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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A4 Bariatric Times • April 2015 • Supplement A 5 th INTERNATIONAL CONSENSUS SUMMIT FOR SLEEVE GASTRECTOMY T he 5th International Consensus for Sleeve G astrectomy was held in Montreal at the Palais des Congres, August 26 to 27, 2014, during IFSO 2014 (International Federation for the Surgery of Obesity and Metabolic Disorders). This follows four similar meetings held in New York, New York, in 2007, Miami Beach, Florida, in 2009, and again in New York, New York, in 2010 and 2012. As with previous ICSSG meetings, the ICSSG-5 featured live surgeries. We viewed a record of 26 live surgeries from multiple operating rooms from four continents. The live surgeries were followed by oral presentations on various subjects related to laparoscopic sleeve gastrectomy (LSG). There were 618 participants (out of nearly 2,000 registrants of IFSO 2014) from 75 countries in the post-graduate courses. We have selected eight of the most influential presentations given during this meeting. Here, the authors give summaries of their presentations. It is important to note that since the last consensus, LSG has become the number one bariatric intervention in the United States and France, as well as in numerous South American and Asian countries. During the ICSSG-5, live surgeries were performed by various expert surgeons. They covered multiple scenarios, such as procedures for type 2 diabetes mellitus (T2DM [Dr. Antonio Lacy, Barcelona, Spain]), LSG performed under regional anesthesia (Dr. Hayssam Fawal, Beirut, Lebanon), surgery performed with SPIDER surgical system (TransEnterix, Morrisville, North Carolina, US [Dr Helmuth Billy, Doha, Qatar]), conversions to single anastomosis gastric bypass (Dr. Mohit Bhandari, Indore, India), duodeno- jejunal bypass (Dr. Kazunori Kasama, Tokyo, Japan) and band to sleeve (Dr. David Nocca, Montpellier, France). This was followed by a wave of surgeries performed for complications/failures, such as re-sleeve (Dr. Patrick Noel, Marseille, France), stricture repair (Dr. Raul Rosenthal, Weston, Florida, United States), and ring added (Dr. Ramesh Makam, Bangalore, India). Conversion surgeries were performed before lunch and included band to sleeve (Dr. GB Cadiere, Brussels, Belgium), sleeve to SADI or single anastomosis with duodeno-ileostomy (Dr. Andres Sanchez-Pernaute, Madrid, Spain) and sleeve to Roux-en-Y gastric bypass (RYGB [Dr. Richard Funke, Santiago, Chile]). In the afternoon, we saw the demonstration of sleeve to duodenal switch (DS [Dr. Laurent Biertho, Quebec City, QC, Canada]), gastric plication (Dr. Martinez, Tijuana, Mexico), and reversal of gastric bypass. Dr. Leonardo Claros (Philadelphia, Pennsylvania, United States) performed a sleeve with a suction calibration system, and Dr. Rami Lutfi ( Chicago, Illinois, United States) and Dr. Jorge Daez (Barranquilla, Colombia) performed their techniques for hiatal hernia repair while doing a sleeve, an increasingly important step to avoid reflux. We also saw more complex cases from Drs. Dana Portenier and Alfonso Torquati (Durham, North Carolina, United States), and more technical tips from Dr. Ashutosh Kaul (Valhalla, New York, United States) and Dr. Hans Schmidt (Paramus, New Jersey, United States). Other highlights included demonstrations of new technology, specifically an endoscopic sleeve (and revision) by Dr. Reem Sharaiha (New York, New York, United States) as well as an ileal interposition from Dr. Augusto Tinoco (Itaperuna, Brazil), a sleeve revised by plication (Dr. Martinez) and stomach intestinal pylorus sparing surgery or SIPS from Dr. Daniel Cottam (Salt Lake City, Utah, United States). The second day of the consensus, the morning oral presentations were dedicated to the prevention of complications, management of those complications, and interesting situations. From these presentations, we requested Drs. Marius Nedelcu (Aubagne, France) and Patrick Noel to discuss their personal experience with leaks, and Dr. Ninh Nguyen (Orange, California, United States) to instruct on new insights into causes of leaks in LSG, specifically the role of tissue perfusion. Dr. Tallal Zeni (Livonia, Michigan, United States) discussed the importance of hiatal hernia closure and Dr. Torquati discussed LSG for T2DM, an increasing indication, with lower morbidity. The sleeve is part of a duodeno-jejunal bypass for patients with low body mass indices (BMI) as discussed by Dr. Kasama. Dr. Cottam discusses SIPS. SIPS was initiated by the pioneering work of Dr. Antonio Torres (Madrid, Spain) and Andres Sanchez-Pernaute (Madrid, Spain) and was discussed in the ICSSG-4 proceedings supplement in 2013). In my opinion, SIPS is undoubtedly the future of LSG for weight regain. Here, Dr. Portenier shares his opinion of SIPS, one that I think reflects the American philosophy. In subsequent afternoon sessions, we revisited innovations. Finally, the experts presented the consensus questionnaire. Dr. Rosenthal and Dr. Camilo Boza (Santiago, Chile) presented and discussed the audience responses. Here, I provide a summary of the consensus questionnaire and results. We hope you will enjoy these articles, and we encourage you to view the accompanying videos in the digital edition available at http://icssg5.metabolicsurgery.tv. DIRECTOR'S MESSAGE Michel Gagner, MD, FRCSC, FACS, FASMBS Clinical Professor of Surgery, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida and Senior Consultant, Department of Surgery, Hopital du Sacre Coeur, Montreal, QC, Canada

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