Journal of metabolic and bariatric surgery最新文献

{"title":"Comparative Analysis of Various Weight Loss Success Criteria Models After Bariatric Metabolic Surgery in Korean Morbid Obese Patients.","authors":"Sangjun Lee, Won Jun Seo, Sungsoo Park, Chang Min Lee, Yeongkeun Kwon, Sung Il Choi, Jong-Han Kim","doi":"10.17476/jmbs.2023.12.2.67","DOIUrl":"10.17476/jmbs.2023.12.2.67","url":null,"abstract":"<p><strong>Purpose: </strong>To identify weight loss prediction models by validating previous models using weight loss success criteria.</p><p><strong>Materials and methods: </strong>Patients with morbid obesity from 4 hospitals were retrospectively analyzed between Jan 2019 and 2022. Preoperative demographics, postoperative data, and 1-year follow-up weight loss outcomes were compared between 2 groups who underwent laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). Additionally, the predictive factors for the success of excess weight loss (EWL) (>50%) and total weight loss (TWL) (>25%) were analyzed.</p><p><strong>Results: </strong>Of the 162 patients, 137 were enrolled during the study period, 75 underwent LSG, and 62 underwent LRYGB. The >50% EWL and >25% TWL 1 year after surgery were 61.3% and 43.1%, respectively. Diabetes mellitus medication use was reduced in 94.8% of patients with type 2 diabetes mellitus. Male sex and body mass index (BMI) were independent risk factors for successful weight loss (SWL) or >50% EWL (odds ratio [OR] for BMI 0.830, 95% confidence interval [CI] 0.764-0.902), whereas achieving >25% TWL was not affected by sex or BMI (OR for BMI 1.010, 95% CI 0.957-1.065). External validation of the prediction models showed an acceptable range of accuracy (adjusted R² 66.5-71.3%).</p><p><strong>Conclusion: </strong>LSG and LRYGB are feasible and effective bariatric procedures for SWL in Korean patients with morbid obesity. The TWL model was a more appropriate criterion than EWL, and weight loss prediction models may help assess the 1-year outcomes of bariatric surgery.</p>","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"12 2","pages":"67-75"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10771973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139405461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Roux-en-Y Gastric Bypass Versus One Anastomosis Gastric Bypass as Revisional Surgery After Failed Sleeve Gastrectomy: A Systematic Review and Meta-analysis.","authors":"Karim Ataya, Al Moutuz Al Jaafreh, Hussein El Bourji, Ayman Bsat, Hussein Nassar, Amir Al Ayoubi, George Abi Saad","doi":"10.17476/jmbs.2023.12.2.57","DOIUrl":"10.17476/jmbs.2023.12.2.57","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to assess the outcomes of revisional procedures, namely Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) following unsuccessful laparoscopic sleeve gastrectomy.</p><p><strong>Materials and methods: </strong>This systematic review and meta-analysis included 817 patients (404 in OAGB group, 413 in RYGB group) from seven retrospective comparative studies. Data on sample size, demographics, perioperative complications, operative time, pre- and post-revisional body mass index, total weight loss, and global weight loss over follow-up were extracted.</p><p><strong>Results: </strong>The mean operative time was 98.2-201 minutes for RYGB versus 78.7-168 minutes for OAGB. Despite classical RYGB gastric bypass taking longer, mini gastric bypass resulted in greater weight loss than RYGB, with a mean difference of -5.84 (95% confidence interval [CI], -6.74 to -4.94; P<0.00001; I²=0%), greater total weight loss, and a higher diabetes remission rate (odds ratio [OR], 0.32; 95% CI, 0.14 to 0.71). However, OAGB was associated with a significantly higher incidence of postoperative gastroesophageal reflux than RYGB (52 vs. 31: OR, 0.40; 95% CI, 0.24 to 0.67; P=0.0005; I²=0%).</p><p><strong>Conclusion: </strong>OAGB was performed more quickly and boasted greater total weight loss and higher diabetes remission rates compared to RYGB after failed sleeve gastrectomy. However, OAGB also demonstrated a higher incidence of postoperative gastroesophageal reflux disease. Thus, careful patient selection is essential when considering OAGB.</p><p><strong>Trial registration: </strong>PROSPERO Identifier: CRD42023474966.</p>","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"12 2","pages":"57-66"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10771971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139405465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies to Maintain the Remission of Diabetes Following Metabolic Surgery.","authors":"Mi Kyung Kim, Hye Soon Kim","doi":"10.17476/jmbs.2023.12.2.26","DOIUrl":"10.17476/jmbs.2023.12.2.26","url":null,"abstract":"<p><p>Obesity is a major risk factor for type 2 diabetes mellitus (T2DM). Bariatric surgery is the most effective means of inducing weight loss, and can ameliorate or induce the remission of obesity-related metabolic comorbidities, including T2DM. The guidelines for the management of T2DM emphasize weight management and recommend metabolic surgery for the treatment of T2DM accompanied by obesity. However, despite the clear beneficial effects of metabolic surgery, only 20-50% of patients who experience remission will stay in remission over the long term. Moreover, the beneficial effects of metabolic surgery tend to diminish with time, and a subset of patients experience a relapse of their diabetes. Therefore, in the present review, we discuss potential strategies for the maintenance of diabetic remission following metabolic surgery.</p>","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"12 2","pages":"26-34"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10771975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139405467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing Accessibility to Metabolic Bariatric Surgery: A Qualitative Study Based on In-Depth Interviews of Korean Adult Patients With Severe Obesity.","authors":"Yoona Chung, MinKyoung Jun, Dongjae Jeon, Bomina Paik, Yong Jin Kim","doi":"10.17476/jmbs.2023.12.2.44","DOIUrl":"10.17476/jmbs.2023.12.2.44","url":null,"abstract":"<p><strong>Purpose: </strong>After the initiation of national health insurance coverage in 2019, the number of metabolic bariatric surgeries (MBSs) in Korea has been increasing. Despite evidence regarding its efficacy, many candidates are hesitant regarding surgery for the treatment of severe obesity. This study interviewed patients who received MBS to further understand potential barriers and increase the accessibility of MBS.</p><p><strong>Materials and methods: </strong>Eight interviewees who received MBS after 2019 participated. The interviews began in mid-July 2022 over approximately a month. Each one-on-one interview lasted a few hours and was done in person. The interviews were transcribed, and the results were analyzed based on grounded theory.</p><p><strong>Results: </strong>This study focused on the quality of life before and after MBS. On a scale of 1 to 10, all patients had a high degree of satisfaction in quality of life after surgery (average score: 8.9, sleeve gastrectomy: 8.8, and bypass surgery: 9). Scores did not differ depending on procedure type, but factors that caused satisfaction and dissatisfaction were distributed differently between the 2 procedures.</p><p><strong>Conclusion: </strong>Quality of life is significantly improved for patients undergoing MBS despite discomfort after surgery. Further promotion of the understanding of obesity as a chronic progressive disease is needed for both surgical candidates and the public to increase acceptance of MBS.</p>","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"12 2","pages":"44-56"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10771974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139405462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic Surgery in Korea.","authors":"Yeon-Ju Huh, Hyuk-Joon Lee","doi":"10.17476/jmbs.2023.12.2.17","DOIUrl":"10.17476/jmbs.2023.12.2.17","url":null,"abstract":"<p><p>Metabolic surgery (MS) is a surgery that focuses on improving obesity-related comorbidities. It is often referred to as \"diabetic surgery\" because of its focus on treating type 2 diabetes. MS is distinguished from bariatric surgery (BS), in which weight loss is the primary goal. However, from a broader perspective, all surgeries for obese patients with diabetes can be considered MS. In Korea, metabolic and bariatric surgery (MBS) has been covered by the national health insurance since 2019. Patients with a body mass index (BMI) ≥35 or those with a BMI ≥30 and obesity-related comorbidities were eligible for MBS. Simultaneously, MS for patients with BMI values between 27.5 and 30 was partly reimbursed. The two major metabolic surgeries are Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). According to the registry of the Korean Society of Metabolic and Bariatric Surgery, 1,560 metabolic surgeries for obese patients with diabetes were performed between 2019 and 2021 in Korea, which was approximately 35.6% of all bariatric surgeries. SG was the most common, followed by RYGB and duodenal switch surgery. When dividing the patients with diabetes who underwent MBS into two groups, specifically those with BMI <35 and ≥35, we found that SG was performed most common procedure in both groups. However, there was a higher proportion of RYGB and duodenal switch operation in the former, indicating a difference in surgical methods between the two groups. MS is a promising tool for the management of poorly controlled diabetes. More data are needed to establish proper patient selection and choice of surgical type.</p>","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"12 2","pages":"17-25"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10771972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139405463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single Anastomosis Duodeno-Ileal Bypass (SADI) as a Second Step After Failed Sleeve Gastrectomy: Systematic Review and Meta-analysis.","authors":"Karim Ataya, Ayman Bsat, Abdul Hafiz Al Tannir, Al Moutuz Al Jaafareh, Amir Rabih Al, George Abi Saad","doi":"10.17476/jmbs.2023.12.2.35","DOIUrl":"10.17476/jmbs.2023.12.2.35","url":null,"abstract":"<p><strong>Purpose: </strong>Our aim in this study is to assess single anastomosis duodeno-ileal bypass (SADI) as a salvage procedure following sleeve gastrectomy (SG), examining its technical feasibility, outcomes, and potential complications.</p><p><strong>Materials and methods: </strong>A systematic review and meta-analysis were conducted, drawing data from PubMed, Medline, and the Cochrane library. The analysis encompassed 14 studies, involving 1,066 patients. We evaluated operative time, comorbidity resolution (hypertension, dyslipidemia, diabetes), post-operative diarrhea incidence, excess weight loss (EWL) at six, twelve, and twenty-four months, and post-operative leak rates.</p><p><strong>Results: </strong>SADI as a salvage procedure following SG yielded positive outcomes. Mean operative time was 125.98 minutes (95% CI 102.50-149.46, I²=99%). Importantly, SADI led to comorbidity resolution in a notable proportion of cases: hypertension in 48% (95% CI 38-57%, I²=44%), dyslipidemia in 55% (95% CI 40-69%, I²=30%), and diabetes in 63% (95% CI 53-72%, I²=30%) of patients. Post-operative diarrhea incidence was relatively low at 2% (95% CI 1-9%, I²=75%). In terms of weight loss, SADI patients exhibited substantial EWL: 47.73% (95% CI 37.86-57.61, I²=95%) at six months, 59.39% (95% CI 51.18-67.61, I²=95%) at twelve months, and 23.84% (95% CI 5.76-41.92, I²=100%). At twenty-four months. Furthermore, post-operative leak rate was relatively low, reported in only 1% (95% CI 0-5%, I²=80%) of cases.</p><p><strong>Conclusion: </strong>SADI as a salvage procedure post-SG demonstrates technical feasibility and marked effectiveness. It offers substantial comorbidity resolution, significant weight loss, and low post-operative complication rates, notably post-operative leaks. Further research should investigate the long-term impact of SADI on patient nutritional status to facilitate its broader adoption.</p>","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"12 2","pages":"35-43"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10771976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139405466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and Adverse Events After Bariatric Surgery: An Updated Systematic Review and Meta-analysis, 2013-2023.","authors":"Jane Chungyoon Kim, Min-Gyu Kim, Jae Kyun Park, Seungho Lee, Jeesun Kim, Yo-Seok Cho, Seong-Ho Kong, Do Joong Park, Hyuk-Joon Lee, Han-Kwang Yang","doi":"10.17476/jmbs.2023.12.2.76","DOIUrl":"10.17476/jmbs.2023.12.2.76","url":null,"abstract":"<p><strong>Purpose: </strong>Bariatric surgery is an increasingly common treatment for obesity and related comorbidities. This meta-analysis aimed to compare the outcomes of bariatric surgery and medical treatment (MT).</p><p><strong>Materials and methods: </strong>A systematic search of articles published from January 2013 to May 2023 identified 20 studies. The treatment arms included Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), gastric banding, and MT. The assessed outcomes included body weight loss, diabetes mellitus (DM) remission, changes in dyslipidemia and hypertension markers, and adverse events.</p><p><strong>Results: </strong>Bariatric surgery resulted in significantly better short- and long-term weight loss than MT, with RYGB and SG showing the most substantial reduction. The DM remission rates were notably higher in the surgery group, with marked improvements in hemoglobin A1c and fasting glucose levels. Improvements in dyslipidemia were inconclusive, whereas hypertension showed modest improvements, particularly with RYGB. Complication rates varied, with RYGB reporting higher rates of early complications, and SG reporting increased rates of late complications. The perioperative reoperation rates were low across all surgical treatments. Specific adverse events, such as intestinal obstruction and anastomosis site problems, were more common in the RYGB group, whereas reflux symptoms were more common in the SG group.</p><p><strong>Conclusion: </strong>Bariatric surgery, especially RYGB and SG, provided superior weight loss and DM remission outcomes compared to MT, although with varied complication profiles. These findings underscore the need for careful patient selection and postoperative management in bariatric surgery. Future studies should aim to refine these processes to improve patient outcomes.</p>","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"12 2","pages":"76-88"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10771970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139405464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Sleeve Gastrectomy in a Morbidly Obese Pediatric Patient With Bardet-Biedl Syndrome.","authors":"Ju-Hee Lee,&nbsp;Tae Kyung Ha","doi":"10.17476/jmbs.2023.12.1.11","DOIUrl":"https://doi.org/10.17476/jmbs.2023.12.1.11","url":null,"abstract":"<p><p>Data on the effect of bariatric surgery for syndromic obesity are lacking. This case report presents the preoperative evaluation and perioperative outcomes of a 7-year-old pediatric patient with Bardet-Biedl syndrome (BBS) who underwent sleeve gastrectomy. The male patient was referred to our department for the surgical treatment of his obesity. His preoperative body mass index (BMI) was 55.2 kg/m² (weight, 83.5 kg), and he was above the 99^th percentile for age and gender. The patient underwent laparoscopic sleeve gastrectomy. The postoperative period was uneventful. Six months after the operation, the patient's weight decreased to 50 kg (BMI, 28.72 kg/m²). Weight loss was maintained until 3 years after surgery. Dyslipidemia and nonalcoholic fatty liver disease were significantly alleviated. Laparoscopic sleeve gastrectomy may be a safe and effective treatment for morbid BBS-related obesity in pediatric patients. Further data are needed to confirm the long-term efficacy and safety of bariatric surgery in BBS.</p>","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"12 1","pages":"11-15"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6a/e2/jmbs-12-11.PMC10320436.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9810327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Loss to Follow-up After Laparoscopic Sleeve Gastrectomy: A Single-Center Retrospective Study.","authors":"Seong-A Jeong,&nbsp;Chang Seok Ko,&nbsp;Na Young Kim,&nbsp;Chung Sik Gong,&nbsp;In-Seob Lee,&nbsp;Beom Su Kim,&nbsp;Moon-Won Yoo","doi":"10.17476/jmbs.2023.12.1.1","DOIUrl":"https://doi.org/10.17476/jmbs.2023.12.1.1","url":null,"abstract":"<p><strong>Purpose: </strong>After bariatric surgery, postoperative follow-up is important for evaluating long-term outcomes, such as successful weight loss and improvement of metabolic parameters. However, many patients are lost to follow-up within 1 year. This study aimed to identify the follow-up rate of bariatric surgery and predictive factors of loss to follow-up (LTF).</p><p><strong>Materials and methods: </strong>We retrospectively reviewed the data of 61 patients receiving bariatric surgery for obesity (laparoscopic sleeve gastrectomy; LSG group) and 872 for early gastric cancer (EGC group) from November 2018 to July 2020 in a single center. After 1:1 matching, we compared the LTF rate. In the LSG group, we analyzed the factors associated with LTF. Additionally, we collected weight data in the LTF group by a telephone survey.</p><p><strong>Results: </strong>By 1:1 matching, 47 patients for each group were identified. The LTF rates of the LSG and EGC groups were 34.0% (16 patients) and 2.1% (one patient), respectively (P=0.0003). In the LSG group, the LTF rate increased over the postoperative month. Of the patients, 29.5% who missed a scheduled appointment within one year comprised the LTF group. In the analysis, no significant factors associated with LTF were identified. The only factor with borderline significance was dyslipidemia with medication (P=0.094).</p><p><strong>Conclusion: </strong>The LSG group demonstrated a high LTF rate, although adherence to follow-up was closely related to postoperative outcomes. Therefore, educating patients on the significance of follow-up is important. Particularly, continuous efforts to identify the associated factors and develop a multidisciplinary management protocol after bariatric surgery are necessary.</p>","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"12 1","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/54/41/jmbs-12-1.PMC10320437.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9807418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Delphi consensus on the surgical technique of laparoscopic sleeve gastrectomy: An obesity and metabolic surgery society of India initiative","authors":"A. Bhasker, O. Tantia, M. Khaitan, R. Wadhawan, KS Kular, S. Baig, Sumeet Shah, V. Bindal, Ashish Vashishtha, Atul Peters, Deep Goel, M. Narwaria, M. Baijal, N. Dukkipati, P. Chowbey, R. Bhojwani, Ramen Goel, S. Aggarwal, S. Borude, S. Patolia, S. Shah, S. Dhorepatil, Sreejoy Patnaik, S. Kalhan, S. Ugale, P. Palanivelu","doi":"10.4103/jbs.jbs_7_23","DOIUrl":"https://doi.org/10.4103/jbs.jbs_7_23","url":null,"abstract":"Introduction: Laparoscopic sleeve gastrectomy (LSG) is the commonest bariatric operation being performed in India and worldwide. There are many technical variations that are being practiced. This Delphi consensus was an Obesity and Metabolic Surgery Society of India (OSSI) initiative to standardize the surgical technique of LSG. Methods: Twenty bariatric surgeons were selected as experts based on their years of experience in LSG, overall patient volumes, publications, and the recommendations of the executive committee of OSSI, to vote on 26 statements regarding the surgical steps of LSG. The minimum cutoff for consensus was taken as 70%. Results: The committee achieved a consensus on 19 out of 26 statements in the first round. One question was sent for reconsideration and 3 were resent after modification. Finally, consensus was reached on 22 statements. The consensus was reached regarding the use of preoperative upper gastrointestinal endoscopy. 85.7% agreed on an antral length of 3–5 cm. 85.7% were in favor of dissecting the left crus of the diaphragm completely and 100% agreed on Roux-en y gastric bypass to be the procedure of choice in the presence of medically refractory gastroesophageal reflux disease with hiatus hernia. Most experts agreed that a calibration tube must be used during LSG and the recommended size was between 36 and 40 Fr. Ninety-five percent agreed that care must be taken to avoid narrowing at the incisura and also to stay away from the angle of His. 71.4% did not recommend any kind of staple line reinforcement and 71.4% recommended a postoperative leak test. Conclusion: This Delphi consensus is a step toward improving the quality of surgical outcomes of LSG in India. This document has attempted to establish technical specifications of performing LSG. This will in turn help to maximize the reliability, standardization, and safety of the procedure until more robust studies are published.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"42 1","pages":"79 - 84"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89912789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}