Sixth international consensus conference on sleeve gastrectomy

The aim of this consensus meeting and survey of international experts in obesity management was to establish a unified agreement on three key aspects of LSG: preoperative workup, intraoperative considerations, and the management of postoperative complications.

The content of this expert review was formulated and subjected to voting by a panel of leading specialists during the Sleeve Consensus Summit, held in Montpellier on 3rd and 4th of October 2024. Previous consensus conferences were analyzed to refine the questionnaires used in this study.

A consensus rate above 70% among experts surveyed was reached for 35 out of 50 statements. The following indications for Sleeve Gastrectomy (SG) were endorsed: adolescent (<18 years old) surgery (92%), elderly (>65 years old) patients (94%), best surgical option for patients with severe liver disease (81%), for patients requiring liver, kidney or heart transplant (100%) and as the best option for patients requiring complex abdominal wall reconstruction (85%). Dissection of the hiatus should not be performed routinely (75% consensus) but small (<3 cm) hiatal hernia discovered during surgery should be directly repaired by cruroplasty (83% consensus). For the endoscopic management of acute leak post SG in stable patients, endoscopic pigtail drainage was judged as the best first-line option (82%), above stenting (29%) or endoscopic suturing (18%). RYGB was deemed indicated for patients with sufficient weight loss and severe GERD (76%) and SADI was judged as the best surgical option for patients with poor weight loss without severe GERD (70%).

LSG has become a safe, efficient and validated procedure during the last 25 years. Both the preoperative workup and intraoperative considerations are well standardized. Our focus in clinical practice should be concentrated to diminish the reflux, but also to offer a better option for revisional surgery following LSG.