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

A1 Refereed original research article in a scientific journal

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

Authors: de Leon-Ballesteros Guillermo Ponce, 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

Publisher: Springer Nature

Publication year: 2024

Journal: Obesity Surgery

Journal name in source: OBESITY SURGERY

Volume: 34

Issue: 3

First page : 790

Last page: 813

ISSN: 0960-8923

eISSN: 1708-0428

DOI: https://doi.org/10.1007/s11695-023-06990-9

Web address : https://link.springer.com/article/10.1007/s11695-023-06990-9

Abstract

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.