Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy

LSG has been increasingly performed. Long-term follow-up is necessary. During the Fourth International Consensus Summit on LSG in New York Dec. 2012, an online questionnaire (SurveyMonkeyA (R)) was filled out by 130 surgeons experienced in LSG. The survey was submitted directly to the statisticians. The 130 surgeons performed 354.9 +/- SD 453 LSGs/surgeon (median 175), for a total of 46,133 LSGs. The LSGs had been performed over 4.9 +/- 2.7 year (range 1-10). Of the 46,133 LSGs, 0.2 +/- 1.0 % (median 0, range 0-10 %) were converted to an open operation. LSG was intended as the sole operation in 93.1 +/- 14.8 %; in 3.0 +/- 6.3 %, a second stage became necessary. Of the 130 surgeons, 40 (32 %) use a 36F bougie, which was most common (range 32-50F). Staple-line is reinforced by 79 %; of these, 57 % use a buttress and 43 % over-sew. Mean %EWL at year 1 was 59.3 %; year 2, 59.0 %; year 3, 54.7 %; year 4, 52.3 %; year 5, 52.4 %; and year 6, 50.6 %. If a second-stage operation becomes necessary, preference was: RYGB 46 %, duodenal switch 24 %, re-sleeve 20 %, single-anastomosis duodenoileal bypass 3 %, sleeve plication 3 %, minigastric bypass 3 %, non-adjustable band 2 %, and side-to-side jejunoileal anastomosis 1 %. Complications were: high leak 1.1 %, hemorrhage 1.8 %, and stenosis at lower sleeve 0.9 %. Postoperative gastroesophageal reflux occurred in 7.9 +/- 8.2 % but was variable (0-30 %). Mortality was 0.33 +/- 1.6 %, which translates to 152 deaths. Eighty-nine percent order multivitamins (including vitamin D, calcium, and iron) and 72 % order B-12. A PPI is ordered by 29 % for 1 month, 29 % for 3 months, and others for 1-12 months depending on the case. LSG was relatively safe. Further long-term surveillance is necessary.