between 0.82 and 0.96 in the first and second rounds. This demonstrates the reliability of the consensus. The presented Delphi consensus showed that the expert panel considered the operative set up phase very important, as none of the proposed sub-steps were excluded in both LRYGB and LSG. In the second surgical step ‘starting laparoscopy’, sub-steps regarding handling of hiatal hernia were excluded for LRYGB but advised for LSG. Some tested sub-steps such as ‘waiting 15 seconds between closing and firing stapler’ and ‘checking 15 second duration by scrub nurse’ depend on the use of specific instruments and should therefore have been regarded as tasks rather than sub-steps in hierarchical task analysis of these procedures. The study was designed to not include most controversial sub-steps by, for example, not stating the lengths of the limbs for LRYGB. But the results of this study do highlight some of the current discussion topics in MBS such as the closure of mesenteric defects. This study shows that closing Petersen’s space and the defect between the jejunojejunal anastomosis were not accepted as standard of care in the Netherlands at the time of the survey. However, some panellists remarked they were willing to change their standard procedure once more evidence on the benefits of closing the defects becomes available. For both procedures leak tests with methylene blue or air were not considered a key step by this expert panel. It could be interesting to summarize this as ‘testing’ in further research to ensure that some sort of testing is indeed not an advisable or key step. While this study provides a consensus between Dutch surgeons of these specific operations, the results could serve as a basis for consensus in other countries and for different procedures such as the laparoscopic one-anastomosis gastric bypass. The list of key steps can also be adjusted to incorporate different anastomosis techniques. 76 4
RkJQdWJsaXNoZXIy MTk4NDMw