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

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Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgical (MBS) procedure worldwide. Despite the desired effect of SG on weight loss and remission of obesity-associated medical problems, there are some concerns regarding the need to do revisional/conversional surgeries after SG. This study aims to make an algorithmic clinical approach based on an expert-modified Delphi consensus regarding redo-surgeries after SG, to give bariatric and metabolic surgeons a guideline that might help for the best clinical decision.


Forty-six recognized bariatric and metabolic surgeons from 25 different countries participated in this Delphi consensus study in two rounds to develop a consensus on redo-surgeries after SG. An agreement/disagreement ≥ 70.0% on statements was considered to indicate a consensus.


Consensus was reached for 62 of 72 statements and experts did not achieve consensus on 10 statements after two rounds of online voting. Most of the experts believed that multi-disciplinary team evaluation should be done in all redo-procedures after SG and there should be at least 12 months of medical and supportive management before performing redo-surgeries after SG for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD). Also, experts agreed that in case of symptomatic GERD in the presence of adequate weight loss, medical treatment for at least 1 to 2 years is an acceptable option and agreed that Roux-en Y gastric bypass is an appropriate option in this situation. There was disagreement consensus on efficacy of omentopexy in rotation and efficacy of fundoplication in the presence of a dilated fundus and GERD.


Redo-surgeries after SG is still an important issue among bariatric and metabolic surgeons. The proper time and procedure selection for redo-surgery need careful considerations. Although multi-disciplinary team evaluation plays a key role to evaluate best options in these situations, an algorithmic clinical approach based on the expert's consensus as a guideline can help for the best clinical decision-making.

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Fig. 1

Similar content being viewed by others



Sleeve gastrectomy (SG)


Gastroesophageal reflux disease


Multi-disciplinary team


Esophagogastroduodenoscopy (EGD)


Upper gastrointestinal


Roux-en Y gastric bypass


One anastomosis gastric bypass


Biliopancreatic diversion/duodenal switch


Single Anastomosis Duodeno-Ileal bypass with Sleeve Gastrectomy


Single Anastomosis Sleeve Ileal Bypass


Sleeve gastrectomy with transit bipartition


Hiatal hernia


Endoscopic sleeve gastroplasty


Biliopancreatic limb


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Authors and Affiliations


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Correspondence to Mohammad Kermansaravi or Natan Zundel.

Ethics declarations


Dr. Bruno Dilemans has an equity interest in Johnson & Johnson and Medtronic& Olympus. Dr. Farah Husain has an equity interest in Ethicon J&J. Dr. Ashraf Haddad has an equity interest consultant for Medtronic and Speaker for EziSurge Medical. Dr. Sonja Chiappetta has an equity interest in Novo Nordisc and Johnson and Johnson. Dr. Ricardo Cohen has an equity interest in Johnson & Johnson and Medtronic and Scientific Advisory Board for Baritek; GI Dynamics. Dr. Karl Miller has an equity interest in J&J as consultant. Dr. Ali Aminian has an equity interest in Honorarium and research support from Medtronic and Ethicon. Dr. Kamal Mahawar has been paid honoraria by Medtronic, Ethicon, Olympus, Gore, and several NHS truts for education activities and mentoring in the field of bariatric surgery (predominantly One Anastomosis Gastric Bypass). Dr. Natan Zundel has an equity interest in Johnson & Johnson and Medtronic, Olympus, Apolo, VHP, LivsMed. Drs Mohammad Kermansaravi, Chetan Parmar, Scott Shikora, Syed Imran Abbas, Luigi Angrisani, Ahmad Bashir, Estuardo Behrens, Mohit Bhandari, Benjamin Clapp, Jerome Dargent, Maurizio De Luca, Khaled Gawdat, Mohamed Hayssam Elfawal, Jaques Himpens, Chih-Kun Huang, Kazunori Kasama, Radwan Kassir, Amir Khan, Lilian Kow, Matthew Kroh, Muffazal Lakdawala, Juan Antonio Lopez Corvala, Mario Musella, Abdelrahman Nimeri, Patrick Noel, Mariano Palermo, Luis Poggi, Tigran Poghosyan, Gerhard Prager, Arun Prasad, Aayad Alqahtani, Karl Rheinwalt, Rui Ribeiro, Asim Shabbir, Antonio Torres, Ramon Villalonga, and Cunchuan Wang have no conflict of interest or financial ties to disclose.

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Appendix: List of modified Delphi consensus experts (in alphabetical order)

Appendix: List of modified Delphi consensus experts (in alphabetical order)



1. Syed Imran Abbas


2. Ali Aminian


3. Luigi Angrisani


4. Ahmad Bashir


5. Estuardo Behrens


6. Mohit Bhandari


7. Sonja Chiappetta


8. Ben Clapp


9. Ricardo Cohen


10. Jerome Dargent


11. Maurizio De Luca


12. Bruno Dillemans


13. Mohamed Hayssam Elfawal


14. Khaled Gawdat


15. Ashraf Haddad


16. Jaques Himpens


17. Chih-Kun Huang


18. Farah Hussain


19. Kazunori Kasama


20. Radwan Kassir


21. Mohammad Kermansaravi


22. Amir Khan


23. Lilian Kow


24. Matthew Kroh


25. Muffazal Lakdawala


26. Juan Antonio Lopez Corvala


27. Kamal Mahawar


28. Karl Miller


29. Mario Musella


30. Abdelrahman Nimeri


31. Patrick Noel


32. Mariano Palermo


33. Chetan Parmar


34. Luis Poggi


35. Tigran Poghosyan


36. Gerhard Prager


37. Arun Prasad


38. Aayad Alqahtani

Saudi Arabia

39. Karl Rheinwalt


40. Rui Ribeiro


41. Asim Shabbir


42. Scott Shikora


43. Antonio Torres


44. Ramon Villalonga


45. Cunchuan Wang


46. Natan Zundel


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Kermansaravi, M., Parmar, C., Chiappetta, S. et al. Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus. Surg Endosc 37, 1617–1628 (2023).

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