The first consensus statement on revisional bariatric surgery using a modified Delphi approach

Surg Endosc. 2020 Apr;34(4):1648-1657. doi: 10.1007/s00464-019-06937-1. Epub 2019 Jun 19.


Background: Revisional 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.

Methods: We 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.

Results: Seventy 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%).

Conclusion: Experts 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.

Keywords: Band to bypass; Band to sleeve; Bariatric surgery; Conversion; Gastric banding; Obesity surgery; One anastomosis gastric bypass; Revisional bariatric surgery; Roux-en-Y gastric bypass; Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy; Sleeve gastrectomy; Sleeve to bypass; Weight regain.

Publication types

  • Consensus Development Conference

MeSH terms

  • Adult
  • Bariatric Surgery / methods*
  • Biliopancreatic Diversion / methods
  • Consensus*
  • Delphi Technique*
  • Duodenum / surgery
  • Female
  • Gastrectomy / methods
  • Gastric Bypass / methods
  • Humans
  • Middle Aged
  • Obesity, Morbid / surgery
  • Preoperative Care
  • Reoperation