International Federation for the Surgery and Other Therapies for Obesity (IFSO) global consensus recommendations for optimizing outcomes after sleeve gastrectomy - Report - MDSpire

International Federation for the Surgery and Other Therapies for Obesity (IFSO) global consensus recommendations for optimizing outcomes after sleeve gastrectomy

  • By

  • Ricardo V Cohen

  • Mohammad Kermansaravi

  • Randy Levinson

  • Muffazal Lakdawala

  • Chetan Parmar

  • Yosuke Seki

  • Gerhard Prager

  • Paulina Salminen

  • members of the Global Consensus Recommendations for Optimizing Outcomes after Sleeve Gastrectomy

  • M Ackerman

  • N Alfaris

  • A Aly

  • A Aminian

  • S Aparicio

  • J Ard

  • C Boza

  • W Brown

  • B A Dayyeh

  • C Domene

  • M Felsenreich

  • K Gawdat

  • A Haddad

  • M Herrera

  • K Higa

  • K Kasama

  • L Kow

  • W J Lee

  • N D Lorenzo

  • S Mattar

  • A Miras

  • V Moize

  • A Nimeri

  • C Peng

  • A S Pernaute

  • R Peterli

  • T Petry

  • J Ponce

  • Y Preiss

  • N Reddy

  • R Rosenthal

  • S A Sabah

  • A Schroeder

  • A Shabbir

  • C Stier

  • October 15, 2025

  • 0 min

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Global Consensus Guidelines on Enhancing Outcomes Following Sleeve Gastrectomy

Overview

The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) developed global consensus guidelines addressing suboptimal outcomes after sleeve gastrectomy (SG), including recurrent weight gain and gastro-oesophageal reflux disease (GORD). These guidelines integrate evidence from randomized controlled trials and expert opinion to improve postoperative management and patient care.

Background

Obesity affects billions worldwide and metabolic bariatric surgery (MBS) remains the most effective long-term treatment. Sleeve gastrectomy is the most commonly performed MBS procedure but may have less favorable outcomes compared to Roux-en-Y gastric bypass, including higher rates of suboptimal weight loss and de novo GORD. Long-term data reveal variability in weight loss success and remission of type 2 diabetes, with significant rates of recurrent weight gain and GORD after SG. Addressing these challenges is critical to optimizing patient outcomes.

Data Highlights

StudyOutcomeSGRYGB
SM-BOSS RCT (10 years)%TWL <20%33%27%
SM-BOSS RCT (10 years)%TWL <5%4%3%
SLEEVEPASS RCT (10 years)%TWL <5%5%3%
SM-BOSS RCT (10 years)De novo GORD43%Not reported
SLEEVEPASS RCT (10 years)De novo GORD52%Not reported
SLEEVEPASS RCT (10 years)Oesophagitis prevalence31%7%
SLEEVEPASS RCT (10 years)Barrett’s oesophagus prevalence4%4%
SM-BOSS RCT (10 years)T2D remission61%Not reported
SLEEVEPASS RCT (10 years)T2D remission26%Not reported

Key Findings

  • Suboptimal initial clinical response after SG is defined as less than 20% total body weight loss or insufficient improvement in obesity-related complications.
  • Recurrent weight gain exceeding 30% of initial surgical weight loss or worsening of obesity-related complications characterizes late postoperative clinical deterioration.
  • SG patients have higher rates of de novo GORD (43-52%) and oesophagitis (31%) compared to RYGB.
  • Remission rates of type 2 diabetes after SG vary significantly, influenced by preoperative disease duration.
  • Recurrence of type 2 diabetes may occur independently of weight regain, reflecting complex disease pathophysiology.
  • There is a lack of robust prospective data on preventive strategies and management of suboptimal outcomes after SG, necessitating expert consensus guidelines.

Clinical Implications

Clinicians should monitor patients closely for suboptimal weight loss and the development of GORD following sleeve gastrectomy. Early identification of recurrent weight gain or metabolic relapse allows timely intervention. Given the high incidence of de novo GORD, procedure selection should consider patient-specific reflux risk. Multidisciplinary management and adherence to consensus guidelines can optimize long-term outcomes.

Conclusion

The IFSO consensus provides evidence-based recommendations to address the challenges of suboptimal clinical response, recurrent weight gain, and GORD after sleeve gastrectomy. These guidelines aim to improve postoperative care and patient outcomes in the context of limited high-quality data.

References

  1. IFSO Global Consensus Guidelines 2024 -- Enhancing Outcomes Following Sleeve Gastrectomy

Original Source(s)

International Federation for the Surgery and Other Therapies for Obesity (IFSO) global consensus recommendations for optimizing outcomes after sleeve gastrectomy

  • by Ricardo V Cohen, Mohammad Kermansaravi, Randy Levinson, Muffazal Lakdawala, Chetan Parmar, Yosuke Seki, Gerhard Prager, Paulina Salminen, members of the Global Consensus Recommendations for Optimizing Outcomes after Sleeve Gastrectomy, M Ackerman, N Alfaris, A Aly, A Aminian, S Aparicio, J Ard, C Boza, W Brown, B A Dayyeh, C Domene, M Felsenreich, K Gawdat, A Haddad, M Herrera, K Higa, K Kasama, L Kow, W J Lee, N D Lorenzo, S Mattar, A Miras, V Moize, A Nimeri, C Peng, A S Pernaute, R Peterli, T Petry, J Ponce, Y Preiss, N Reddy, R Rosenthal, S A Sabah, A Schroeder, A Shabbir, C Stier

  • October 15, 2025

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