A Delphi consensus on the surgical technique of laparoscopic sleeve gastrectomy: An obesity and metabolic surgery society of India initiative

Aparna Govil Bhasker; Om Tantia; Manish Khaitan; Randeep Wadhawan; KS Kular; Sarfaraz Jalil Baig; Sumeet Shah; Vivek Bindal; Ashish Vashishtha; Atul N. C. Peters; Deep Goel; Mahendra Narwaria; Manish Baijal; Nandakishore Dukkipati; Pradeep Chowbey; Rajesh Bhojwani; Ramen Goel; Sandeep Aggarwal; Sanjay Borude; Sanjay Patolia; Shashank Shah; Shrihari Dhorepatil; Sreejoy Patnaik; Sudhir Kalhan; Surendra Ugale; Praveen Raj Palanivelu

doi:10.4103/jbs.jbs_7_23

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ORIGINAL ARTICLE

Year : 2023 \| Volume : 2 \| Issue : 2 \| Page : 79-84

A Delphi consensus on the surgical technique of laparoscopic sleeve gastrectomy: An obesity and metabolic surgery society of India initiative Aparna Govil Bhasker¹, Om Tantia², Manish Khaitan³, Randeep Wadhawan⁴, KS Kular⁵, Sarfaraz Jalil Baig⁶, Sumeet Shah⁷, Vivek Bindal⁸, Ashish Vashishtha⁹, Atul N. C. Peters¹⁰, Deep Goel¹¹, Mahendra Narwaria¹², Manish Baijal¹³, Nandakishore Dukkipati¹⁴, Pradeep Chowbey¹⁵, Rajesh Bhojwani¹⁶, Ramen Goel¹⁷, Sandeep Aggarwal¹⁸, Sanjay Borude¹⁹, Sanjay Patolia²⁰, Shashank Shah²¹, Shrihari Dhorepatil²², Sreejoy Patnaik²³, Sudhir Kalhan²⁴, Surendra Ugale²⁵, Praveen Raj Palanivelu²⁶ ¹ Saifee Hospital, Mumbai, India ² ILS Hospital, Kolkata, India ³ KD Hospital, Ahmedabad, India ⁴ Manipal Hospital, New Delhi, India ⁵ Kular Jospital, Bija, Punjab, India ⁶ Belle Vue Hospital, Kolkata, West Bengal, India ⁷ PSRI Hospital, Delhi, India ⁸ Max Hospital, Delhi, India ⁹ Department of General Surgery & Robotics, Bariatric & Robotic Surgeon, Max Superspeciality Hospital, Saket, New Delhi, India ¹⁰ Max Smart Superspecialty Hospital, Saket, Delhi, India ¹¹ Max-BLK Super Specialty Hospital, New Delhi, India ¹² Asian Bariatric Pvt. Ltd, Ahmedabad, Gujarat, India ¹³ Max Institute of Laparoscopic, Endoscopic and Bariatric Surgery, Hyderabad, India ¹⁴ LivLife Hospital, Hyderabad, India ¹⁵ Max Healthcare, New Delhi, India ¹⁶ Santokba Durlabhji Memorial Hospital, Jaipur, Rajasthan, India ¹⁷ Wockhardt Hospital, Mumbai, India ¹⁸ All India Institute of Medical Sciences, New Delhi, India ¹⁹ Breach Candy Hospital, Mumbai, India ²⁰ Asian Bariatrics, Ahmedabad, India ²¹ Laparo-obeso Center, Pune, India ²² Shree Hospital, Pune, Maharashtra, India ²³ Shanti Memorial Hospital, Cuttack, India ²⁴ Gangaram Hospital, Delhi, India ²⁵ Kirloskar Hospital, Hyderabad, India ²⁶ Gem Hospital, Coimbatore, India Correspondence Address: Aparna Govil Bhasker Saifee Hospital, Mumbai, Maharashtra India Source of Support: None, Conflict of Interest: None DOI: 10.4103/jbs.jbs_7_23

Introduction: Laparoscopic sleeve gastrectomy (LSG) is the commonest bariatric operation being performed in India and worldwide. There are many technical variations that are being practiced. This Delphi consensus was an Obesity and Metabolic Surgery Society of India (OSSI) initiative to standardize the surgical technique of LSG. Methods: Twenty bariatric surgeons were selected as experts based on their years of experience in LSG, overall patient volumes, publications, and the recommendations of the executive committee of OSSI, to vote on 26 statements regarding the surgical steps of LSG. The minimum cutoff for consensus was taken as 70%. Results: The committee achieved a consensus on 19 out of 26 statements in the first round. One question was sent for reconsideration and 3 were resent after modification. Finally, consensus was reached on 22 statements. The consensus was reached regarding the use of preoperative upper gastrointestinal endoscopy. 85.7% agreed on an antral length of 3–5 cm. 85.7% were in favor of dissecting the left crus of the diaphragm completely and 100% agreed on Roux-en y gastric bypass to be the procedure of choice in the presence of medically refractory gastroesophageal reflux disease with hiatus hernia. Most experts agreed that a calibration tube must be used during LSG and the recommended size was between 36 and 40 Fr. Ninety-five percent agreed that care must be taken to avoid narrowing at the incisura and also to stay away from the angle of His. 71.4% did not recommend any kind of staple line reinforcement and 71.4% recommended a postoperative leak test. Conclusion: This Delphi consensus is a step toward improving the quality of surgical outcomes of LSG in India. This document has attempted to establish technical specifications of performing LSG. This will in turn help to maximize the reliability, standardization, and safety of the procedure until more robust studies are published.



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