EXPERT COMMENTARY
MAJOR FINDINGS This study, now almost 5 years old, still represents a milestone publication. While several authors discussed modifications of operative technique, including trocar placement, sleeve size (in relation to bougie size), and staple size with or without the use of buttressing material, the overall results concerning weight loss, comorbidity resolution, and incidence of complications was remarkably similar. As befits a conference of early adopters, hypothesis of mechanisms of action (ghrelin levels, gastric emptying, and alterations of distal hormones GLP-1 and PYY) were presented. Finally, there was prescience in the presentations concerning leak management, gastroesophageal reflux disease and sleeve gastrectomy, and the use of this procedure as revisional surgery, all of which are certainly ardent topics of discussion today.
LIMITATIONS
Unfortunately as concerns "consensus," the title of both the conference and the article are somewhat misleading. The panelists varied in experience with the procedure, and the mean of 2.5 years performing sleeve gastrectomy and a mean of 27 procedures certainly does not imply "voter" expertise. Consensus methodology was never defined and taking a (low) average of 60% (66% is more standard) to imply consensus, all that could be "agreed" on was that LSG is indicated for high-risk patients (high risk was also not defined); LSG is easy to revise to another procedure;
and LSG does not require an institutional review board protocol. There was no consensus that this operation was indicated as a primary procedure for any BMI or special patient groups.
WHY IS THIS STUDY IMPORTANT TO THE FIELD?
This article serves as a model to provide an innovative way to allow an international forum of surgeons to present their variations in technique and outcomes on a new type of surgery for morbid obesity.
ALFONS POMP, MD, FACS, FRCSC Leon C. Hirsch Professor; Vice Chairman, Department of Surgery; Chief, Section of Laparoscopic and Bariatric Surgery; Weill Medical College of Cornell University; New York Presbyterian Hospital, New York, New York
June 2012 • Supplement • Bariatric Times 7S