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 journalArticleAcademicpeer-review

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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 languageEnglish
Pages (from-to)1648-1657
Number of pages10
JournalSurgical endoscopy and other interventional techniques
Issue number4
Publication statusPublished - Apr 2020


  • 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

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