New Gastric Sleeve Recommendations Offer Best Practices for Surgeons

An international panel of surgeons has issued a consensus statement on best practices for gastric sleeve surgery aimed at fostering standardization and reducing the risks involved with the weight loss surgery procedure.

“Standardization of the technique of laparoscopic sleeve gastrectomy (LSG) is paramount to improving the safety and maintaining the minimal morbidity and high weight loss efficacy rates,” wrote the authors in their report, published this month in Surgery for Obesity and Related Diseases.

The recommendations, which address issues ranging from patient selection and technique to complication management, aim to provide a guide for experienced bariatric surgeons, as well as those that are new to the gastric sleeve procedure, said Kelvin Higa, MD, one of the panelists and clinical professor of surgery, University of California, San Francisco, and director of minimally invasive and bariatric surgery at the Fresno Heart and Surgical Hospital. Although the recommendations reflect current best practices, as determined by recognized experts in the laparoscopic sleeve gastrectomy procedure, the document is not intended to dictate the standard of care, Dr. Higa cautioned.

The 27-member panel was led by Raul J. Rosenthal, MD, professor of surgery and chair of minimally invasive surgery and the bariatric and metabolic institute, Cleveland Clinic Florida, and consisted of surgeons who had each performed at least 500 laparoscopic sleeve gastrectomy procedures. Panelists agreed on 69 key recommendations for best practices, based on their collective experience of more than 12,000 cases.

The laparoscopic sleeve gastrectomy was initially performed as a two-stage operation for super-obese patients. The panel recommended that the gastric sleeve was deemed a valid standalone procedure and a valid option for high-risk patients, transplant candidates, patients with inflammatory bowel disease, morbidly obese patients with metabolic syndrome, adolescent morbidly obese patients, and patients with a body mass index (BMI) of 30-35 with associated comorbidities.

The Centers for Medicare & Medicaid Services (CMS) this week released a new ruling regarding Medicare coverage for the gastric sleeve procedure for the treatment of morbid obesity, based on a review of available evidence.

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