Laparoscopic Sleeve Gastrectomy Lacks Intrasurgeon and Intersurgeon Agreement in Technical Key Points That May Affect Gastroesophageal Reflux Disease After the Procedure

• Published in: Obesity surgery Vol. 34; no. 2; pp. 542 - 548
• Main Authors: Katayama, Rafael C., Herbella, Fernando A. M., Patti, Marco G., Arasaki, Carlos H., Oliveira, Rafaella O., de Grande, Ana C.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2024; Springer Nature B.V
• Subjects: Esophagogastric Junction; Female; Gastrectomy - methods; Gastroesophageal reflux; Gastroesophageal Reflux - epidemiology; Gastroesophageal Reflux - etiology; Gastroesophageal Reflux - surgery; Gastrointestinal surgery; Hernia, Hiatal - surgery; Humans; Laparoscopy; Laparoscopy - methods; Male; Medicine; Medicine & Public Health; Obesity, Morbid - surgery; Original Contributions; Surgeons; Surgery; Surgical outcomes; Surgical techniques; Obesity; Surgeon´s agreement; Video evaluation; Gastroesophageal reflux disease; Sleeve gastrectomy
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-023-07016-0

Purpose Gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG) may be related to surgical technique. The fact that there is a lack of technical standardization may explain large differences in GERD incidence. The aim of this study is to evaluate auto- and hetero-agreement for SG technical key points based on recorded videos. Methods Ten experienced (minimum of 5 years performing bariatric surgery, minimum of 30 SG per year) bariatric surgeons (9 (90%) males) were selected. Participants were invited to send an unedited video with a typical laparoscopic SG (first round of the Delphi process). Videos were cropped into small clips comprising 11 key points of the technique. All anonymized clips (including their own) were returned to all surgeons. Individuals were asked to agree or not with the technique demonstrated (second round). The percentage of agreement was presented to the entire group that was asked for a second vote (third round). Results Agreement was poor/fair for all points except hiatal repair that had a very good agreement in the second round. For the third round, there was a slight increase in agreement for distance esophagogastric junction/proximal stapling and gastric mobilization for stapling and a slight decrease in agreement for gastric tube final shape. Only 1 (10%) surgeon recognized that he evaluated his own video. Five (50%) surgeons disagreed with themselves on 1 or more points. Conclusion SG lacks intrasurgeon and intersurgeon agreement in technical key points that may justify significant differences in GERD incidence after the procedure.