Fifth International Consensus Conference: current status of sleeve gastrectomy
Abstract
Background For the purpose of building best practice guidelines, an international expert panel was surveyed in 2014 and compared with the 2011 Sleeve Gastrectomy Consensus and with survey data culled from a general surgeon audience.Objectives To measure advancement on aspects of laparoscopic sleeve gastrectomy and identify current best practices.Setting International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) 2014, Fifth International Summit for Laparoscopic Sleeve Gastrectomy, Montréal, Canada.Methods In August 2014, expert surgeons (based on having performed>1000 cases) completed an online anonymous survey. Identical survey questions were then administered to general surgeon attendees.Results One hundred twenty bariatric surgeons completed the expert survey, along with 103 bariatric surgeons from IFSO 2014 general surgeon audience. The following indications were endorsed: as a stand-alone procedure (97.5%); in high-risk patients (92.4%); in kidney and liver transplant candidates (91.6%); in patients with metabolic syndrome (83.8%); body mass index 30-35 with associated co-morbidities (79.8%); in patients with inflammatory bowel disease (87.4%); and in the elderly (89.1%). Significant differences existed between the expert and general surgeons groups in endorsing several contraindications: Barrett's esophagus (80.0% versus 31.3% [P<.001]), gastroesophageal reflux disease (23.3% versus 52.5% [P<.001]), hiatal hernias (11.7% versus 54.0% [P<.001]), and body mass index>60 kg/m(2) (5.0% versus 28.0% [P<.001]). Average reported weight loss outcomes 5 years postoperative were significantly higher for the expert surgeons group (P = .005), as were reported stricture (P = .001) and leakage (P = .005) rates. The following significant differences exist between 2014 and 2011 expert surgeons: Patients with gastroesophageal reflux disease should have pH and manometry study pre-laparoscopic sleeve gastrectomy (32.8% versus 50.0%; P = .033); it is important to take down the vessels before resection (88.1% versus 81.8%; P = .025); it is acceptable to buttress (81.4% versus 77.3%; P<.001); the smaller the bougie size and tighter the sleeve, the higher the incidence of leaks (78.8% versus 65.2%; P = .006).Conclusion This study highlights areas of new and improved best practices on various aspects of laparoscopic sleeve gastrectomy performance among experts from 2011 and 2014 and among the current general surgeon population.
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According to the Fifth International Consensus Summit on Sleeve Gastrectomy, 43% of surgeons preferred buttressing material for suture line reinforcement, 29% preferred oversewing, and 28% did not use suture line reinforcement.
“According to the Fifth International Consensus Summit on Sleeve Gastrectomy, 43% of surgeons preferred buttressing material for suture line reinforcement, 29% preferred oversewing and the remaining 28% did not use suture line reinforcement [96].”
The Fifth International Consensus Summit survey found that bariatric surgeons tend to use a larger bougie than previously recorded, with a median size of 36F, and that more experts believe smaller bougies are associated with stricture and leaks (from 65% in 2011 to 79% in 2014, P = 0.006).
“The Fifth International Consensus Summit survey found that bariatric surgeons tend to use a larger bougie than previously recorded, the median size being 36F, most probably to avoid strictures and leak associated with stricture [96]. One of the widest differences between the consensus summit report of 2011 and 2014 is that more experts believe that smaller bougies are associated with stricture and”
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- Authors
- Gagner, M., Hutchinson, C., & Rosenthal, R.
- Affiliations
- Florida International University (US)
- Cleveland Clinic Florida (US)
- Corresponding author
- Rosenthal, Raul
- Venue
- Surgery for Obesity and Related Diseases
- Publisher
- Elsevier BV
- Published
- 2016-05
- Volume
- 12
- Issue
- 4
- Pages
- 750-756
- ISSN
- 1550-7289 (ISSN-L)
- OpenAlex
- W2250960278
- Cited by
- 401
- References
- 51
- Citations by year
- 2026: 11 · 2025: 29 · 2024: 47 · 2023: 38 · 2022: 38 · 2021: 63 · 2020: 61 · 2019: 46 · 2018: 43 · 2017: 16 · 2016: 7 · 2015: 1 · 2014: 1
- FWCI
- 41.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Surgery for Obesity and Related Diseases (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Medtronic
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Health Sciences › Medicine › Surgery › Body Contouring and Surgery
- Keywords
- laparoscopic sleeve gastrectomy, bariatric surgery
- MeSH terms
- Adult, Aged, Aged, 80 and over, Female, Gastrectomy, Gastroesophageal Reflux, Humans, Male, Middle Aged, Obesity, Morbid, Laparoscopy, Gastroplasty, Weight Loss, Treatment Outcome, Bariatric Surgery
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