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

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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.

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Abbreviations

RBS:

Revisional bariatric surgery

IFSO:

International Federation for the Surgery of Obesity and Metabolic Disorders

OAGB/MGB:

One anastomosis (mini) gastric bypass

RYGB:

Roux-en-Y gastric bypass

SADI-S:

Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy

SG:

Sleeve gastrectomy

BPL:

Bilio-pancreatic limb

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Author information

Authors and Affiliations

  1. Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK

    Kamal K. Mahawar & Peter K. Small

  2. St Pierre University Hospital, Brussels, Belgium

    Jacques M. Himpens

  3. Brigham and Women’s Hospital, Harvard Medical School, Boston, USA

    Scott A. Shikora

  4. Gastro-Obeso-Center Metabolic Optimisation Institute, Sao Paulo, Brazil

    Almino C. Ramos

  5. Hospital Clinico San Carlos, Complutense University, Madrid, Spain

    Antonio Torres

  6. Portsmouth Hospitals NHS Trust, Portsmouth, UK

    Shaw Somers

  7. AZ Sint Jan AV, Bruges, Oostend, Belgium

    Bruno Dillemans

  8. Department of Public Health, University of Naples “Federico II”, Naples, Italy

    Luigi Angrisani

  9. Zuyderland Medical Center, Heerlen, The Netherlands

    Jan Willem M. Greve

  10. The Netherlands and Maastricht University (MUMC+), Maastricht, The Netherlands

    Jan Willem M. Greve

  11. Université Paris 5, Paris, France

    Jean-Marc Chevallier

  12. Max Institute of Minimal Access Metabolic and Bariatric Surgery, Max Hospital, Saket, New Delhi, India

    Pradeep Chowbey

  13. Castelfranco and Montebelluna Hospitals, Treviso, Italy

    Maurizio De Luca

  14. Clinic Obesity Surgery, Sana-Klinikum Offenbach, Offenbach, Germany

    Rudolf Weiner

  15. Medical University of Vienna, Vienna, Austria

    Gerhard Prager

  16. Universitary Hospital Vall Hebron, Barcelona, Spain

    Ramon Vilallonga

  17. University College London Hospital, London, UK

    Marco Adamo

  18. Emek Medical Center, Afula, Israel

    Nasser Sakran

  19. Flinders Private Hospital, Adelaide, Australia

    Lilian Kow

  20. Digestive Health Institute, Saifee Hospital, Mumbai, India

    Mufazzal Lakdawala

  21. Polyclinique Lyon Nord, Lyon, France

    Jerome Dargent

  22. Bariatric & Metabolic Institute (BMI), Abu Dhabi, United Arab Emirates

    Abdelrahman Nimeri

Authors
  1. Kamal K. Mahawar
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  2. Jacques M. Himpens
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  3. Scott A. Shikora
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  4. Almino C. Ramos
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  5. Antonio Torres
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  6. Shaw Somers
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  7. Bruno Dillemans
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  8. Luigi Angrisani
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  9. Jan Willem M. Greve
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  10. Jean-Marc Chevallier
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  11. Pradeep Chowbey
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  12. Maurizio De Luca
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  13. Rudolf Weiner
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  14. Gerhard Prager
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  15. Ramon Vilallonga
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  16. Marco Adamo
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  17. Nasser Sakran
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  18. Lilian Kow
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  19. Mufazzal Lakdawala
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  20. Jerome Dargent
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  21. Abdelrahman Nimeri
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  22. Peter K. Small
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Contributions

KKM conceived the idea for this exercise, moderated it, analysed the results, and wrote large sections of the manuscript. All other authors helped with determining the methodology of the exercise, provided feedback at every stage, took part in the online voting, critically reviewed the draft of the manuscript, and provided robust leadership. All authors have seen the final draft and approve of it.

Corresponding author

Correspondence to Kamal K. Mahawar.

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Disclosures

Dr. Mahawar has been paid honoraria by Medtronic, Gore, and Olympus for educational activities, outside the submitted work. Dr. Himpens is a consultant with Medtronic and Ethicon. Dr. Torres reports personal fees from Ethicon, personal fees from Medtronic, outside the submitted work. Dr. Dillemans is a consultant with Medtronic and with Ethicon. Dr. Greve reports personal fees from GI Dynamics, outside the submitted work. Dr. Adamo reports grants from Ethicon, grants from Gore, personal fees from Olympus, personal fees from Gore, and personal fees from Stryker. Drs. Shikora, Ramos, Somers, Angrisani, Chevallier, Chowbey, De Luca, Weiner, Prager, Vilallonga, Sakran, Kow, Lakdawala, Dargent, Nimeri, and Small have no conflicts of interests or financial ties to disclose.

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Mahawar, K.K., Himpens, J.M., Shikora, S.A. et al. The first consensus statement on revisional bariatric surgery using a modified Delphi approach. Surg Endosc 34, 1648–1657 (2020). https://doi.org/10.1007/s00464-019-06937-1

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