• Kamal K Mahawar, Jacques M Himpens, Scott A Shikora, Almino C Ramos, Antonio Torres, Shaw Somers, Bruno Dillemans, Luigi Angrisani, GreveJan Willem MJWMZuyderland Medical Center, Heerlen, The Netherlands.The Netherlands and Maastricht University (MUMC+), Maastricht, The Netherlands., Jean-Marc Chevallier, Pradeep Chowbey, Maurizio De Luca, Rudolf Weiner, Gerhard Prager, Ramon Vilallonga, Marco Adamo, Nasser Sakran, Lilian Kow, Mufazzal Lakdawala, Jerome Dargent, Abdelrahman Nimeri, and Peter K Small.
• Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK. kmahawar@gmail.com.
• Surg Endosc. 2020 Apr 1; 34 (4): 1648-1657.

BackgroundRevisional bariatric surgery (RBS) constitutes a possible solution for patients who experience an inadequate response following bariatric surgery or significant weight regain following an initial satisfactory response. This paper reports results from the first modified Delphi consensus-building exercise on RBS.MethodsWe created a committee of 22 recognised opinion-makers with a special interest in RBS. The committee invited 70 RBS experts from 27 countries to vote on 39 statements concerning RBS. An agreement amongst ≥ 70.0% experts was regarded as a consensus.ResultsSeventy experts from twenty-seven countries took part. There was a consensus that the decision for RBS should be individualised (100.0%) and multi-disciplinary (92.8%). Experts recommended a preoperative nutritional (95.7%) and psychological evaluation (85.7%), endoscopy (97.1%), and a contrast series (94.3%). Experts agreed that Roux-Y gastric bypass (RYGB) (94.3%), One anastomosis gastric bypass (OAGB) (82.8%), and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) (71.4%) were acceptable RBS options after gastric banding (84.3%). OAGB (84.3%), bilio-pancreatic diversion/duodenal switch (BPD/DS) (81.4%), and SADI-S (88.5%) were agreed as consensus RBS options after sleeve gastrectomy. lengthening of bilio-pancreatic limb was the only consensus RBS option after RYGB (94.3%) and OAGB (72.8%).ConclusionExperts achieved consensus on a number of aspects of RBS. Though expert opinion can only be regarded as low-quality evidence, the findings of this exercise should help improve the outcomes of RBS while we develop robust evidence to inform future practice.

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