Browsing by Author "De Luca, M"
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- Metabolic and Bariatric Surgery in Patients with Obesity Class V (BMI > 60 kg/m2): a Modified Delphi StudyPublication . 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, CBackground: 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.
- Patient Selection in One Anastomosis/Mini Gastric Bypass—an Expert Modified Delphi ConsensusPublication . Kermansaravi, M; Parmar, C; Chiappetta, S; Shahabi, S; Abbass, A; Abbas, SI; Abouzeid, M; Antozzi, L; Asghar, ST; Bashir, A; Bhandari, M; Billy, H; Caina, D; Campos, FJ; Carbajo, MA; Chevallier, JM; Jazi, AH; de Gordejuela, AG; Haddad, A; ElFawal, MH; Himpens, J; Inam, A; Kassir, R; Kasama, K; Khan, A; Kow, L; Kular, KS; Lakdawala, M; Layani, LA; Lee, WJ; Luque-de-León, E; Loi, K; Mahawar, K; Mahdy, T; Musella, M; Nimeri, A; González, JC; Pazouki, A; Poghosyan, T; Prager, G; Prasad, A; Ramos, AC; Rheinwalt, K; Ribeiro, R; Ruiz-Úcar, E; Rutledge, R; Shabbir, A; Shikora, S; Singhal, R; Taha, O; Talebpour, M; Verboonen, JS; Wang, C; Weiner, R; Yang, W; Vilallonga, R; De Luca, MPurpose: One anastomosis/mini gastric bypass (OAGB/MGB) is up to date the third most performed obesity and metabolic procedure worldwide, which recently has been endorsed by ASMBS. The main criticisms are the risk of bile reflux, esophageal cancer, and malnutrition. Although IFSO has recognized this procedure, guidance is needed regarding selection criteria. To give clinicians a daily support in performing the right patient selection in OAGB/MGB, the aim of this paper is to generate clinical guidelines based on an expert modified Delphi consensus. Methods: A committee of 57 recognized bariatric surgeons from 24 countries created 69 statements. Modified Delphi consensus voting was performed in two rounds. An agreement/disagreement among ≥ 70.0% of the experts was considered to indicate a consensus. Results: Consensus was achieved for 56 statements. Remarkably, ≥ 90.0% of the experts felt that OAGB/MGB is an acceptable and suitable option "in patients with Body mass index (BMI) > 70, BMI > 60, BMI > 50 kg/m2 as a one-stage procedure," "as the second stage of a two-stage bariatric surgery after Sleeve Gastrectomy for BMI > 50 kg/m2 (instead of BPD/DS)," and "in patients with weight regain after restrictive procedures. No consensus was reached on the statement that OAGB/MGB is a suitable option in case of resistant Helicobacter pylori. This is likely as there is a concern that this procedure is associated with reflux and its related long-term complications including risk of cancer in the esophagus or stomach. Also no consensus reached on OAGB/MGB as conversional surgery in patients with GERD after restrictive procedures. Consensus for disagreement was predominantly achieved "in case of intestinal metaplasia of the stomach" (74.55%), "in patients with severe Gastro Esophageal Reflux Disease (GERD)(C,D)" (75.44%), "in patients with Barrett's metaplasia" (89.29%), and "in documented insulinoma" (89.47%). Conclusion: Patient selection in OAGB/MGB is still a point of discussion among experts. There was consensus that OAGB/MGB is a suitable option in elderly patients, patients with low BMI (30-35 kg/m2) with associated metabolic problems, and patients with BMIs more than 50 kg/m2 as one-stage procedure. OAGB/MGB can also be a safe procedure in vegetarian and vegan patients. Although OAGB/MGB can be a suitable procedure in patients with large hiatal hernia with concurrent hiatal hernia, it should not be offered to patients with grade C or D esophagitis or Barrett's metaplasia.