Citations 1
Toward a Standardized Definition of Distal (Ileal) Metabolic Bariatric Surgery: An International Modified Delphi Consensus
Leon-Ballesteros, Guillermo Ponce de, Pouwels, Sjaak, Ghanem, Omar M., Arana, Sebastián, Rodriguez, Christian, Aceves, Manuel , Berry, Marcos, Brown, Wendy, Caiazzo, Robert, Carbajo, Miguel A., Cottam, Daniel, Dib, Victor, Dillemans, Bruno, Elli, Enrique F., Estrada, Roberto, Ferraro, Ariel, Gutiérrez-Rojas, Carlos A., Herrera, Miguel F., Huang, Chih‐Kun , Panagiotis, Lainas, MARTINEZ, SANDY, NAVARRETE, SALVADOR, Ortiz, Elias, Pantoja, Juan Pablo, Parmar, Chetan, Pattou, F , Ponce, Jaime , Ramirez, Christian, Ribeiro, Rui , Rodriguez-Esquerra, Antonio, Romero, Gustavo, Rotundo, Adriana, Salvi, Prashant, Sanchez-Pernaute, Andres, Santoro, Sérgio , Topart, Philippe, Torres, Antonio, Ungson, Gilberto , Weiner, Sylvia, Zerrweck, Carlos, León‐Ballesteros, Guillermo Ponce de , Pouwels, Sjaak , Ghanem, Omar M. , Arana-Garza, Sebastián, Angrisani, Luigi , Berry, Marcos A. , Brown, Wendy, Caiazzo, Robert J. , Carbajo, Miguel‐A., Chiappetta, Sonja , Cottam, Daniel Rhead , Dib, Victor Ramos Mussa , Dillemans, Bruno , Elli, Enrique F. , Ferraro, Ariel, Gutiérrez-Rojas, Carlos Alberto , Herrera, Miguel F. , Kermansaravi, Mohammad , Kurian, Marina S. , Laïnas, Panagiotis , Madalosso, Carlos Augusto Scussel , Martinez, Sandy, Parmar, Chetan D. , Salvi, Prashant H., Sánchez-Pernaute, Andrés , Topart, Philippe A. , Weiner, Sylvia R., Zerrweck, Carlos
No container title available | June 2, 2026 | Volume: No volume available | Issue: No issue available | Pages: No page available
Abstract Background Distal (ileal) metabolic bariatric surgeries (DMBS) have gained increasing adoption due to their enhanced metabolic effects. However, the absence of standardized definitions, classification, and clinical indications limits their consistent application. This consensus aimed to establish an international consensus on the definition, classification, indications, and postoperative management of DMBS. Methods A three-round modified Delphi study was conducted including international expert surgeons from 16 countries. A total of 98 statements were developed across three domains: procedural characteristics, patient selection, and postoperative follow-up. Consensus was defined as ≥75% agreement. Statements not reaching consensus were revised and resubmitted. Results Consensus was achieved on 81 statements. DMBS were defined as procedures involving gastro-ileal or duodeno-ileal bypass, emphasizing ileal stimulation as a key metabolic mechanism. Procedures with a common channel ≤350 cm, including single-anastomosis duodenal-ileal with SG (SADI-S), single anastomosis sleeve-ileal transit bipartition (SASI), sleeve gastrectomy with Roux-en-Y transit bipartition (SG+TB), and biliopancreatic diversion with duodenal switch (BPD-DS), as well as one-anastomosis gastric bypass (OAGB) with biliopancreatic limb > 50% of total small bowel length were classified as DMBS. Routine measurement of total small bowel length was strongly recommended. DMBS were considered appropriate as primary procedures in patients with BMI ≥40 kg/m² with comorbidities, a BMI ≥50–60 kg/m², irrespective of the presence of comorbidities, and as revisional options for suboptimal clinical response (SoCR), recurrent weight gain (RWG), or persistent metabolic disease. Comprehensive preoperative and multidisciplinary evaluation was deemed mandatory, and liver cirrhosis, heart failure, end-stage kidney disease, and inflammatory bowel disease were considered contraindications. Postoperative care requires lifelong multidisciplinary follow-up, with increased attention to nutritional deficiencies and supplementation. Conclusions This consensus provides a standardized framework for DMBS, supporting harmonization of practice and improved patient safety.