Department of Surgery, Esophagus and Stomach Division, Federal University of São Paulo, Napoleão de Barros Street, São Paulo, 71504024-002, Brazil.
Department of Surgery, University of Virginia, Charlottesville, VA, USA.
Obes Surg. 2024 Feb;34(2):542-548. doi: 10.1007/s11695-023-07016-0. Epub 2023 Dec 29.
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.
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).
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.
SG lacks intrasurgeon and intersurgeon agreement in technical key points that may justify significant differences in GERD incidence after the procedure.
袖状胃切除术（SG）后胃食管反流病（GERD）可能与手术技术有关。缺乏技术标准化的事实可能解释了 GERD 发生率的巨大差异。本研究旨在评估基于记录视频的 SG 技术要点的自动和异质一致性。
选择了 10 名经验丰富的（至少从事 5 年减重手术，每年至少进行 30 例 SG）减肥外科医生（9 名男性（90%））。邀请参与者发送带有典型腹腔镜 SG 的未经编辑的视频（德尔菲过程的第一轮）。视频被裁剪成 11 个技术要点的小片段。所有匿名剪辑（包括他们自己的剪辑）都被返还给所有外科医生。要求个人对演示的技术是否同意（第二轮）。呈现一致性百分比给整个小组，要求他们进行第二次投票（第三轮）。
除了食管裂孔修复在第二轮具有非常好的一致性外，所有点的一致性都很差/一般。对于第三轮，距离食管胃交界/近端吻合的一致性略有增加，用于吻合的胃动员略有增加，而胃管最终形状的一致性略有下降。只有 1 名（10%）外科医生承认他评估了自己的视频。有 5 名（50%）外科医生在 1 个或多个点上不同意自己。
SG 在技术要点上缺乏外科医生内部和外科医生之间的一致性，这可能解释了手术后 GERD 发生率的显著差异。
