Bariatric Times

Sleeve Gastrectomy 2015

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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A22 Bariatric Times • April 2015 • Supplement A 5 th INTERNATIONAL CONSENSUS SUMMIT FOR SLEEVE GASTRECTOMY L aparoscopic sleeve gastrectomy (LSG) was first conceived as a first step of a two-stage procedure that included a duodenal switch in 2000, and later Roux-en-Y gastric bypass (RYGB), popularized by myself. 1 Subsequently, the operation was used as a primary procedure with smaller bougies, leaving a smaller antrum, such that this procedure is now the most popular bariatric operation in several countries (e.g., France and United States). Most studies have demonstrated an effective weight loss and resolution of type 2 diabetes mellitus (T2DM), quite similar to RYGB, but with lower mortality and morbidity. 2 On August 28, 2014, in the Palais des Congres in the beautiful city of Montreal, Quebec, Canada, another consensus on LSG was attempted. Preliminary results of an expert questionnaire were presented publicly and moderated by Drs. Raul Rosenthal (Weston, Florida, United States) and Camilo Boza (Santiago, Chile). Dr. Rosenthal had previously published in 2012, an expert consensus of a group of highly motivated surgeons who had performed the highest number of LSGs at that time. This collected series included more than 12,000 cases. During the 2014 consensus, over 106 surgeons with an experience of more than one thousand sleeves represented a pool of over 103,000 sleeve gastrectomy procedures performed. When we looked at contraindications, 94.5 percent of surgeons mentioned Barrett's esophagus and 28 percent mentioned gastroesophageal reflux disease (GERD). This reflects the uncertainty of studies on the subject, which the most recent, well-done publication by the team of Dr. Mario Morino (Torino, Italy), with preoperative studies for reflux, followed for two years after LSG, shows dramatic reduction of reflux with only five percent de novo GERD. 3 Special considerations for indications (e.g., cirrhosis, transplantation, age, low body mass index [BMI], inflammatory bowel disease [IBD]) have not changed since the last consensus; however, this year we tried to introduce the concept of abdominal mesh incisional repair and sleeve gastrectomy simultaneously. This did not reach consensus among experts (less than 70% but above 60%), and will remain controversial for the moment. TECHNIQUE The preferred bougie size shows a mean of 35 Fr, a larger size than previously recorded in these conferences since 2007, probably because previous experiences had demonstrated a higher leak rate and stricture formation with smaller bougies (i.e., 32 FR or below). Most operators will reinforce the staple line in order to decrease bleeding and leaks, and • Contraindications for laparoscopic sleeve gastrectomy (LSG), 94.5 percent of experts mentioned Barrett's esophagus and 28 percent gastroesophageal reflux disease (GERD). • Forty-five percent of those experts use buttress materials, and 28 percent oversew. • At five years postoperative, the experts surveyed reported results of 60 percent EWL sustained weight loss (or body mass index [BMI] of 29.8kg/m 2 ). • Conversions for weight loss failures of sleeve to other types of operations were reported to be 4.8 percent, while for refractory GERD was reported at 2.9 percent. KEY POINTS 5 th International Consensus Summit for Sleeve Gastrectomy: Is There a Consensus? MICHEL GAGNER, MD, FRCSC, FACS, FASMBS Hôpital Du Sacre Cœur, Montréal, Canada Bariatric Times. 2015;12(4 Suppl A):A22–A23. DISCLOSURE: Dr. Gagner is a speaker for and/or has received honorarium from the following companies: Olympus, Ethicon (Cincinnati, Ohio, United States), Covidien (North Haven, Connecticut, United States), Medical Innovation Developpement (MID [Dardilly France]), Transenterix (Morrisville, North Carolina, United States), W. L. Gore and Associates, Inc., Boehringer Labs (Phoenixville, Pennsylvania, United States). ADDRESS CORRESPONDENCE TO: Dr. Michel Gagner, 315 Place D'Youville, #191, Montreal, QC, Canada, H2Y 0A4; E-mail: Michel Gagner gagner.michel@gmail.com

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