Abstract：
Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgical (MBS) procedure worldwide. Despite the desired effect of SG on weight loss and remission of obesity-associated medical problems, there are some concerns regarding the need to do revisional/conversional surgeries after SG. This study aims to make an algorithmic clinical approach based on an expert-modified Delphi consensus regarding redo-surgeries after SG, to give bariatric and metabolic surgeons a guideline that might help for the best clinical decision.
Forty-six recognized bariatric and metabolic surgeons from 25 different countries participated in this Delphi consensus study in two rounds to develop a consensus on redo-surgeries after SG. An agreement/disagreement ≥ 70.0% on statements was considered to indicate a consensus.
Consensus was reached for 62 of 72 statements and experts did not achieve consensus on 10 statements after two rounds of online voting. Most of the experts believed that multi-disciplinary team evaluation should be done in all redo-procedures after SG and there should be at least 12 months of medical and supportive management before performing redo-surgeries after SG for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD). Also, experts agreed that in case of symptomatic GERD in the presence of adequate weight loss, medical treatment for at least 1 to 2 years is an acceptable option and agreed that Roux-en Y gastric bypass is an appropriate option in this situation. There was disagreement consensus on efficacy of omentopexy in rotation and efficacy of fundoplication in the presence of a dilated fundus and GERD.
Redo-surgeries after SG is still an important issue among bariatric and metabolic surgeons. The proper time and procedure selection for redo-surgery need careful considerations. Although multi-disciplinary team evaluation plays a key role to evaluate best options in these situations, an algorithmic clinical approach based on the expert\'s consensus as a guideline can help for the best clinical decision-making.
Forty-six recognized bariatric and metabolic surgeons from 25 different countries participated in this Delphi consensus study in two rounds to develop a consensus on redo-surgeries after SG. An agreement/disagreement ≥ 70.0% on statements was considered to indicate a consensus.
Consensus was reached for 62 of 72 statements and experts did not achieve consensus on 10 statements after two rounds of online voting. Most of the experts believed that multi-disciplinary team evaluation should be done in all redo-procedures after SG and there should be at least 12 months of medical and supportive management before performing redo-surgeries after SG for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD). Also, experts agreed that in case of symptomatic GERD in the presence of adequate weight loss, medical treatment for at least 1 to 2 years is an acceptable option and agreed that Roux-en Y gastric bypass is an appropriate option in this situation. There was disagreement consensus on efficacy of omentopexy in rotation and efficacy of fundoplication in the presence of a dilated fundus and GERD.
Redo-surgeries after SG is still an important issue among bariatric and metabolic surgeons. The proper time and procedure selection for redo-surgery need careful considerations. Although multi-disciplinary team evaluation plays a key role to evaluate best options in these situations, an algorithmic clinical approach based on the expert\'s consensus as a guideline can help for the best clinical decision-making.
摘要：
背景：袖状胃切除术（SG）是全球最常见的代谢和减肥手术（MBS）程序。尽管SG对体重减轻和缓解肥胖相关的医疗问题有预期的效果，对于SG后进行修改/转换手术的必要性，存在一些担忧。本研究旨在根据专家修改的Delphi共识制定算法临床方法，为减肥和代谢外科医生提供可能有助于最佳临床决策的指南。
方法：来自25个不同国家的46名公认的减肥和代谢外科医生分两轮参与了这项Delphi共识研究，以就SG后的重做手术达成共识。关于声明的同意/分歧≥70.0%被认为表明达成共识。
结果：在经过两轮在线投票后，72份声明中有62份达成了共识，专家们对10份声明没有达成共识。大多数专家认为，应在SG后的所有重做程序中进行多学科团队评估，并且在SG后进行重做手术之前，应至少进行12个月的医疗和支持管理，以减少体重。体重恢复,胃食管反流病（GERD）。此外，专家们一致认为，如果有症状的GERD存在足够的体重减轻，至少1~2年的药物治疗是一种可接受的选择,并同意Roux-enY胃旁路术是这种情况下的适当选择.在存在扩张的眼底和GERD的情况下，对大网膜固定术在旋转中的疗效和胃底折叠术的疗效存在分歧。
结论：SG后的重做手术仍然是减肥和代谢外科医生的重要问题。重做手术的适当时间和程序选择需要仔细考虑。尽管多学科团队评估在评估这些情况下的最佳选择方面起着关键作用，以专家共识为指导的算法临床方法有助于制定最佳的临床决策.
方法：来自25个不同国家的46名公认的减肥和代谢外科医生分两轮参与了这项Delphi共识研究，以就SG后的重做手术达成共识。关于声明的同意/分歧≥70.0%被认为表明达成共识。
结果：在经过两轮在线投票后，72份声明中有62份达成了共识，专家们对10份声明没有达成共识。大多数专家认为，应在SG后的所有重做程序中进行多学科团队评估，并且在SG后进行重做手术之前，应至少进行12个月的医疗和支持管理，以减少体重。体重恢复,胃食管反流病（GERD）。此外，专家们一致认为，如果有症状的GERD存在足够的体重减轻，至少1~2年的药物治疗是一种可接受的选择,并同意Roux-enY胃旁路术是这种情况下的适当选择.在存在扩张的眼底和GERD的情况下，对大网膜固定术在旋转中的疗效和胃底折叠术的疗效存在分歧。
结论：SG后的重做手术仍然是减肥和代谢外科医生的重要问题。重做手术的适当时间和程序选择需要仔细考虑。尽管多学科团队评估在评估这些情况下的最佳选择方面起着关键作用，以专家共识为指导的算法临床方法有助于制定最佳的临床决策.
