Repository logo

Browsing by Author "Aminian, A"

Now showing 1 - 2 of 2
  • Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus
    Publication . Kermansaravi, M; Parmar, C; Chiappetta, S; Shikora, S; Aminian, A; Abbas, SI; Angrisani, L; Bashir, A; Behrens, E; Bhandari, M; Clapp, B; Cohen, R; Dargent, Jerome; Dilemans, Bruno; De Luca, Maurizio; Haddad, Ashraf; Gawdat, Khaled; Elfawal, Mohamed Hayssam; Himpens, Jaques; Huang, Chih-Kun; Husain, Farah; Kasama, Kazunori; Kassir, Radwan; Khan, Amir; Kow, Lilian; Kroh, Matthew; Lakdawala, Muffazal; Lopez Corvala, JA; Miller, Karl; Musella, M; Nimeri, A; Noel, P; Palermo, M; Poggi, L; Poghosyan, T; Prager, G; Prasad, A; Alqahtani, A; Rheinwalt, K; Ribeiro, R; Shabbir, A; Torres, A; Villalonga, R; Wang, C; Mahawar, K; Zundel, N
    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.
    2023Journal article Open access Show more
  • Metabolic and Bariatric Surgery in Patients with Obesity Class V (BMI > 60 kg/m2): a Modified Delphi Study
    Publication . Ponce de Leon-Ballesteros, G; Pouwels, S; Romero-Velez, G; Aminian, A; Angrisani, L; Bhandari, M; Brown, W; Copaescu, C; De Luca, M; Fobi, M; Ghanem, OM; Hasenberg, T; Herrera, MF; Herrera-Kok, JH; Himpens, J; Kow, L; Kroh, M; Kurian, M; Musella, M; Narwaria, M; Noel, P; Pantoja, JP; Ponce, J; Prager, G; Ramos, A; Ribeiro, R; Ruiz-Ucar, E; Salminen, P; Shikora, S; Small, P; Stier, C; Taha, S; Taskin, EH; Torres, A; Vaz, C; Vilallonga, R; Verboonen, S; Zerrweck, C; Zundel, N; Parmar, C
    Background: Metabolic and bariatric surgery (MBS) is the preferred method to achieve significant weight loss in patients with Obesity Class V (BMI > 60 kg/m2). However, there is no consensus regarding the best procedure(s) for this population. Additionally, these patients will likely have a higher risk of complications and mortality. The aim of this study was to achieve a consensus among a global panel of expert bariatric surgeons using a modified Delphi methodology. Methods: A total of 36 recognized opinion-makers and highly experienced metabolic and bariatric surgeons participated in the present Delphi consensus. 81 statements on preoperative management, selection of the procedure, perioperative management, weight loss parameters, follow-up, and metabolic outcomes were voted on in two rounds. A consensus was considered reached when an agreement of ≥ 70% of experts' votes was achieved. Results: A total of 54 out of 81 statements reached consensus. Remarkably, more than 90% of the experts agreed that patients should be notified of the greater risk of complications, the possibility of modifications to the surgical procedure, and the early start of chemical thromboprophylaxis. Regarding the choice of the procedure, SADI-S, RYGB, and OAGB were the top 3 preferred operations. However, no consensus was reached on the limb length in these operations. Conclusion: This study represents the first attempt to reach consensus on the choice of procedures as well as perioperative management in patients with obesity class V. Although overall consensus was reached in different areas, more research is needed to better serve this high-risk population.
    2024Journal article Open access Show more