ABSTRACT
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Subject(s)
Gastric Bypass , Gastroesophageal Reflux , Obesity, Morbid , Humans , Delphi Technique , Reoperation/methods , Gastric Bypass/methods , Gastrectomy/methods , Gastroesophageal Reflux/etiology , Gastroesophageal Reflux/surgery , Weight Loss , Obesity, Morbid/surgery , Retrospective Studies , Treatment OutcomeABSTRACT
INTRODUCTION: For the acquisition of skills in laparoscopic surgery, practices in experimental labs are gaining increasing relevance. Activities in experimental labs include Pelvitrainers, virtual reality simulators, and experimental animals (frequently pigs). However, the best model for surgical formation is the performance of interventions on cadavers. The Thiel method gives the body elasticity, which allows the performance of laparoscopic procedures. METHODS: An observational prospective study was performed on surgeons attending to two courses of laparoscopic bariatric surgery on cadavers embalmed by the Thiel method. A questionnaire was given to the participants (students and professors) when finishing the course. Similarities between the procedures performed on cadavers and on patients were investigated. The satisfaction degree was also analyzed. RESULTS: The students recognized that the Thiel cadaver presents elasticity and aspect similar to the patient, and the practice on cadavers is considered the best method for the formation in laparoscopic bariatric surgery. The assistants were extremely satisfied with the acquired skills and considered that these courses should be included in the formation programs for bariatric surgery. The results of the survey on professors agreed with the students in considering the practice on cadavers as the best method for the formation in laparoscopic bariatric surgery. However, they highlighted as drawbacks of the Thiel cadaver, the absence of bleeding, and excessive elasticity of the tissues. CONCLUSION: The participants (students and professors) to the courses of laparoscopic bariatric surgery on cadaver Thiel recognize that these are the most similar model to real conditions in bariatric surgery.
