The first modified Delphi consensus statement on sleeve gastrectomy.

INTRODUCTION: Sleeve gastrectomy (SG) is the commonest bariatric procedure worldwide. Yet there is significant variation in practice concerning its various aspects. This paper report results from the first modified Delphi consensus-building exercise on SG. METHODS: We established a committee of 54 globally recognized opinion makers in this field. The committee agreed to vote on several statements concerning SG. An agreement or disagreement amongst ≥ 70.0% experts was construed as a consensus. RESULTS: The committee achieved a consensus of agreement (n = 71) or disagreement (n = 7) for 78 out of 97 proposed statements after two rounds of voting. The committee agreed with 96.3% consensus that the characterization of SG as a purely restrictive procedure was inaccurate and there was 88.7% consensus that SG was not a suitable standalone, primary, surgical weight loss option for patients with Barrett's esophagus (BE) without dysplasia. There was an overwhelming consensus of 92.5% that the sleeve should be fashioned over an orogastric tube of 36-40 Fr and a 90.7% consensus that surgeons should stay at least 1 cm away from the angle of His. Remarkably, the committee agreed with 81.1% consensus that SG patients should undergo a screening endoscopy every 5 years after surgery to screen for BE. CONCLUSION: A multinational team of experts achieved consensus on several aspects of SG. The findings of this exercise should help improve the outcomes of SG, the commonest bariatric procedure worldwide, and guide future research on this topic.

Omentopexy during laparoscopic sleeve gastrectomy: Is it effective in reducing postoperative gastrointestinal symptoms. A retrospective cohort study.

BACKGROUND: Postoperative gastrointestinal symptoms are common in patients undergoing sleeve gastrectomy. This study is aimed to assess the effectiveness of omentopexy during laparoscopic sleeve gastrectomy in reducing gastrointestinal symptoms. METHODS: A retrospective analysis of patients who underwent laparoscopic sleeve gastrectomy with and without omentopexy in the period between January 2016 to September 2017. All procedures were performed by three surgeons utilizing the same surgical technique. Data extracted included patient socio-demographics', preoperative body mass index (BMI), hospitalization period, treatments and post-operative gastrointestinal symptoms. It contained the GERD-Health Related Quality of Life Questionnaire (GERD-HRQL) measuring symptom severity in gastro esophageal reflux disease (GERD). Data were analyzed at 6, 12 and 18 months with reference to weight loss. RESULTS: A total of 140 patients were included in this study, 70 in each group arm. Age, preoperative BMI, pre-operative co-morbid conditions like hypertension, diabetes, and asthma were considered as confounding variables among the two groups. None of the previous factors were statistically significantly different among both groups. The outcomes of both groups were compared in terms of postoperative nausea, vomiting, regurgitation, intra-hospital stay, medication use, early return to work, and EWL%. None of the previous outcomes except for days of hospital stay and ondansetron use was found to be significantly different between both groups. CONCLUSION: Omentopexy does not change the outcome for laparoscopic sleeve gastrectomy in terms of gastrointestinal symptoms or weight loss results.

The Safety and Efficacy of Procedureless Gastric Balloon: a Study Examining the Effect of Elipse Intragastric Balloon Safety, Short and Medium Term Effects on Weight Loss with 1-Year Follow-Up Post-removal.

INTRODUCTION: The Ellipse intragastric balloon (EIGB) is a new swallowable balloon that does not require endoscopy at insertion or removal. The aim of this study is to investigate the safety of EIGB and its efficiency in weight reduction even after 1 year of expulsion. METHOD: Prospective study on our initial experience with a consecutive group of patients who underwent the insertion of EIGB in the period between September 2016 and February 2017. The patients were followed up to assess pain, nausea, and vomiting after procedure. As well as, the time of balloon extraction, route of extraction, and weight loss. RESULTS: Total of 112 patients underwent EIGB placement. A 1-year follow-up was obtained on 85% of patients. Mean weight and BMI before the procedure 92.2 kg and 34.3 kg/m2, respectively. One patient had small bowel obstruction. Six patients did not tolerate EIGB and three patients had early deflation. Total weight loss % (TWL%) 10.7, 10.9, and 7.9% at 3, 6, and at date of last follow-up. When data were stratified according to BMI into two groups: group 1 (BMI 27.5-34.9) and group 2 (BMI 35-49), the TWL% for group 1 at 3 months, 6 months, and last day of follow-up are as follows: 10.2%, 10.6%, and 8.8%, while it was 11.5%, 11.2%, and 6.6% for group 2. CONCLUSION: EIGB are effective, safe, and feasible non-invasive method for weight loss.