A Central Asian Delphi consensus on the prevention, diagnosis, and management of surgical complications in metabolic and bariatric surgery

Background: The volume of metabolic and bariatric surgery (MBS) is rapidly increasing in Central Asia and is accompanied by a growing burden of postoperative complications. Despite the availability of international guidelines, regional differences in healthcare infrastructure and resources necessitate context-specific, evidence-based recommendations. This study establishes the first standardized, regionally agreed-upon consensus for managing MBS complications, specifically tailored to the infrastructure and resources of Central Asia. Methods: A modified Delphi consensus was reached under the auspices of the Society of Bariatric and Metabolic Surgeons of Kazakhstan. A steering committee developed 29 statements addressing early and late surgical complications after MBS. Forty expert bariatric surgeons from four Central Asian countries were invited to participate. Consensus was defined as ≥70% agreement on a three-point Likert scale across two rounds: an online survey followed by an in-person consensus meeting under international observation. Results: Twenty-seven experts (67.5%) completed round 1. Consensus was achieved for 24 of 29 statements (82.8%), covering prevention, diagnosis, and management of bleeding, staple-line leaks, strictures, metabolic disturbances, marginal ulcers, and internal hernias. Five statements did not reach consensus, reflecting heterogeneity in resources and unresolved evidence gaps. Analysis of non-consensus statements reveals critical resource limitations and evidence gaps, providing a clear roadmap for targeted training and future multicenter research. Conclusions: This study presents the first regionally agreed-upon consensus for managing MBS complications in Central Asia. The endorsed statements provide a practical framework aligned with international standards while accommodating regional realities. Areas without consensus highlight priorities for future education and collaborative research, offering a model for other middle-income countries facing similar barriers.

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