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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35.6F±4.9F. • More than 95% of surgeons first mobilize the greater curvature before constructing the sleeve; 4.7% enter the lesser sac and first construct the sleeve before mobilizing the greater curvature. • Resection was commenced 5.0±1.4cm proximal to the pylorus. • 33.1±29.3% of antrum was removed. • 65.1% of surgeons reported that they reinforced the staple line of the gastric tube: 50.9% over sew the staple line; 42.1% use a buttress on the staple line; and 7.0% do both. • 95.8±12.0% of the fundus was removed; many surgeons expressed caution in avoiding the esophagus. • 95% of surgeons believe a silastic ring should not be placed around the sleeve. • 76.3% of surgeons give postoperative supplementation. • 65.9% administer vitamin B12. • 63.6% prescribe proton pump inhibitors. Changes in weight following LSG reported by respondents are summarized in Table 1. Complications See Table 2. CONCLUSION According to the consensus, LSG is a very promising primary bariatric procedure for the treatment of morbid obesity. EXPERT COMMENTARY MAJOR FINDINGS This study involved 303 bariatric surgeons from 31 countries, many with several years of experience performing LSG. Live surgery was performed to demonstrate technical options, and a consensus summit was held to develop technical standards for the sleeve gastrectomy. Previously, the LSG operation was poorly standardized with a broad range in pouch sizes, leak rates, and weight loss. The consensus supported using a smaller bougie size of 35.6±4.9Fr, resecting the antrum, and removing 95% of the fundus. Four year %EWL was 64.6%. Complications were very low and overall acceptable. Postoperative reflux was reported to occur in 6.5% of patients. LIMITATIONS The major limitation is the data were self reported on questionnaires and not clinically reviewed via an institutional review board protocol. Nevertheless, many of the respondents had already published GREGG H. JOSSART, MD, FACS Director, Minimally Invasive Surgery, California Pacific Medical Center, San Francisco, California their outcomes, and the current literature continues to support the outcomes reported in the consensus conference. This conference achieved consensus on the technical factors that yield the best weight loss outcomes with minimum morbidity. WHY IS THIS STUDY IMPORTANT TO THE FIELD? The LSG consensus conference has helped to standardize the operation and by doing so it has become more common worldwide. The LSG consensus conference has helped to establish an operation that has a very high patient acceptance rate and is an excellent alternative to banding and intestinal bypass surgery. WHAT SHOULD YOU DO WITH THESE DATA AND THESE FINDINGS? Clinicians should educate patients about the option of LSG. They can now choose an operation that has lower morbidity than adjustable gastric banding and intestinal bypass procedures with weight loss comparable to the gastric bypass. Moreover, many patients who would not benefit from a banding procedure or are too high risk for an intestinal bypass procedure now have an option that is safe and effective. This group may include autoimmune syndrome patients, anticoagulated patients, organ failure patients, patients with high BMI, and patients with ulcer histories. June 2012 • Supplement • Bariatric Times 9S