title: Fifth International Consensus Conference: current status of sleeve gastrectomy.
abstract: BACKGROUND
  For the purpose of building best practice guidelines, an international expert panel was surveyed in 2014 and compared with the 2011 Sleeve Gastrectomy Consensus and with survey data culled from a general surgeon audience.
  
  
  OBJECTIVE
  To measure advancement on aspects of laparoscopic sleeve gastrectomy and identify current best practices.
  
  
  METHODS
  International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) 2014, Fifth International Summit for Laparoscopic Sleeve Gastrectomy, Montréal, Canada.
  
  
  METHODS
  In August 2014, expert surgeons (based on having performed>1000 cases) completed an online anonymous survey. Identical survey questions were then administered to general surgeon attendees.
  
  
  RESULTS
  One hundred twenty bariatric surgeons completed the expert survey, along with 103 bariatric surgeons from IFSO 2014 general surgeon audience. The following indications were endorsed: as a stand-alone procedure (97.5%); in high-risk patients (92.4%); in kidney and liver transplant candidates (91.6%); in patients with metabolic syndrome (83.8%); body mass index 30-35 with associated co-morbidities (79.8%); in patients with inflammatory bowel disease (87.4%); and in the elderly (89.1%). Significant differences existed between the expert and general surgeons groups in endorsing several contraindications: Barrett's esophagus (80.0% versus 31.3% [P<.001]), gastroesophageal reflux disease (23.3% versus 52.5% [P<.001]), hiatal hernias (11.7% versus 54.0% [P<.001]), and body mass index>60 kg/m(2) (5.0% versus 28.0% [P<.001]). Average reported weight loss outcomes 5 years postoperative were significantly higher for the expert surgeons group (P = .005), as were reported stricture (P = .001) and leakage (P = .005) rates. The following significant differences exist between 2014 and 2011 expert surgeons: Patients with gastroesophageal reflux disease should have pH and manometry study pre-laparoscopic sleeve gastrectomy (32.8% versus 50.0%; P = .033); it is important to take down the vessels before resection (88.1% versus 81.8%; P = .025); it is acceptable to buttress (81.4% versus 77.3%; P<.001); the smaller the bougie size and tighter the sleeve, the higher the incidence of leaks (78.8% versus 65.2%; P = .006).
  
  
  CONCLUSIONS
  This study highlights areas of new and improved best practices on various aspects of laparoscopic sleeve gastrectomy performance among experts from 2011 and 2014 and among the current general surgeon population.
authors.affiliation: Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Department of Surgery, Hopital du Sacre Coeur, Montreal, Quebec, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Gagner
authors.affiliation: Cleveland Clinic Florida, Weston, Florida.
authors.forename: Colleen
authors.initials: C
authors.lastname: Hutchinson
authors.affiliation: Cleveland Clinic Florida, Weston, Florida. Electronic address: rosentr@ccf.org.
authors.forename: Raul
authors.initials: R
authors.lastname: Rosenthal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050110:Bariatric Surgery / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D005743:Gastrectomy / Q000706:statistics & numerical data / Q000639:trends*; D005764:Gastroesophageal Reflux / Q000209:etiology; D015391:Gastroplasty / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology
keywords: Bariatric surgery; Complications; Consensus conference; Consensus statement; International Sleeve Gastrectomy Expert Panel; International conference on laparoscopic sleeve gastrectomy; Laparoscopic sleeve gastrectomy; Morbid obesity; Outcomes