Original article
International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases

https://doi.org/10.1016/j.soard.2011.10.019Get rights and content

Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) is an emerging surgical approach, but 1 that has seen a surge in popularity because of its perceived technical simplicity, feasibility, and good outcomes. An international expert panel was convened in Coral Gables, Florida on March 25 and 26, 2011, with the purpose of providing best practice guidelines through consensus regarding the performance of LSG. The panel comprised 24 centers and represented 11 countries, spanning all major regions of the world and all 6 populated continents, with a collective experience of >12,000 cases. It was thought prudent to hold an expert consensus meeting of some of the surgeons across the globe who have performed the largest volume of cases to discuss and provide consensus on the indications, contraindications, and procedural aspects of LSG. The panel undertook this consensus effort to help the surgical community improve the efficacy, lower the complication rates, and move toward adoption of standardized techniques and measures. The meeting took place at on-site meeting facilities, Biltmore Hotel, Coral Gables, Florida.

Methods

Expert panelists were invited to participate according to their publications, knowledge and experience, and identification as surgeons who had performed >500 cases. The topics for consensus encompassed patient selection, contraindications, surgical technique, and the prevention and management of complications. The responses were calculated and defined as achieving consensus (≥70% agreement) or no consensus (<70% agreement).

Results

Full consensus was obtained for the essential aspects of the indications and contraindications, surgical technique, management, and prevention of complications. Consensus was achieved for 69 key questions.

Conclusion

The present consensus report represents the best practice guidelines for the performance of LSG, with recommendations in the 3 aforementioned areas. This report and its findings support a first effort toward the standardization of techniques and adoption of working recommendations formulated according to expert experience.

Section snippets

Panel data

A questionnaire was sent to all panelists before the consensus meeting to compile various data on the total number of LSG cases performed by the group (Table 1). These data comprise a total of 12,799 LSG cases. The data are reported as the mean ± SD, where appropriate. In addition to providing a rich source of information from which insights and conclusions could be drawn beyond the confines of the present consensus report, it reflects the panel's breadth and depth of experience with both the

Methods

Four chairpersons, who are surgeons with vast experience in LSG, convened and set the goals and panel inclusion criteria for this consensus endeavor. These 4 have collectively performed almost 2500 LSG cases and represent 4 different regional surgical societies (United States, Latin America, Europe, and Asia Pacific). The chairpersons determined the makeup of the expert international panel of surgeons, whom they invited to participate in this consensus meeting because of their individual level

Results

The consensus statements determined from the question responses are detailed in the following sections, and those statements of consensus considered the most critical by the expert panel are listed in Table 2. Consensus was obtained for the essential aspects of indications and contraindications, proper surgical technique, and the prevention and management of perioperative and postoperative complications (Table 3, Table 4, Table 5). In addition, consensus was achieved on certain points

Conclusions

The present consensus report was predicated on the collective knowledge and proficiency of a select group of very experienced surgeons performing LSG, case data collected from the expert panel, and a review of existing published data. As such, the present report can serve as a summary of consensus statements that can be used as best practice guidelines in the performance of LSG.

The durability of this procedure is evidenced in the 3- and 5-year data [2], and the number of procedures is expected

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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    A complete list of the International Sleeve Gastrectomy Expert Panel can found in Appendix A.

    Support provided by an educational grant from Ethicon Endo-Surgery, Cincinnati, Ohio.

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