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The SAGES MASTERS program bariatric surgery pathway selects 10 seminal publications on adjustable gastric banding

Obeid, Nabeel R; Gibbs, Karen E; Faler, Byron; Eckhouse, Shaina; Corcelles, Ricard; Alvarez, Rafael; Chen, Judy; Husain, Farah; Ghanem, Omar M; Kroh, Matthew; Kurian, Marina
BACKGROUND:Bariatric surgery is one of the clinical pathways of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Masters Program, and laparoscopic adjustable gastric banding (LAGB) is one of the three anchoring bariatric procedures. To improve surgeon lifelong learning, the Masters Program seeks to identify sentinel articles of each of the 3 bariatric anchoring procedures. In this article, we present the top 10 articles on LAGB. METHODS:A systematic literature search of papers on LAGB was completed, and publications with the most citations and citation index were selected and shared with SAGES Metabolic and Bariatric Surgery Committee members for review. The individual committee members then ranked these papers, and the top 10 papers were chosen based on the composite ranking. RESULTS:The top 10 sentinel publications on LAGB contributed substantially to the body of literature related to the procedure, whether for surgical technique, novel information, or outcome analysis. A summary of each paper including expert appraisal and commentary is presented here. CONCLUSION/CONCLUSIONS:These seminal articles have had significant contribution to our understanding and appreciation of the LAGB procedure. Bariatric surgeons should use this resource to enhance their continual education and acquisition of specialized skills.
PMID: 38714569
ISSN: 1432-2218
CID: 5663122

Management of symptomatic, asymptomatic, and recurrent hiatal hernia: a systematic review and meta-analysis

Hanna, Nader M; Kumar, Sunjay S; Collings, Amelia T; Pandya, Yagnik K; Kurtz, James; Kooragayala, Keshav; Barber, Meghan W; Paranyak, Mykola; Kurian, Marina; Chiu, Jeffrey; Abou-Setta, Ahmed; Ansari, Mohammed T; Slater, Bethany J; Kohn, Geoffrey P; Daly, Shaun
BACKGROUND:The surgical management of hiatal hernia remains controversial. We aimed to compare outcomes of mesh versus no mesh and fundoplication versus no fundoplication in symptomatic patients; surgery versus observation in asymptomatic patients; and redo hernia repair versus conversion to Roux-en-Y reconstruction in recurrent hiatal hernia. METHODS:We searched PubMed, Embase, CINAHL, Cochrane Library and the ClinicalTrials.gov databases between 2000 and 2022 for randomized controlled trials (RCTs), observational studies, and case series (asymptomatic and recurrent hernias). Screening was performed by two trained independent reviewers. Pooled analyses were performed on comparative data. Risk of bias was assessed using the Cochrane Risk of Bias tool and Newcastle Ottawa Scale for randomized and non-randomized studies, respectively. RESULTS: = 0%). Conversion to Roux-en-Y was associated with a lower reintervention risk after 30 days compared to redo surgery. CONCLUSIONS:The evidence for optimal management of symptomatic and recurrent hiatal hernia remains controversial, underpinned by studies with a high risk of bias. Shared decision making between surgeon and patient is essential for optimal outcomes.
PMID: 38630179
ISSN: 1432-2218
CID: 5663032

Correction: Management of symptomatic, asymptomatic, and recurrent hiatal hernia: a systematic review and meta-analysis

Hanna, Nader M; Kumar, Sunjay S; Collings, Amelia T; Pandya, Yagnik K; Kurtz, James; Kooragayala, Keshav; Barber, Meghan W; Paranyak, Mykola; Kurian, Marina; Chiu, Jeffrey; Abou-Setta, Ahmed; Ansari, Mohammed T; Slater, Bethany J; Kohn, Geoffrey P; Daly, Shaun
PMID: 38671326
ISSN: 1432-2218
CID: 5657892

The SAGES MASTERS program bariatric surgery pathway selects 10 seminal publications on revisional bariatrics

Shin, Thomas H; Dang, Jerry; Howell, Melanie; Husain, Farah A; Ghanem, Omar M; GBittner, James; Eckhouse, Shaina R; Fearing, Nicole; Elli, Enrique; Hussain, Mustafa; Galvani, Carlos; Johnson, Shaneeta; Chand, Bipan; Pandya, Yagnik; Rogers, Ann M; Kroh, Matthew; Kurian, Marina
BACKGROUND:The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Masters Program designated bariatric surgery as a clinical pathway. Among the tiers of the Masters Program, revisional bariatric surgery is the highest tier of "mastery" within the pathway. This article presents the top 10 seminal studies representing the current landscape of revisional bariatrics. METHODS:The literature was systematically searched and seminal articles designated by consensus agreement of the SAGES Metabolic and Bariatric Surgery committee using multiple criteria, including impact on the field, citation frequency, and expert opinion. Articles were reviewed by committee members and presented in summarized fashion. RESULTS:The top 10 papers are presented in grouped thematic categories covering the early evolution of revisional bariatrics, changing criteria for reoperative bariatric surgery, divergence of revision versus conversion bariatric surgery, and recent technologic innovations in revisional bariatric surgery. Each summary is presented with expert appraisal and commentary. CONCLUSION/CONCLUSIONS:These seminal papers represent a snapshot of the dynamic field of revisional bariatric surgery and emphasize the need to not only remain current with contemporary trends but also keep a patient-oriented perspective on patient and intervention selection for optimal success.
PMID: 38555320
ISSN: 1432-2218
CID: 5645422

The Management of Biliary Disease in Patients with Severe Obesity Undergoing Metabolic and Bariatric Surgery-An International Expert Survey

Kermansaravi, Mohammad; Shikora, Scott; Dillemans, Bruno; Kurian, Marina; LaMasters, Teresa; Vilallonga, Ramon; Prager, Gerhard; Chiappetta, Sonja; ,
OBJECTIVE:This study aimed to survey international experts in metabolic and bariatric surgery (MBS) to improve and consolidate the management of biliary disease in patients with severe obesity undergoing MBS. BACKGROUND:Obesity and rapid weight loss after MBS are risk factors for the development of gallstones. Complications, such as cholecystitis, acute cholangitis, and biliary pancreatitis, are potentially life-threatening, and no guidelines for the proper management of gallstone disease exist. METHODS:An international scientific team designed an online confidential questionnaire with 26 multiple-choice questions. The survey was answered by 86 invited experts (from 38 different countries), who participated from August 1, 2023, to September 9, 2023. RESULTS:Two-thirds of experts (67.4%) perform concomitant cholecystectomy in symptomatic gallstones during MBS. Half of experts (50%) would wait 6-12 weeks between both surgeries with an interval approach. Approximately 57% of the experts prescribe ursodeoxycholic acid (UDCA) prophylactically after MBS, and most recommend a 6-month course. More than the half of the experts (59.3%/53.5%) preferred laparoscopic assisted transgastric ERCP as the approach for treating CBD stones in patients who previously had RYGB/OAGB. CONCLUSION/CONCLUSIONS:Concomitant cholecystectomy is preferred by the experts, although evidence in the literature reports an increased complication rate. Prophylactic UDCA should be recommended to every MBS patient, even though the current survey demonstrated that not all experts are recommending it. The preferred approach for treating common bile duct stones is a laparoscopic assisted transgastric ERCP after gastric bypass. The conflicting responses will need more scientific work and clarity in the future.
PMID: 38400945
ISSN: 1708-0428
CID: 5634662

Measuring Outcomes in the Treatment of Obesity

Jenkins, Megan; Kurian, Marina; Moore, Rachel
PMID: 38055228
ISSN: 2168-6262
CID: 5595752

Current recommendations for procedure selection in class I and II obesity developed by an expert modified Delphi consensus

Kermansaravi, Mohammad; Chiappetta, Sonja; Parmar, Chetan; Shikora, Scott A; Prager, Gerhard; LaMasters, Teresa; Ponce, Jaime; Kow, Lilian; Nimeri, Abdelrahman; Kothari, Shanu N; Aarts, Edo; Abbas, Syed Imran; Aly, Ahmad; Aminian, Ali; Bashir, Ahmad; Behrens, Estuardo; Billy, Helmuth; Carbajo, Miguel A; Clapp, Benjamin; Chevallier, Jean-Marc; Cohen, Ricardo V; Dargent, Jerome; Dillemans, Bruno; Faria, Silvia L; Neto, Manoel Galvao; Garneau, Pierre Y; Gawdat, Khaled; Haddad, Ashraf; ElFawal, Mohamad Hayssam; Higa, Kelvin; Himpens, Jaques; Husain, Farah; Hutter, Matthew M; Kasama, Kazunori; Kassir, Radwan; Khan, Amir; Khoursheed, Mousa; Kroh, Matthew; Kurian, Marina S; Lee, Wei-Jei; Loi, Ken; Mahawar, Kamal; McBride, Corrigan L; Almomani, Hazem; Melissas, John; Miller, Karl; Misra, Monali; Musella, Mario; Northup, C Joe; O'Kane, Mary; Papasavas, Pavlos K; Palermo, Mariano; Peterson, Richard M; Peterli, Ralph; Poggi, Luis; Pratt, Janey S A; Alqahtani, Aayad; Ramos, Almino C; Rheinwalt, Karl; Ribeiro, Rui; Rogers, Ann M; Safadi, Bassem; Salminen, Paulina; Santoro, Sergio; Sann, Nathaniel; Scott, John D; Shabbir, Asim; Sogg, Stephanie; Stenberg, Erik; Suter, Michel; Torres, Antonio; Ugale, Surendra; Vilallonga, Ramon; Wang, Cunchuan; Weiner, Rudolf; Zundel, Natan; Angrisani, Luigi; De Luca, Maurizio
Metabolic and bariatric surgery (MBS) is widely considered the most effective option for treating obesity, a chronic, relapsing, and progressive disease. Recently, the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) issued new guidelines on the indications for MBS, which have superseded the previous 1991 National Institutes of Health guidelines. The aim of this study is to establish the first set of consensus guidelines for selecting procedures in Class I and II obesity, using an Expert Modified Delphi Method. In this study, 78 experienced bariatric surgeons from 32 countries participated in a two-round Modified Delphi consensus voting process. The threshold for consensus was set at an agreement or disagreement of ≥ 70.0% among the experts. The experts reached a consensus on 54 statements. The committee of experts reached a consensus that MBS is a cost-effective treatment option for Class II obesity and for patients with Class I obesity who have not achieved significant weight loss through non-surgical methods. MBS was also considered suitable for patients with Type 2 diabetes mellitus (T2DM) and a body mass index (BMI) of 30 kg/m2 or higher. The committee identified intra-gastric balloon (IGB) as a treatment option for patients with class I obesity and endoscopic sleeve gastroplasty (ESG) as an option for patients with class I and II obesity, as well as for patients with T2DM and a BMI of ≥ 30 kg/m2. Sleeve gastrectomy (1) and Roux-en-Y gastric bypass (RYGB) were also recognized as viable treatment options for these patient groups. The committee also agreed that one anastomosis gastric bypass (OAGB) is a suitable option for patients with Class II obesity and T2DM, regardless of the presence or severity of obesity-related medical problems. The recommendations for selecting procedures in Class I and II obesity, developed through an Expert Modified Delphi Consensus, suggest that the use of standard primary bariatric endoscopic (IGB, ESG) and surgical procedures (SG, RYGB, OAGB) are acceptable in these patient groups, as consensus was reached regarding these procedures. However, randomized controlled trials are still needed in Class I and II Obesity to identify the best treatment approach for these patients in the future.
PMCID:10858961
PMID: 38341469
ISSN: 2045-2322
CID: 5635252

Management of symptomatic, asymptomatic, and recurrent hiatal hernia: a systematic review and meta-analysis

Hanna, Nader M.; Kumar, Sunjay S.; Collings, Amelia T.; Pandya, Yagnik K.; Kurtz, James; Kooragayala, Keshav; Barber, Meghan W.; Paranyak, Mykola; Kurian, Marina; Chiu, Jeffrey; Abou-Setta, Ahmed; Ansari, Mohammed T.; Slater, Bethany J.; Kohn, Geoff; Daly, Shaun
Background: The surgical management of hiatal hernia remains controversial. We aimed to compare outcomes of mesh versus no mesh and fundoplication versus no fundoplication in symptomatic patients; surgery versus observation in asymptomatic patients; and redo hernia repair versus conversion to Roux-en-Y reconstruction in recurrent hiatal hernia. Methods: We searched PubMed, Embase, CINAHL, Cochrane Library and the ClinicalTrials.gov databases between 2000 and 2022 for randomized controlled trials (RCTs), observational studies, and case series (asymptomatic and recurrent hernias). Screening was performed by two trained independent reviewers. Pooled analyses were performed on comparative data. Risk of bias was assessed using the Cochrane Risk of Bias tool and Newcastle Ottawa Scale for randomized and non-randomized studies, respectively. Results: We included 45 studies from 5152 retrieved records. Only six RCTs had low risk of bias. Mesh was associated with a lower recurrence risk (RR = 0.50, 95%CI 0.28, 0.88; I2 = 57%) in observational studies but not RCTs (RR = 0.98, 95%CI 0.47, 2.02; I2 = 34%), and higher total early dysphagia based on five observational studies (RR = 1.44, 95%CI 1.10, 1.89; I2 = 40%) but was not statistically significant in RCTs (RR = 3.00, 95%CI 0.64, 14.16). There was no difference in complications, reintervention, heartburn, reflux, or quality of life. There were no appropriate studies comparing surgery to observation in asymptomatic patients. Fundoplication resulted in higher early dysphagia in both observational studies and RCTs ([RR = 2.08, 95%CI 1.16, 3.76] and [RR = 20.58, 95%CI 1.34, 316.69]) but lower reflux in RCTs (RR = 0.31, 95%CI 0.17, 0.56, I2 = 0%). Conversion to Roux-en-Y was associated with a lower reintervention risk after 30 days compared to redo surgery. Conclusions: The evidence for optimal management of symptomatic and recurrent hiatal hernia remains controversial, underpinned by studies with a high risk of bias. Shared decision making between surgeon and patient is essential for optimal outcomes.
SCOPUS:85190757661
ISSN: 0930-2794
CID: 5662262

The SAGES MASTERS program bariatric surgery pathway selects 10 seminal publications on adjustable gastric banding

Obeid, Nabeel R.; Gibbs, Karen E.; Faler, Byron; Eckhouse, Shaina; Corcelles, Ricard; Alvarez, Rafael; Chen, Judy; Husain, Farah; Ghanem, Omar M.; Kroh, Matthew; Kurian, Marina
Background: Bariatric surgery is one of the clinical pathways of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Masters Program, and laparoscopic adjustable gastric banding (LAGB) is one of the three anchoring bariatric procedures. To improve surgeon lifelong learning, the Masters Program seeks to identify sentinel articles of each of the 3 bariatric anchoring procedures. In this article, we present the top 10 articles on LAGB. Methods: A systematic literature search of papers on LAGB was completed, and publications with the most citations and citation index were selected and shared with SAGES Metabolic and Bariatric Surgery Committee members for review. The individual committee members then ranked these papers, and the top 10 papers were chosen based on the composite ranking. Results: The top 10 sentinel publications on LAGB contributed substantially to the body of literature related to the procedure, whether for surgical technique, novel information, or outcome analysis. A summary of each paper including expert appraisal and commentary is presented here. Conclusion: These seminal articles have had significant contribution to our understanding and appreciation of the LAGB procedure. Bariatric surgeons should use this resource to enhance their continual education and acquisition of specialized skills.
SCOPUS:85192241063
ISSN: 0930-2794
CID: 5661522

Metabolic and Bariatric Surgery in Patients with Obesity Class V (BMI > 60 kg/m2): a Modified Delphi Study

Ponce de Leon-Ballesteros, Guillermo; Pouwels, Sjaak; Romero-Velez, Gustavo; Aminian, Ali; Angrisani, Luigi; Bhandari, Mohit; Brown, Wendy; Copaescu, Catalin; De Luca, Maurizio; Fobi, Mathias; Ghanem, Omar M.; Hasenberg, Till; Herrera, Miguel F.; Herrera-Kok, Johnn H.; Himpens, Jacques; Kow, Lilian; Kroh, Matthew; Kurian, Marina; Musella, Mario; Narwaria, Mahendra; Noel, Patrick; Pantoja, Juan P.; Ponce, Jaime; Prager, Gerhard; Ramos, Almino; Ribeiro, Rui; Ruiz-Ucar, Elena; Salminen, Paulina; Shikora, Scott; Small, Peter; Stier, Christine; Taha, Safwan; Taskin, Eren Halit; Torres, Antonio; Vaz, Carlos; Vilallonga, Ramon; Verboonen, Sergio; Zerrweck, Carlos; Zundel, Natan; Parmar, Chetan
Background: Metabolic and bariatric surgery (MBS) is the preferred method to achieve significant weight loss in patients with Obesity Class V (BMI > 60 kg/m2). However, there is no consensus regarding the best procedure(s) for this population. Additionally, these patients will likely have a higher risk of complications and mortality. The aim of this study was to achieve a consensus among a global panel of expert bariatric surgeons using a modified Delphi methodology. Methods: A total of 36 recognized opinion-makers and highly experienced metabolic and bariatric surgeons participated in the present Delphi consensus. 81 statements on preoperative management, selection of the procedure, perioperative management, weight loss parameters, follow-up, and metabolic outcomes were voted on in two rounds. A consensus was considered reached when an agreement of ≥ 70% of experts"™ votes was achieved. Results: A total of 54 out of 81 statements reached consensus. Remarkably, more than 90% of the experts agreed that patients should be notified of the greater risk of complications, the possibility of modifications to the surgical procedure, and the early start of chemical thromboprophylaxis. Regarding the choice of the procedure, SADI-S, RYGB, and OAGB were the top 3 preferred operations. However, no consensus was reached on the limb length in these operations. Conclusion: This study represents the first attempt to reach consensus on the choice of procedures as well as perioperative management in patients with obesity class V. Although overall consensus was reached in different areas, more research is needed to better serve this high-risk population. Graphical Abstract: [Figure not available: see fulltext.]
SCOPUS:85182420013
ISSN: 0960-8923
CID: 5629712