journal	Surgical endoscopy and other interventional techniques
Volume	34
Issue number	4
DOIs	https://doi.org/10.1007/s00464-019-06937-1
Publication status	Published - Apr 2020

Keywords

Bariatric surgery
Revisional bariatric surgery
Gastric banding
Sleeve gastrectomy
Roux-en-Y gastric bypass
One anastomosis gastric bypass
Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy
Obesity surgery
Conversion
Weight regain
Band to sleeve
Band to bypass
Sleeve to bypass
Y GASTRIC BYPASS
SLEEVE GASTRECTOMY
WEIGHT REGAIN
OUTCOMES

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10.1007/s00464-019-06937-1

Cite this

Mahawar, K. K., Himpens, J. M., Shikora, S. A., Ramos, A. C., Torres, A., Somers, S., Dillemans, B., Angrisani, L., Greve, J. W. M., Chevallier, J.-M., Chowbey, P., De Luca, M., Weiner, R., Prager, G., Vilallonga, R., Adamo, M., Sakran, N., Kow, L., Lakdawala, M., ... Small, P. K. (2020). The first consensus statement on revisional bariatric surgery using a modified Delphi approach. Surgical endoscopy and other interventional techniques, 34(4), 1648-1657. https://doi.org/10.1007/s00464-019-06937-1

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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.",

keywords = "Bariatric surgery, Revisional bariatric surgery, Gastric banding, Sleeve gastrectomy, Roux-en-Y gastric bypass, One anastomosis gastric bypass, Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy, Obesity surgery, Conversion, Weight regain, Band to sleeve, Band to bypass, Sleeve to bypass, Y GASTRIC BYPASS, SLEEVE GASTRECTOMY, WEIGHT REGAIN, OUTCOMES",

author = "Mahawar, {Kamal K} and Himpens, {Jacques M} and Shikora, {Scott A} and Ramos, {Almino C} and Antonio Torres and Shaw Somers and Bruno Dillemans and Luigi Angrisani and Greve, {Jan Willem M} and Jean-Marc Chevallier and Pradeep Chowbey and {De Luca}, Maurizio and Rudolf Weiner and Gerhard Prager and Ramon Vilallonga and Marco Adamo and Nasser Sakran and Lilian Kow and Mufazzal Lakdawala and Jerome Dargent and Abdelrahman Nimeri and Small, {Peter K}",

note = "Publisher Copyright: {\textcopyright} 2019, Springer Science+Business Media, LLC, part of Springer Nature.",

year = "2020",

month = apr,

doi = "10.1007/s00464-019-06937-1",

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Mahawar, KK, Himpens, JM, Shikora, SA, Ramos, AC, Torres, A, Somers, S, Dillemans, B, Angrisani, L, Greve, JWM, Chevallier, J-M, Chowbey, P, De Luca, M, Weiner, R, Prager, G, Vilallonga, R, Adamo, M, Sakran, N, Kow, L, Lakdawala, M, Dargent, J, Nimeri, A & Small, PK 2020, 'The first consensus statement on revisional bariatric surgery using a modified Delphi approach', Surgical endoscopy and other interventional techniques, vol. 34, no. 4, pp. 1648-1657. https://doi.org/10.1007/s00464-019-06937-1

TY - JOUR

T1 - The first consensus statement on revisional bariatric surgery using a modified Delphi approach

AU - Mahawar, Kamal K

AU - Himpens, Jacques M

AU - Shikora, Scott A

AU - Ramos, Almino C

AU - Torres, Antonio

AU - Somers, Shaw

AU - Dillemans, Bruno

AU - Angrisani, Luigi

AU - Greve, Jan Willem M

AU - Chevallier, Jean-Marc

AU - Chowbey, Pradeep

AU - De Luca, Maurizio

AU - Weiner, Rudolf

AU - Prager, Gerhard

AU - Vilallonga, Ramon

AU - Adamo, Marco

AU - Sakran, Nasser

AU - Kow, Lilian

AU - Lakdawala, Mufazzal

AU - Dargent, Jerome

AU - Nimeri, Abdelrahman

AU - Small, Peter K

PY - 2020/4

Y1 - 2020/4

N2 - 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.

AB - 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.

KW - Bariatric surgery

KW - Revisional bariatric surgery

KW - Gastric banding

KW - Sleeve gastrectomy

KW - Roux-en-Y gastric bypass

KW - One anastomosis gastric bypass

KW - Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy

KW - Obesity surgery

KW - Conversion

KW - Weight regain

KW - Band to sleeve

KW - Band to bypass

KW - Sleeve to bypass

KW - Y GASTRIC BYPASS

KW - SLEEVE GASTRECTOMY

KW - WEIGHT REGAIN

KW - OUTCOMES

U2 - 10.1007/s00464-019-06937-1

DO - 10.1007/s00464-019-06937-1

M3 - Article

C2 - 31218425

SN - 0930-2794

VL - 34

SP - 1648

EP - 1657

JO - Surgical endoscopy and other interventional techniques

JF - Surgical endoscopy and other interventional techniques

IS - 4

ER -