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4th INTERNATIONAL CONSENSUS SUMMIT FOR SLEEVE GASTRECTOMY V: Conversions technical and outcome advantages as compared to revision to RYGB or resleeve. Furthermore, the time interval following SG allows the surgeon the opportunity to assess patient adherence to follow up and healthrelated behaviors and exclude those patients who may not be able to comport to the more rigorous nutritional requirements following DS. This time also allows the patient the opportunity to adjust to the restrictive component of DS (LSG) prior to adding the malabsorptive component, reducing the likelihood of developing early nutritional deficiency following DS. As such, in this era of rapid adoption of LSG, revision to DS is an approach that should become a fundamental component of the armamentarium of the bariatric surgeon. REFERENCES 1. Kellogg TA. Revisional bariatric surgery. Surg Clin North Am. 2011;91(6):1353–1371 2. Gagner M, Chu C, Quinn T et al. Twostage laparoscopic diversion with duodenal switch: An alternative approach to super-super morbid obesity. Presented at SAGES Annual Meeting, St. Louis, Missouri, April 18–20, 2001. 3. Boza C, Gamboa C, Salinas J, et al. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy: a case-control study and 3 years of follow-up. Surg Obes Relat Dis. 2012;8(3):243–249. 4. Kehagias I, Karamanakos SN, Argentou 5. 6. 7. M, Kalfarentzos F. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI<50 kg/m2. Obes Surg. 2011;21(11):1650–1656. Baltasar A, Serra C, Pérez N, Bou R, Bengochea M. Re-sleeve gastrectomy. Obes Surg. 2006;16(11):1535–1538. Magee CJ, Barry J, Brocklehurst J, et al. Outcome of laparoscopic duodenal switch for morbid obesity. Br J Surg. 2011;98(1):79–84. Parikh MS, Laker S, Weiner M, Hajiseyedjavadi O, Ren CJ. Objective comparison of complications resulting from laparoscopic bariatric procedures. J Am Coll Surg. 2006;202(2):252–261. VI: Controversies and Debates Technical Options and Alternatives for Sleeve Gastrectomy by PAUL T. CIRANGLE, MD, FACS, FASMBS Bariatric Times. 2013;10(5 Suppl A):A24–A26 AUTHOR AFFILIATIONS: Dr. Cirangle is from Laparoscopic Associates of San Francisco, San Francisco, California, and the Surgical Weight Loss Center of Hawaii, Kailua, Hawaii. ADDRESS FOR CORRESPONDENCE: Paul T. Cirangle, MD, FACS, FASMBS, Laparoscopic Assoc. of SF, 1700 California Street, #280, San Francisco, CA 94109; Phone: (415) 820-5939; Toll Free: (866) 957-3627; Fax: (415) 820-5946; E-mail: PCirangle@LapSF.com FUNDING AND DISCLOSURES: No funding was provided. The author reports no conflicts of interest relevant to the content of this article T he Fourth Annual International Consensus Summit on Sleeve Gastrectomy (ICSSG-4) was a valiant attempt to reach agreement regarding the clinical issues and technical aspects of the laparoscopic sleeve gastrectomy (LSG). As with most surgical procedures, the method and procedural details employed can A24 have a significant effect on the results and outcome. Despite a seemingly high rate of concordance reported at the meeting regarding the vertical sleeve gastrectomy (VSG), it seems that there still exists a large variability among individual surgeons in their approach and performance of the VSG. To surmise the degree of variability Bariatric Times • May 2013 • Supplement A amongst the meeting participants, Covidien, along with Drs. Paul Cirangle and Daniel Cottam, held a luncheon at the ICSSG-4 to present technical options and alternatives in the following six specific areas: 1. Mobilization of the greater curvature—before or after stapling 2. Dissection of the hiatus and repair