Abstract：
OBJECTIVE: There is a lack of evidence for treatment of some conditions including complication management, suboptimal initial weight loss, recurrent weight gain, or worsening of a significant obesity complication after one anastomosis gastric bypass (OAGB). This study was designed to respond to the existing lack of agreement and to provide a valuable resource for clinicians by employing an expert-modified Delphi consensus method.
METHODS: Forty-eight recognized bariatric surgeons from 28 countries participated in the modified Delphi consensus to vote on 64 statements in two rounds. An agreement/disagreement among ≥ 70.0% of the experts was regarded to indicate a consensus.
RESULTS: A consensus was achieved for 46 statements. For recurrent weight gain or worsening of a significant obesity complication after OAGB, more than 85% of experts reached a consensus that elongation of the biliopancreatic limb (BPL) is an acceptable option and the total bowel length measurement is mandatory during BPL elongation to preserve at least 300-400 cm of common channel limb length to avoid nutritional deficiencies. Also, more than 85% of experts reached a consensus on conversion to Roux-en-Y gastric bypass (RYGB) with or without pouch downsizing as an acceptable option for the treatment of persistent bile reflux after OAGB and recommend detecting and repairing any size of hiatal hernia during conversion to RYGB.
CONCLUSIONS: While the experts reached a consensus on several aspects regarding revision/conversion surgeries after OAGB, there are still lingering areas of disagreement. This highlights the importance of conducting further studies in the future to address these unresolved issues.
METHODS: Forty-eight recognized bariatric surgeons from 28 countries participated in the modified Delphi consensus to vote on 64 statements in two rounds. An agreement/disagreement among ≥ 70.0% of the experts was regarded to indicate a consensus.
RESULTS: A consensus was achieved for 46 statements. For recurrent weight gain or worsening of a significant obesity complication after OAGB, more than 85% of experts reached a consensus that elongation of the biliopancreatic limb (BPL) is an acceptable option and the total bowel length measurement is mandatory during BPL elongation to preserve at least 300-400 cm of common channel limb length to avoid nutritional deficiencies. Also, more than 85% of experts reached a consensus on conversion to Roux-en-Y gastric bypass (RYGB) with or without pouch downsizing as an acceptable option for the treatment of persistent bile reflux after OAGB and recommend detecting and repairing any size of hiatal hernia during conversion to RYGB.
CONCLUSIONS: While the experts reached a consensus on several aspects regarding revision/conversion surgeries after OAGB, there are still lingering areas of disagreement. This highlights the importance of conducting further studies in the future to address these unresolved issues.
摘要：
目的：缺乏治疗某些疾病的证据，包括并发症处理，初始体重减轻次优，经常性的体重增加,或一次吻合胃旁路术（OAGB）后严重肥胖并发症恶化。这项研究旨在通过采用专家修改的德尔菲共识方法来应对现有的缺乏共识，并为临床医生提供宝贵的资源。
方法：来自28个国家的48名公认的减肥外科医生参加了改良的德尔菲共识，在两轮中对64项声明进行了投票。≥70.0％的专家之间的同意/分歧被认为表明共识。
结果：对46个陈述达成共识。对于OAGB后复发性体重增加或严重肥胖并发症的恶化，超过85%的专家达成共识,认为延长胆胰肢(BPL)是一种可接受的选择,并且在延长BPL期间必须进行总肠长度测量,以保留至少300~400cm的共同通道肢体长度,以避免营养缺乏.此外，超过85%的专家就转换为Roux-en-Y胃旁路术(RYGB)(无论是否缩小囊袋)作为OAGB术后持续性胆汁反流的可接受治疗方案达成共识,并建议在转换为RYGB期间检测和修复任何大小的食管裂孔疝.
结论：虽然专家们就OAGB后的修订/转换手术的几个方面达成了共识，仍然存在挥之不去的分歧。这突出了今后进行进一步研究以解决这些悬而未决的问题的重要性。
方法：来自28个国家的48名公认的减肥外科医生参加了改良的德尔菲共识，在两轮中对64项声明进行了投票。≥70.0％的专家之间的同意/分歧被认为表明共识。
结果：对46个陈述达成共识。对于OAGB后复发性体重增加或严重肥胖并发症的恶化，超过85%的专家达成共识,认为延长胆胰肢(BPL)是一种可接受的选择,并且在延长BPL期间必须进行总肠长度测量,以保留至少300~400cm的共同通道肢体长度,以避免营养缺乏.此外，超过85%的专家就转换为Roux-en-Y胃旁路术(RYGB)(无论是否缩小囊袋)作为OAGB术后持续性胆汁反流的可接受治疗方案达成共识,并建议在转换为RYGB期间检测和修复任何大小的食管裂孔疝.
结论：虽然专家们就OAGB后的修订/转换手术的几个方面达成了共识，仍然存在挥之不去的分歧。这突出了今后进行进一步研究以解决这些悬而未决的问题的重要性。
