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

Area of Science:

• Bariatric and Metabolic Surgery
• Surgical Outcomes
• Gastroenterology

Background:

• Sleeve gastrectomy (SG) is a leading bariatric procedure for obesity and related conditions.
• Revisional or conversional surgeries post-SG are a growing concern for surgeons.
• Developing clear guidelines for redo-surgeries after SG is crucial.

Purpose of the Study:

• To establish an algorithmic clinical approach for redo-surgeries following sleeve gastrectomy.
• To provide bariatric and metabolic surgeons with expert-guided decision-making protocols.
• To address common issues like insufficient weight loss, weight regain, and GERD post-SG.

Main Methods:

• A two-round Delphi consensus study involving 46 bariatric and metabolic surgeons from 25 countries.
• Consensus defined as agreement/disagreement ≥ 70.0% on statements regarding redo-surgeries after SG.
• Analysis of expert opinions on timing, management, and surgical options for redo-procedures.

Main Results:

• Consensus was achieved on 62 out of 72 statements.
• Experts agreed on multidisciplinary team evaluation for all redo-surgeries.
• A minimum of 12 months of medical/supportive management is recommended before redo-surgery for weight loss issues or GERD.

Conclusions:

• Redo-surgeries after SG remain a significant clinical challenge.
• An algorithmic approach based on expert consensus can aid decision-making for redo-surgeries.
• Careful consideration of timing and procedure selection, guided by a multidisciplinary team, is essential.