Advertisement

International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases

  • Raul J. Rosenthal
    Correspondence
    Correspondence: Raul J. Rosenthal, M.D., F.A.C.S., F.A.S.M.B.S., Department of Surgery, Section of Minimally Invasive Surgery, Bariatric and Metabolic Institute, General Surgery Residency Program, Fellowship in Minimally Invasive and Bariatric Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331
    Search for articles by this author
  • International Sleeve Gastrectomy Expert Panel
Published:November 11, 2011DOI:https://doi.org/10.1016/j.soard.2011.10.019

      Abstract

      Background

      Laparoscopic sleeve gastrectomy (LSG) is an emerging surgical approach, but 1 that has seen a surge in popularity because of its perceived technical simplicity, feasibility, and good outcomes. An international expert panel was convened in Coral Gables, Florida on March 25 and 26, 2011, with the purpose of providing best practice guidelines through consensus regarding the performance of LSG. The panel comprised 24 centers and represented 11 countries, spanning all major regions of the world and all 6 populated continents, with a collective experience of >12,000 cases. It was thought prudent to hold an expert consensus meeting of some of the surgeons across the globe who have performed the largest volume of cases to discuss and provide consensus on the indications, contraindications, and procedural aspects of LSG. The panel undertook this consensus effort to help the surgical community improve the efficacy, lower the complication rates, and move toward adoption of standardized techniques and measures. The meeting took place at on-site meeting facilities, Biltmore Hotel, Coral Gables, Florida.

      Methods

      Expert panelists were invited to participate according to their publications, knowledge and experience, and identification as surgeons who had performed >500 cases. The topics for consensus encompassed patient selection, contraindications, surgical technique, and the prevention and management of complications. The responses were calculated and defined as achieving consensus (≥70% agreement) or no consensus (<70% agreement).

      Results

      Full consensus was obtained for the essential aspects of the indications and contraindications, surgical technique, management, and prevention of complications. Consensus was achieved for 69 key questions.

      Conclusion

      The present consensus report represents the best practice guidelines for the performance of LSG, with recommendations in the 3 aforementioned areas. This report and its findings support a first effort toward the standardization of techniques and adoption of working recommendations formulated according to expert experience.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Surgery for Obesity and Related Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bellanger D.E.
        • Greenway F.L.
        Laparoscopic sleeve gastrectomy, 529 cases without a leak: short-term results and technical considerations.
        Obes Surg. 2011; 21: 146-150
        • Brethauer S.A.
        • Hammel J.P.
        • Schauer P.R.
        Systematic review of sleeve gastrectomy as a staging and primary bariatric operation.
        Surg Obes Relat Dis. 2009; 5: 469-475
        • Campos J.M.
        • Pereira E.F.
        • Evangelista L.F.
        • et al.
        Gastrobronchial fistula after sleeve gastrectomy and gastric bypass: endoscopic management and prevention.
        Obes Surg. 2011; 21: 1520-1529
        • Surg O.
        Clinical Issues Committee of the American Society for Metabolic and Bariatric Surgery: updated position statement on sleeve gastrectomy as a bariatric procedure.
        Surg Obes Relat Dis. 2010; 6: 1-5
        • Dapri G.
        • Cadière G.B.
        • Himpens J.
        Laparoscopic repeat sleeve gastrectomy versus duodenal switch after isolated sleeve gastrectomy for obesity.
        Surg Obes Relat Dis. 2011; 7: 38-43
        • Dapri G.
        • Cadière G.B.
        • Himpens J.
        Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing three different techniques.
        Obes Surg. 2010; 20: 462-467
        • Felberbauer F.X.
        • Langer F.
        • Shakeri-Manesch S.
        • et al.
        Laparoscopic sleeve gastrectomy as an isolated bariatric procedure: intermediate-term results from a large series in three Austrian Centers.
        Obes Surg. 2008; 18: 814-818
        • Fuks D.
        • Verhaeghe P.
        • Brehant O.
        • et al.
        Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity.
        Surgery. 2009; 145: 106-113
        • Gagner M.
        • Gumbs A.A.
        • Milone L.
        • Yung E.
        • Goldenberg L.
        • Pomp A.
        Laparoscopic sleeve gastrectomy for the super-super-obese (body mass index >60 kg/m(2)).
        Surg Today. 2008; 38: 399-403
        • Himpens J.
        • De Schepper M.
        • Dapri G.
        Laparoscopic conversion of adjustable gastric banding to sleeve gastrectomy: a feasibility study.
        Surg Laparosc Endosc Percutan Tech. 2010; 20: 162-165
        • Himpens J.
        • Dobbeleir J.
        • Peeters G.
        Long-term results of laparoscopic sleeve gastrectomy for obesity.
        Ann Surg. 2010; 252: 319-324
        • Hakeam H.A.
        • O'Regan P.J.
        • Salem A.M.
        • Bamehriz F.Y.
        • Jomaa L.F.
        Inhibition of C-reactive protein in morbidly obese patients after laparoscopic sleeve gastrectomy.
        Obes Surg. 2009; 19: 456-460
        • Jossart G.H.
        Complications of sleeve gastrectomy: bleeding and prevention.
        Surg Laparosc Endosc Percutan Tech. 2010; 20: 146-147
        • Karamanakos S.N.
        • Vagenas K.
        • Kalfarentzos F.
        • Alexandrides T.K.
        Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric by- pass and sleeve gastrectomy: a prospective, double blind study.
        Ann Surg. 2008; 247: 401-407
        • Kasalicky M.
        • Michalsky D.
        • Housova J.
        • et al.
        Laparoscopic sleeve gastrectomy without an over-sewing of the staple line.
        Obes Surg. 2008; 18: 1257-1262
        • Lakdawala M.A.
        • Bhasker A.
        • Mulchandani D.
        • Goel S.
        • Jain S.
        Comparison between the results of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass in the Indian population: a retrospective 1 year study.
        Obes Surg. 2010; 20: 1-6
        • Mui W.L.
        • Ng E.K.
        • Tsung B.Y.
        • Lam C.C.
        • Yung M.Y.
        Laparoscopic sleeve gastrectomy in ethnic obese Chinese.
        Obes Surg. 2008; 18: 1571-1574
        • Ou Yang O.
        • Loi K.
        • Liew V.
        • Talbot M.
        • Jorgensen J.
        Staged laparoscopic sleeve gastrectomy followed by Roux-en-Y gastric bypass for morbidly obese patients: a risk reduction strategy.
        Obes Surg. 2008; 18: 1575-1580
        • Parikh M.
        • Gagner M.
        • Heacock L.
        • Strain G.
        • Dakin G.
        • Pomp A.
        Laparoscopic sleeve gastrectomy: does bougie size affect mean %EWL?.
        Surg Obes Relat Dis. 2008; 4: 528-533
        • Quesada B.M.
        • Roff H.E.
        • Kohan G.
        • Salvador Oría A.
        • Chiappetta Porras L.T.
        Laparoscopic sleeve gastrectomy as an alternative to gastric bypass in patients with multiple intraabdominal adhesions.
        Obes Surg. 2008; 18: 566-568
        • Ramos A.C.
        • Zundel N.
        • Neto M.G.
        • Maalouf M.
        Human hybrid NOTES transvaginal sleeve gastrectomy: initial experience.
        Surg Obes Relat Dis. 2008; 4: 660-663
        • Rubin M.
        • Yehoshua R.T.
        • Stein M.
        • et al.
        Laparoscopic sleeve gastrectomy with minimal morbidity early results in 120 morbidly obese patients.
        Obes Surg. 2008; 18: 1567-1570
        • Shah P.S.
        • Todkar J.S.
        • Shah S.S.
        Effectiveness of laparoscopic sleeve gastrectomy on glycemic control in obese Indians with type 2 diabetes mellitus.
        Surg Obes Relat Dis. 2010; 6: 138-141
        • Skrekas G.
        • Lapatsanis D.
        • Stafyla V.
        • Papalambros A.
        One year after laparoscopic “tight” sleeve gastrectomy: technique and outcome.
        Obes Surg. 2008; 18: 810-813
        • Stroh C.
        • Birk D.
        • Flade-Kuthe R.
        • et al.
        Results of sleeve gastrectomy data from a nationwide survey on bariatric surgery in Germany.
        Obes Surg. 2009; 19: 105-112
        • Tagaya N.
        • Kasama K.
        • Kikkawa R.
        • et al.
        Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity.
        Obes Surg. 2009; 19: 1371-1376
        • Takata M.C.
        • Campos G.M.
        • Ciovica R.
        • et al.
        Laparoscopic bariatric surgery improves candidacy in morbidly obese patients awaiting transplantation.
        Surg Obes Relat Dis. 2008; 4: 159-165
        • Todkar J.S.
        • Shah S.S.
        • Shah P.S.
        • Gangwani J.
        Long-term effects of laparoscopic sleeve gastrectomy in morbidly obese subjects with type 2 diabetes mellitus.
        Surg Obes Relat Dis. 2010; 6: 142-145
        • Tucker O.N.
        • Szomstein S.
        • Rosenthal R.J.
        Indications for sleeve gastrectomy as a primary procedure for weight loss in the morbidly obese.
        J Gastrointest Surg. 2008; 12: 662-667
        • Uglioni B.
        • Wölnerhanssen B.
        • Peters T.
        • Christoffel-Courtin C.
        • Kern B.
        • Peterli R.
        Midterm results of primary vs. secondary laparoscopic sleeve gastrectomy (LSG) as an isolated operation.
        Obes Surg. 2009; 19: 401-406
        • Vidal J.
        • Ibarzabal A.
        • Romero F.
        • et al.
        Type 2 diabetes mellitus and the metabolic syndrome following sleeve gastrectomy in severely obese subjects.
        Obes Surg. 2008; 18: 1077-1082