Repository logo

Browsing by Author "Kermansaravi, M"

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
  • Patient Selection in One Anastomosis/Mini Gastric Bypass—an Expert Modified Delphi Consensus
    Publication . 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, M
    Purpose: 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.
    2022Journal article Open access Show more