Rosenthal RJ, International Sleeve Gastrectomy Expert P, Diaz AA, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases

Department of Surgery, Section of Minimally Invasive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA.
Surgery for Obesity and Related Diseases (Impact Factor: 4.07). 01/2012; 8(1):8-19. DOI: 10.1016/j.soard.2011.10.019
Source: PubMed


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.
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).
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.
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.

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    • "There were no staple line leaks in the 332 patients given the synthetic bioabsorbable PGA/TMC staple line reinforcement material, even though the stomach resection was begun close to the pylorus and bougies smaller than 40 F were employed. Like others [10, 13, 15], we believe that use of a smaller bougie produces greater weight loss, but we are aware that employing a small bougie may increase the risk of staple line leaks caused by an increase in intraluminal pressure, especially at the angle of His [35, 41]. However, our results provide new evidence that using the PGA/TMC reinforcement material mitigates that risk. "
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    ABSTRACT: Background Stand-alone laparoscopic sleeve gastrectomy (LSG) has been found to be effective in producing weight loss but few large, one-center LSG series have been reported. Gastric leakage from the staple line is a life-threatening complication of LSG, but there is controversy about whether buttressing the staple line with a reinforcement material will reduce leaks. We describe a single-center, 518-patient series of LSG procedures in which a synthetic buttressing material (GORE® SEAMGUARD® Bioabsorbable Staple Line Reinforcement) was used in the most recently treated patients. Methods We retrospectively reviewed the medical records of all patients who underwent LSG in our unit between September 2007 and December 2011. Patients treated before August 2009 did not receive the staple line reinforcement material (n = 186), whereas all patients treated afterward did (n = 332). Results The percentages of excess weight loss in the 518 patients (mean age, 41 years; 82 % female; mean preoperative body mass index, 44 kg/m2) were 67 % (79 % follow-up rate) at 6 months postoperatively, 81 % (64 %) at 1 year, and 84 % (30 %) at 2 years. Type 2 diabetes resolved in 71 % of patients (91/128). Patients given reinforcement material had baseline characteristics similar to those in the no-reinforcement-material group, but had no postoperative staple line leaks or bleeding. The no-reinforcement group had three leaks (p = 0.045) and one case of bleeding. Conclusions LSG resulted in substantial short-term weight loss. Use of the bioabsorbable staple line reinforcement material may decrease leaks after LSG.
    Obesity Surgery 07/2014; 24(7). DOI:10.1007/s11695-014-1251-9 · 3.75 Impact Factor
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    • "Laparoscopic sleeve gastrectomy (LSG) is a relatively new and increasingly popular surgical approach, due to its perceived simplicity of surgical technique and good midterm outcomes. However, due to the past lack of standardization associated with LSG, the results may differ between surgical teams [6] and consequently QOL outcomes may also differ. Some data suggest that LSG is just as effective as RYGB in improving QOL [7], but also less than desired QOL results have been reported [8]. "

    Surgery for Obesity and Related Diseases 06/2014; 11(1). DOI:10.1016/j.soard.2014.06.003 · 4.07 Impact Factor
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    • "Patients enrolled into the study underwent laparoscopic sleeve gastrectomy (LSG). In this study, LSG was performed according to the commonly used technique [9, 10]. Greater curvature vessels were divided using the LigaSure device (Covidien™, USA). "
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    ABSTRACT: Studies have shown that obesity is associated with venous flow disturbances that lead to changes of the biomechanical forces on the venous wall known as shear stress. We hypothesized that weight loss due to bariatric surgery affects the venous hemodynamics and biomechanical forces on the venous wall. The aim of this study was to evaluate the effects of laparoscopic sleeve gastrectomy (LSG) on the wall shear stress (WSS) and the venous hemodynamics of the femoral vein. We studied ten morbidly obese patients who underwent LSG. We investigated venous hemodynamics before, 6 and 12 months after LSG. The femoral vein diameter, cross-sectional area, peak (PeakV) and maximum (TAmax) velocities, WSS, and shear rate (SR) were assessed. PeakV and TAmax were significantly lower in the obese patients compared with the control group. WSS and SR were significantly lower in the obese patients compared with the control subjects. Venous hemodynamic parameters increased in the postoperative period at baseline compared with 12 months after surgery: PeakV increased from 17.53 (14.25-20.01) cm/s to 25.1 (20.9-30.1) cm/s (P = 0.04) and the TAmax from 12.97 (11.51-14.6) cm/s to 18.46 (13.24-24.13) cm/s (P = 0.057). WSS significantly increased from 0.21 (0.19-0.23) Pa at baseline to 0.31 (0.23-0.52) Pa 12 months after surgery (P = 0.031). SR also significantly increased from 47.92 (43.93-58.55) s(-1) at baseline to 76.81 (54.04-109.5) s(-1) 12 months after surgery (P = 0.02). This study showed that weight loss due to LSG significantly changes the biomechanical forces on the femoral vein generated by blood flow.
    Obesity Surgery 01/2014; 24(5). DOI:10.1007/s11695-013-1175-9 · 3.75 Impact Factor
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