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Ospanov O. Training and Certification for the Bariatric and Metabolic Surgery Specialization in Kazakhstan. Obes Surg 2023; 33:368-369. [PMID: 36418770 DOI: 10.1007/s11695-022-06358-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/06/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Oral Ospanov
- Department of Surgical Disease and Bariatric Surgery, Astana Medical University, 49a, Beibitshilik Street, 010000, Astana, Kazakhstan.
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Zambare WV, Hess DT, Kenzik K, Pernar LI. Outcomes in Laparoscopic Roux-en-Y Gastric Bypass and Implications for Surgical Resident Education. J Surg Educ 2021; 78:e161-e168. [PMID: 34219036 DOI: 10.1016/j.jsurg.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/12/2021] [Accepted: 06/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Some surgery residents feel inadequately prepared to perform advanced operations, partly due to losing operative opportunities to fellows. In turn, they are prompted to pursue fellowships. Allowing residents the opportunity to participate in advanced procedures and complex cases may alleviate this cycle, if their participation is safe. This study examined the effects of resident participation in laparoscopic Roux-en-Y gastric bypass procedures (LRYGBs). DESIGN Our MBSAQIP database was used to identify LRYGBs performed at our institution between 2015 and 2018. Operative notes were reviewed to determine training level of the assistant. Patient comorbidities and outcomes (duration of surgery, length of stay, post-operative complications, readmissions, and reoperations) were stratified by assistant level of training for comparison. SETTING Urban tertiary care hospital. PARTICIPANTS Trainees and attending surgeons acting as assistants during LRYGBs. RESULTS Among 987 total cases, the assistants for the procedures were chief residents (n = 549, 56%), fourth-year residents (n = 258, 26%), attending surgeons (n = 143, 14%), and third-year residents (n = 37, 4%). Attending surgeons assisted more often when patients had a BMI ≥ 45 (38% attendings vs. 25% residents, p = 0.007), ≥ 2 comorbidities (54% vs. 40%, p = 0.007), or had a history of prior bariatric surgery (22% vs. 3%, p < 0.0001).Post-operative complication rate was low (4%) and did not differ significantly between all training levels (p = 0.86). Average length of stay, readmission rates, and reoperation rates were not significantly different across training levels (p = 0.75, p = 0.072, and p = 0.91 respectively). CONCLUSION Complication rates, hospital length of stay, readmission rates, and reoperation rates were equivalent for patients regardless of the level of training of the assistant for LRYGBs. Involving residents in complex bariatric procedures such as LRYGB is a safe model of education that does not compromise patient safety or hospital outcomes. Involvement in advanced cases allows general surgery residents to more confidently move toward independent practice.
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Affiliation(s)
| | - Donald T Hess
- Boston University School of Medicine, Boston, MA; Department of Surgery, Boston Medical Center, Boston, Massachusetts
| | - Kelly Kenzik
- Department of Surgery, Boston Medical Center, Boston, Massachusetts; Institute for Cancer Outcomes and Survivorship; University of Alabama at Birmingham, Birmingham, Alabama
| | - Luise I Pernar
- Boston University School of Medicine, Boston, MA; Department of Surgery, Boston Medical Center, Boston, Massachusetts.
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Greenberg CC, Byrnes ME, Engler TA, Quamme SP, Thumma JR, Dimick JB. Association of a Statewide Surgical Coaching Program With Clinical Outcomes and Surgeon Perceptions. Ann Surg 2021; 273:1034-1039. [PMID: 33605579 PMCID: PMC8119316 DOI: 10.1097/sla.0000000000004800] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess risk-adjusted outcomes and participant perceptions following a statewide coaching program for bariatric surgeons. SUMMARY OF BACKGROUND DATA Coaching has emerged as a new approach for improving individual surgeon performance, but lacks evidence linking to clinical outcomes. METHODS This program took place between October 2015 and February 2018 in the Michigan Bariatric Surgery Collaborative. Surgeons were categorized as coach, participant, or nonparticipant for an interrupted time series analysis. Multilevel logistic regression models included patient characteristics, time trends, and number of sessions. Risk-adjusted overall and surgical complication rates are reported, as are within-group relative risk ratios and 95% confidence intervals. We also compared operative times and report risk differences and 95% confidence intervals. Iterative thematic analysis of semi-structured interviews examined participant and coach perceptions of the program. RESULTS The coaching program was viewed favorably by most surgeons and many participants described numerous technical and nontechnical practice changes. The program was not associated with significant change in risk-adjusted complications with relative risks for coaches, participants, and nonparticipants of 0.99 (0.62-1.37), 0.91 (0.64-1.17), and 1.15 (0.83-1.47), respectively. Operative times did improve for participants, but not coaches or nonparticipants, with risk differences of -14.0 (-22.3, -5.7), -1.0 (-4.5, 2.4), and -2.6 (-6.9, 1.7). Future coaching programmatic design should consider dose-complexity matching, hierarchical leveling, and optimizing video review. CONCLUSIONS This statewide surgical coaching program was perceived as valuable and surgeons reported numerous practice changes. Operative times improved, but there was no significant improvement in risk-adjusted outcomes.
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Affiliation(s)
- Caprice C. Greenberg
- Department of Surgery, University of Wisconsin, and the Wisconsin Surgical Outcomes Research Program (WiSOR), Madison, WI
| | - Mary E. Byrnes
- Department of Surgery, University of Michigan and the Center for Healthcare Outcomes and Policy (CHOP), Ann Arbor, MI
| | - Tedi A. Engler
- Department of Surgery, University of Michigan and the Center for Healthcare Outcomes and Policy (CHOP), Ann Arbor, MI
| | - Sudha Pavuluri Quamme
- Department of Surgery, University of Wisconsin, and the Wisconsin Surgical Outcomes Research Program (WiSOR), Madison, WI
| | - Jyothi R Thumma
- Department of Surgery, University of Michigan and the Center for Healthcare Outcomes and Policy (CHOP), Ann Arbor, MI
| | - Justin B. Dimick
- Department of Surgery, University of Michigan and the Center for Healthcare Outcomes and Policy (CHOP), Ann Arbor, MI
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Wehrtmann FS, de la Garza JR, Kowalewski KF, Schmidt MW, Müller K, Tapking C, Probst P, Diener MK, Fischer L, Müller-Stich BP, Nickel F. Learning Curves of Laparoscopic Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in Bariatric Surgery: a Systematic Review and Introduction of a Standardization. Obes Surg 2021; 30:640-656. [PMID: 31664653 DOI: 10.1007/s11695-019-04230-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The most commonly performed bariatric procedures are laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (LSG). Impact of learning curves on operative outcome has been well shown, but the necessary learning curves have not been clearly defined. This study provides a systematic review of the literature and proposes a standardization of phases of learning curves for RYGB and LSG. METHODS A systematic literature search was performed using PubMed, Web of Science, and CENTRAL databases. All studies specifying a number or range of approaches to characterize the learning curve for RYGB and LSG were selected. RESULTS A total of 28 publications related to learning curves for 27,770 performed bariatric surgeries were included. Parameters used to determine the learning curve were operative time, complications, conversions, length of stay, and blood loss. Learning curve range was 30-500 (RYGB) and 30-200 operations (LSG) according to different definitions and respective phases of learning curves. Learning phases described the number of procedures necessary to achieve predefined skill levels, such as competency, proficiency, and mastery. CONCLUSIONS Definitions of learning curves for bariatric surgery are heterogeneous. Introduction of the three skill phases competency, proficiency, and mastery is proposed to provide a standardized definition using multiple outcome variables to enable better comparison in the future. These levels are reached after 30-70, 70-150, and up to 500 RYGB, and after 30-50, 60-100, and 100-200 LSG. Training curricula, previous laparoscopic experience, and high procedure volume are hallmarks for successful outcomes during the learning curve.
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Affiliation(s)
- F S Wehrtmann
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - J R de la Garza
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - K F Kowalewski
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - M W Schmidt
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - K Müller
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - C Tapking
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - P Probst
- The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - M K Diener
- The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - L Fischer
- Department of Surgery, Hospital Mittelbaden, Balger Strasse 50, 76532, Baden-Baden, Germany
| | - B P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - F Nickel
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Somers F, Lasserre Mouttet A, Joly C, Touveneau S, Pataky Z, Golay A. [Start to collaborate with partner patients : an evidence?]. Rev Med Suisse 2020; 16:596-598. [PMID: 32216184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The societal, political and institutional context is today favorable for the establishment of a partnership between patient and healthgivers. Despite the tangible benefits, the perception of partners ambivalent attitudes reinforces the importance of the construction for this collaboration. This article describes this collaborative approach born out of the transformation of a bariatric surgery preparation educational program. In this context, the implementation strategy is the founding stage to explore the needs of partners. This highlights the need to secure the healthgivers regarding power issues, as well as to question the skills required for patient partners. The definition of the partnership model by the partners provides answers.
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Affiliation(s)
- Florence Somers
- Unité d'éducation thérapeutique du patient, Service d'endocrinologie, diabétologie, nutrition et éducation thérapeutique du patient, Département de médecine, HUG, 1206 Genève
| | - Aline Lasserre Mouttet
- Unité d'éducation thérapeutique du patient, Service d'endocrinologie, diabétologie, nutrition et éducation thérapeutique du patient, Département de médecine, HUG, 1206 Genève
| | - Catherine Joly
- Unité d'éducation thérapeutique du patient, Service d'endocrinologie, diabétologie, nutrition et éducation thérapeutique du patient, Département de médecine, HUG, 1206 Genève
| | | | - Zoltan Pataky
- Unité d'éducation thérapeutique du patient, Service d'endocrinologie, diabétologie, nutrition et éducation thérapeutique du patient, Département de médecine, HUG, 1206 Genève
| | - Alain Golay
- Unité d'éducation thérapeutique du patient, Service d'endocrinologie, diabétologie, nutrition et éducation thérapeutique du patient, Département de médecine, HUG, 1206 Genève
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Köhler H, Dorozhkina R, Gruner-Labitzke K, de Zwaan M. Specific Health Knowledge and Health Literacy of Patients before and after Bariatric Surgery: A Cross-Sectional Study. Obes Facts 2020; 13:166-178. [PMID: 32208386 PMCID: PMC7250322 DOI: 10.1159/000505837] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/08/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND It is an important condition for adequate weight loss and prevention of adverse events that bariatric surgery (BS) candidates possess good specific health knowledge. There is a paucity of standardized instruments to evaluate the specific health knowledge of patients before and after BS. Therefore, we developed a 32-item multiple-choice test covering the main aspects of life which are important after BS, and investigated the correlation of specific health knowledge with health literacy, level of depression and anxiety, percentage of excess weight loss, and specific complications of BS in postoperative patients. METHODS Two groups participated in the cross-sectional study: the preoperative group (n = 109) was recruited from candidates for BS (gastric bypass or sleeve gastrectomy), the postoperative group (n = 110) was recruited from patients 12-74 months after BS (average 33 months, SD = 16.5). Both groups had completed a preoperative multimodal training program. Specific health knowledge was assessed with a newly developed knowledge questionnaire. Health literacy was evaluated with the short version of the European Health Literacy Survey (HLS-EU-Q16). The 9-item Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Scale (GAD-7) were used to assess the levels of depression and anxiety. RESULTS The pre- and postoperative group did not differ with regard to the number of correctly answered questions on the knowledge questionnaire, with 75% correct answers in both groups (p = 0.059). No correlations were found with health literacy (p = 0.498) and levels of depression (preoperative group: p = 0.279; postoperative group: p = 0.242) and anxiety (preoperative group: p = 0.866; postoperative group: p = 0.119). In postoperative patients specific health knowledge was not associated with the weight loss achieved (p = 0.437). CONCLUSION The newly designed knowledge questionnaire can be useful for screening specific knowledge of BS patients at different time points.
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Affiliation(s)
- Hinrich Köhler
- Department of General, Abdominal, and Bariatric Surgery, Herzogin Elisabeth Hospital, Braunschweig, Germany,
| | - Renata Dorozhkina
- Department of General, Abdominal, and Bariatric Surgery, Herzogin Elisabeth Hospital, Braunschweig, Germany
| | - Kerstin Gruner-Labitzke
- Department of General, Abdominal, and Bariatric Surgery, Herzogin Elisabeth Hospital, Braunschweig, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
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Frick SE, Muller MK, Klasen JM. Hands-on teaching and feedback: challenges in surgical workshops. Med Educ 2019; 53:511-512. [PMID: 30907451 DOI: 10.1111/medu.13844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Ferhatoglu MF, Kartal A, Ekici U, Gurkan A. Evaluation of the Reliability, Utility, and Quality of the Information in Sleeve Gastrectomy Videos Shared on Open Access Video Sharing Platform YouTube. Obes Surg 2019; 29:1477-1484. [PMID: 30706318 DOI: 10.1007/s11695-019-03738-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Abdulcabbar Kartal
- Faculty of Medicine, Department of General Surgery, Okan University, Istanbul, Turkey
| | - Ugur Ekici
- Istanbul Gelisim University Health Sciences Colleges, Istanbul, Turkey
| | - Alp Gurkan
- Faculty of Medicine, Department of General Surgery, Okan University, Istanbul, Turkey
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Kaijser M, van Ramshorst G, van Wagensveld B, Pierie JP. Current Techniques of Teaching and Learning in Bariatric Surgical Procedures: A Systematic Review. J Surg Educ 2018; 75:730-738. [PMID: 29033273 DOI: 10.1016/j.jsurg.2017.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 08/26/2017] [Accepted: 09/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The gastric sleeve resection and gastric bypass are the 2 most commonly performed bariatric procedures. This article provides an overview of current teaching and learning methods of those techniques in resident and fellow training. DESIGN A database search was performed on Pubmed, Embase, and the Education Resources Information Center (ERIC) to identify the methods used to provide training in bariatric surgery worldwide. After exclusion based on titles and abstracts, full texts of the selected articles were assessed. Included articles were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS In total, 2442 titles were identified and 14 full text articles met inclusion criteria. Four publications described an ex vivo training course, and 6 focused on at least 1 step of the gastric bypass procedure. Two randomized controlled trials (RCT) provided high-quality evidence on training aspects. Surgical coaching caused significant improvement of Bariatric Objective Structured Assessment of Technical Skills (BOSATS) scores (3.60 vs. 3.90, p = 0.017) and reduction of technical errors (18 vs. 10, p = 0.003). A preoperative warm-up increased global rating scales (GRS) scores on depth perception (p = 0.02), bimanual dexterity (p = 0.01), and efficiency of movements (p = 0.03). CONCLUSION Stepwise education, surgical coaching, warming up, Internet-based knowledge modules, and ex vivo training courses are effective in relation to bariatric surgical training of residents and fellows, possibly shortening their learning curves.
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Affiliation(s)
- Mirjam Kaijser
- University of Groningen, University Medical Centre Groningen, Post Graduate School of Medicine, Groningen, The Netherlands; Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands; Heelkunde Friesland Groep, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
| | - Gabrielle van Ramshorst
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - Bart van Wagensveld
- Department of Surgery, Onze Lieve Vrouwe Gasthuis West, Amsterdam, The Netherlands
| | - Jean-Pierre Pierie
- University of Groningen, University Medical Centre Groningen, Post Graduate School of Medicine, Groningen, The Netherlands; Heelkunde Friesland Groep, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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Shea B, Boyan W, Botta J, Ali S, Fenig Y, Paulin E, Binenbaum S, Borao F. Five Years, Two Surgeons, and over 500 Bariatric Procedures: What Have We Learned? Obes Surg 2018; 27:2742-2749. [PMID: 28795300 DOI: 10.1007/s11695-017-2873-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bariatric surgery has become an increasingly popular method for weight loss and mitigation of co-morbidities in the obese population. Like any field, there is a desire to standardize and accelerate the postoperative period while maintaining safe outcomes. METHODS All laparoscopic sleeve gastrectomies (LSG) and gastric bypasses (LGB) were performed over a 5-year period were logged along with several aspects of postoperative care. Trends were followed in aspects of postoperative care over years as well as any documentation of complications or re-admissions. RESULTS A total of 545 LSGs and LBPs were performed between 2012 and 2016. Improvements were noted in nearly every field over time, including faster Foley removal, decreased length of hospital stay, decreased use of patient controlled analgesics (PCAs), and faster advancement of diet. There was also an abandonment of utilization of the ICU and step down setting for these patients, leading to significant decreases in hospital cost. There was no change in complications, re-operations, or re-admission in this time period. CONCLUSIONS The surgeons involved in this project have built a busy bariatric surgery practice, while continually evolving the postoperative algorithm. Nearly every aspect of postoperative care has been deescalated while decreasing length of stay and cost to the hospital. All of this has been obtained without incurring any increase in complications, re-operations, or re-admissions. The authors of this paper hope to use this article as a launching point for a formal advanced recovery pathway for bariatric surgery at their institution and others.
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Affiliation(s)
- Brian Shea
- Monmouth Medical Center, Long Branch, NJ, USA
| | - William Boyan
- Monmouth Medical Center, Long Branch, NJ, USA.
- , 110 Robinson Place, Shrewsbury, NJ, 07702, USA.
| | - James Botta
- Monmouth Medical Center, Long Branch, NJ, USA
| | - Syed Ali
- School of Medicine, St. George's University, West Indies, Grenada
| | - Yaniv Fenig
- Monmouth Medical Center, Long Branch, NJ, USA
| | | | | | - Frank Borao
- Monmouth Medical Center, Long Branch, NJ, USA
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Graham YNH, Mansour D, Small PK, Hinshaw K, Gatiss S, Mahawar KK, McGarry K, Wilkes S. A Survey of Bariatric Surgical and Reproductive Health Professionals' Knowledge and Provision of Contraception to Reproductive-Aged Bariatric Surgical Patients. Obes Surg 2017; 26:1918-23. [PMID: 26801788 DOI: 10.1007/s11695-015-2037-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Over 80 % of bariatric surgical patients are women with obesity in their reproductive years. Obesity adversely affects fertility; the rapid weight loss following bariatric surgery can increase fecundity. Current guidelines recommend avoiding pregnancy for up to 24 months following surgery, but little is known about current contraceptive care of women who undergo bariatric surgery. Two surveys were undertaken with bariatric surgical and contraceptive practitioners in England to establish current contraceptive practices in both groups. METHODS Two anonymous on-line surveys were sent to all 382 members of the British Obesity and Metabolic Surgery Society (BOMSS) and an estimated 300 contraceptive practitioners in the North East of England. RESULTS The BOMSS survey elicited a response rate of 17 % (n = 65), mainly from bariatric surgeons (n = 24 (36 %)). Most respondents (97 %) acknowledged the need to educate patients, but contraceptive information was only provided by 7 % (n = 4) of respondents in bariatric surgical clinics. Less than half of respondents were confident discussing contraception, and the majority requested further training, guidance and communication with contraceptive practitioners. The majority of respondents to the contraceptive practitioner survey were general practitioners (28 %, n = 20). Three quarters of respondents reported little knowledge of bariatric surgery, and many reported not seeing women with obesity requiring contraception before (66 %, n = 45) or after surgery (71 %, n = 49). CONCLUSIONS There is a need to increase knowledge levels of contraception within bariatric surgical teams and to understand why, despite increasing levels of bariatric surgery, women do not seem to be appearing for advice in contraceptive settings.
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Affiliation(s)
- Yitka N H Graham
- Department of Pharmacy, Health and Well-being, University of Sunderland, Sunderland, Tyne and Wear, UK.
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, Tyne and Wear, UK.
| | - Diana Mansour
- Department of Sexual Health, New Croft Centre, Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle Upon Tyne, Tyne and Wear, UK
| | - Peter K Small
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, Tyne and Wear, UK
| | - Kim Hinshaw
- Department of Pharmacy, Health and Well-being, University of Sunderland, Sunderland, Tyne and Wear, UK
- Department of Obstetrics and Gynaecology, Sunderland Royal Hospital, Sunderland, Tyne and Wear, UK
| | - Sarah Gatiss
- Department of Obstetrics and Gynaecology, Sunderland Royal Hospital, Sunderland, Tyne and Wear, UK
| | - Kamal K Mahawar
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, Tyne and Wear, UK
| | - Ken McGarry
- Department of Pharmacy, Health and Well-being, University of Sunderland, Sunderland, Tyne and Wear, UK
| | - Scott Wilkes
- Department of Pharmacy, Health and Well-being, University of Sunderland, Sunderland, Tyne and Wear, UK
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Inaba CS, Koh CY, Sujatha-Bhaskar S, Lee Y, Pejcinovska M, Nguyen NT. The effect of hospital teaching status on outcomes in bariatric surgery. Surg Obes Relat Dis 2017; 13:1723-1727. [PMID: 28867305 PMCID: PMC6281390 DOI: 10.1016/j.soard.2017.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/23/2017] [Accepted: 07/05/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Studies have shown conflicting effects of resident involvement on outcomes after laparoscopic bariatric surgery. Resident involvement may be a proxy for a teaching environment in which multiple factors affect patient outcomes. However, no study has examined outcomes of laparoscopic bariatric surgery based on hospital teaching status. OBJECTIVE To compare outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) between teaching hospitals (THs) and nonteaching hospitals (NTHs). SETTING Retrospective review of a national database in the United States. METHODS The Nationwide Inpatient Sample database (2011-2013) was reviewed for obese patients who underwent LRYGB or LSG. Patient demographic characteristics and outcomes were analyzed according to hospital teaching status. Primary outcome measures included risk-adjusted inpatient mortality and serious morbidity. RESULTS We analyzed 32,449 LRYGBs and 26,075 LSGs. There were 35,160 (60.1%) cases performed at THs and 23,364 (39.9%) cases performed at NTHs. At THs, the distribution of LRYGB versus LSG cases was 20,461 (58.2%) versus 14,699 (41.8%), respectively; at NTHs, the distribution was 11,988 (51.3%) versus 11,376 (48.7%), respectively. For LRYGB, there were no significant differences between THs versus NTHs in mortality (AOR 1.14; P = 0.99), but there was an increase in odds of serious morbidity at THs (AOR 1.36; P<0.001). For LSG, there were no significant differences between THs versus NTHs for mortality (AOR 1.15; P = 0.99) or serious morbidity (AOR 1.03; P = 0.99). CONCLUSIONS There is an association between THs and increased serious morbidity for LRYGB, but hospital teaching status has no effect on morbidity or mortality after LSG. Further research is warranted to elucidate the reasons for these associations.
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Affiliation(s)
- Colette S Inaba
- Department of Surgery, University of California Irvine Medical Center, Orange, California
| | - Christina Y Koh
- Department of Surgery, University of California Irvine Medical Center, Orange, California
| | - Sarath Sujatha-Bhaskar
- Department of Surgery, University of California Irvine Medical Center, Orange, California
| | - Yoon Lee
- Department of Surgery, University of California Irvine Medical Center, Orange, California
| | - Marija Pejcinovska
- Center for Statistical Consulting, University of California at Irvine, Irvine, California
| | - Ninh T Nguyen
- Department of Surgery, University of California Irvine Medical Center, Orange, California.
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Abstract
A world-wide rise in the prevalence of obesity continues. This rise increases the occurrence of, risks of, and costs of treating obesity-related medical conditions. Diet and activity programs are largely inadequate for the long-term treatment of medically-complicated obesity. Physicians who deliver gastrointestinal care after completing traditional training programs, including gastroenterologists and general surgeons, are not uniformly trained in or familiar with available bariatric care. It is certain that gastrointestinal physicians will incorporate new endoscopic methods into their practice for the treatment of individuals with medically-complicated obesity, although the long-term impact of these endoscopic techniques remains under investigation. It is presently unclear whether gastrointestinal physicians will be able to provide or coordinate important allied services in bariatric surgery, endocrinology, nutrition, psychological evaluation and support, and social work. Obtaining longitudinal results examining the effectiveness of this ad hoc approach will likely be difficult, based on prior experience with other endoscopic measures, such as the adenoma detection rates from screening colonoscopy. As a long-term approach, development of a specific curriculum incorporating one year of subspecialty training in bariatrics to the present training of gastrointestinal fellows needs to be reconsidered. This approach should be facilitated by gastrointestinal trainees’ prior residency training in subspecialties that provide care for individuals with medical complications of obesity, including endocrinology, cardiology, nephrology, and neurology. Such training could incorporate additional rotations with collaborating providers in bariatric surgery, nutrition, and psychiatry. Since such training would be provided in accredited programs, longitudinal studies could be developed to examine the potential impact on accepted measures of care, such as complication rates, outcomes, and costs, in individuals with medically-complicated obesity.
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Affiliation(s)
- Timothy R Koch
- Center for Advanced Laparoscopic General and Bariatric Surgery, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC 20010, United States
| | - Timothy R Shope
- Center for Advanced Laparoscopic General and Bariatric Surgery, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC 20010, United States
| | - Christopher J Gostout
- Professor Emeritus, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
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Affiliation(s)
- Hasan Erdem
- General Surgery Department, Dr. NB Kadikoy Hospital, Istanbul, Turkey
| | - Abdullah Sisik
- General Surgery Department, Health Science University, Umraniye Education and Research Hospital, Istanbul, Turkey.
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Ryan JP, Borgert AJ, Kallies KJ, Carlson LM, McCollister H, Severson PA, Kothari SN. Can Rural Minimally Invasive Surgery Fellowships Provide Operative Experience Similar to Urban Programs? J Surg Educ 2016; 73:793-798. [PMID: 27211880 DOI: 10.1016/j.jsurg.2016.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/15/2016] [Accepted: 04/13/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Operative experience in rural fellowship programs is largely unknown. The 2 of the most rural minimally invasive surgery (MIS)/bariatric fellowships are located in the upper Midwest. We hypothesized that these 2 programs would offer a similar operative experience to other U.S. programs in more urban locations. DESIGN The 2011 to 2012 and 2012 to 2013 fellowship case logs from 2 rural Midwest programs were compared with case logs from 23 U.S. MIS/bariatric programs. All rural Midwest fellowship graduates completed a survey describing their fellowship experience and current practice. Statistical analysis included Wilcoxon rank-sum test. SETTING Setting included the 2 rural Midwest U.S. MIS/bariatric fellowship programs. PARTICIPANTS Graduates from MIS/bariatric fellowship programs participated in the study. RESULTS Mean volumes for bariatric, foregut, abdominal wall, small intestine, and hepatobiliary cases for rural Midwest fellows vs. other U.S. programs were 123.8 ± 23.7 vs. 150.2 ± 49.2 (p = 0.20); 44.3 ± 19.4 vs. 66.3 ± 35.5 (p = 0.18); 48.3 ± 28.0 vs. 57.9 ± 27.8 (p = 0.58); 11.3 ± 1.9 vs. 12.0 ± 8.7 (p = 0.58); and 55.0 ± 34.8 vs. 48.1 ± 42.6 (p = 0.63), respectively. Mean endoscopy volume was significantly higher among rural Midwest fellows (451.0 ± 395.2 vs. 99.7 ± 83.4; p = 0.05). All rural Midwest fellows reported an adequate number of cases as operating surgeon during fellowship. A total of 60% of fellows currently practice in a rural area. In all, 87% and 13% reported that their fellowship training was extremely or somewhat beneficial to their current practice, respectively. CONCLUSIONS Rural MIS fellowship programs offer a similar operative experience to other U.S. programs. A greater volume of endoscopy cases was observed in rural Midwest fellowships.
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Affiliation(s)
- James Patrick Ryan
- Minnesota Institute for Minimally Invasive Surgery, Cuyuna Regional Medical Center, Crosby, Minnesota
| | - Andrew J Borgert
- Department of Medical Research, Gundersen Medical Foundation, La Crosse, Wisconsin
| | - Kara J Kallies
- Department of Medical Research, Gundersen Medical Foundation, La Crosse, Wisconsin
| | - Lea M Carlson
- Minnesota Institute for Minimally Invasive Surgery, Cuyuna Regional Medical Center, Crosby, Minnesota
| | - Howard McCollister
- Minnesota Institute for Minimally Invasive Surgery, Cuyuna Regional Medical Center, Crosby, Minnesota
| | - Paul A Severson
- Minnesota Institute for Minimally Invasive Surgery, Cuyuna Regional Medical Center, Crosby, Minnesota
| | - Shanu N Kothari
- Department of General Surgery, Gundersen Health System, La Crosse, Wisconsin.
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Mundi MS, Lorentz PA, Grothe K, Kellogg TA, Collazo-Clavell ML. Feasibility of Smartphone-Based Education Modules and Ecological Momentary Assessment/Intervention in Pre-bariatric Surgery Patients. Obes Surg 2016; 25:1875-81. [PMID: 25702141 DOI: 10.1007/s11695-015-1617-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Bariatric surgery is the most effective means of long-term weight loss. Knowledge gaps and lack of engagement in pre-operative patients can result in suboptimal outcome after surgery. Mobile technology, utilizing ecological momentary assessment (EMA)/intervention (EMI), has shown tremendous promise in changing behaviors. The primary objective of the study is to assess feasibility of using smartphone app with EMA/EMI functionality to prepare patients for bariatric surgery. METHODS Subjects seeking primary bariatric surgery were provided a smartphone app containing video-based education modules with linked assessments to evaluate mastery of topic. Subjects received algorithmic EMA text messages soliciting a response regarding lifestyle behavior. Upon answering, subjects received tailored EMI text messaging supporting healthy lifestyle. RESULTS Thirty subjects (27 female and 3 male), with age of 41.3 ± 11.4 years and BMI of 46.3 ± 7.4 kg/m(2) were enrolled. Twenty subjects completed the study. Ten subjects withdrew. On average, seven out of nine education modules were completed (70.9 ± 27.3%), and 37.8/123 EMA were answered (30.7 ± 21.7%), with response time of 17.4 ± 4.4 min. Subjects reported high satisfaction with the app. Many felt that the app fit into their routine "somewhat easily" or "very easily" (n = 12), had "perfect" amount of EMA messages (n = 8), and was very helpful in preparing for surgery (n = 7). CONCLUSIONS This study is the first to reveal the feasibility of using a smartphone app in the education and engagement of patients prior to bariatric surgery. The app was well-received based on subject satisfaction scores and revealed trends toward positive behavior change and increased weight loss. Randomized trials are necessary to delineate true efficacy.
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Affiliation(s)
- Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA,
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Giusti V, Schwab L, Benoit M. [Bariatric surgery: what is the ideal length of the preoperative track?]. Rev Med Suisse 2015; 11:720-725. [PMID: 26027203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Bariatric surgery not only has significant somatic implications but also imposes substantial behavioural and psychological changes. It is therefore essential to check previously that the potential candidate has not psychosomatic contraindications and its psychoocial context to allow adaptation to the changes requested by the intervention. After this preliminary phase the multidisciplinary support must provide a complete and adequate preparation for potential intervention, and ensure a follow-up to life in these patients. Bariatric support is therefore an ongoing process, which involves, in the preoperative phase, three steps: (1) to inform, (2) to assess and (3) prepare candidates.
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Grewal BS, El-Sharkawy AM, Morris DLJ, Quarmby JW, Rowlands TE. Daycase bariatric surgery--just how much experience is potentially lost to trainees? Obes Surg 2013; 23:1678. [PMID: 23797959 DOI: 10.1007/s11695-013-1008-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Olbers T. [Bariatric surgery or the fairy tale about the ugly duckling]. Lakartidningen 2011; 108:2570-2573. [PMID: 22468392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Bailey CW, Saunders JC, Ballecer C, Bour ES, Scott JD. The bariatric surgery resident training experience: results of a national resident survey. Am Surg 2011; 77:1094-1095. [PMID: 21944531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Christopher W Bailey
- Greenville Memorial Hospital, University Medical Center, Greenville, South Carolina, USA.
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Abstract
Bariatric surgery is a growing segment of minimally invasive surgery. Laparoscopic bariatric procedures are considered some of the most technically challenging surgeries, requiring advanced surgical skills. Successful care of the morbidly obese patient requires a multidisciplinary team approach. These unique requirements are difficult to meet during residency and surgeons interested in bariatric surgery should pursue fellowship training in bariatric surgery.
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22
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Laparoscopic adjustable gastric band surgery. Clin Privil White Pap 2010;:1-12. [PMID: 20540222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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23
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Bariatric surgery. Clin Privil White Pap 2010;:1-16. [PMID: 20336858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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25
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Behr M. Bariatric surgery. Medsurg Nurs 2008; 17:330-331. [PMID: 19051981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Mary Behr
- TRIWEST Healthcare Alliance, Phoenix, AZ, USA
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26
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Angstadt J, Whipple O. Developing a new bariatric surgery program. Am Surg 2007; 73:1092-1097. [PMID: 18092640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We initiated a new bariatric surgery program in February 2004. Before starting the program, we initiated a systemic planning process to design, develop, and implement a comprehensive, multidisciplinary program. Between May 2004 and June 2006, 178 patients underwent Roux-en-Y gastric bypass to treat morbid obesity at our institution. We have had no pulmonary emboli and no deaths. Twenty-one patients (11.8%) developed wound infection after surgery. Thirteen patients (7.3%) developed stenosis at the gastrojejunostomy. Five patients (2.8%) bled from the gastrojejunostomy. Four patients (2.2%) developed atelectasis. Three patients (1.6%) developed an internal hernia after surgery. One patient (0.5%) developed deep venous thrombosis. Two patients (1.1%) developed small bowel obstruction from adhesions. One patient developed a leak (0.6%). By 6 months after surgery, our patients have lost an average of 85 pounds (53% excess weight loss). By 12 months, they have lost an average of 104 pounds (65% excess weight loss). A focused effort to reduce infection has dropped our wound infection rate to 0 per cent in the past 6 months. Our results indicate that with proper planning, it is possible to initiate a new program and achieve excellent outcomes. Proper planning, systematic implementation, and a focus on patient education are critical to success.
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Affiliation(s)
- John Angstadt
- Memorial Health University Medical Center, Savannah, Georgia, USA.
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Abstract
Laparoscopic bariatric surgery has gained popularity but has been proven to be a technically challenging set of operations that requires a long learning curve. Trainees must acquire advanced laparoscopic skills and knowledge of the perioperative care of the bariatric patient. The challenge is to ensure that those surgeons performing gastric bypass, gastric banding, and duodenal switch procedure are trained appropriately. In the past, very different opportunities have been available for the general surgeon seeking to practice bariatric surgery. Early on, many surgeons began performing bariatric surgery without any formal training. Later, weekend courses, mini-fellowships, and formal minimally invasive surgery/bariatric fellowships were established. Today, best practice requires an intensive training experience and ongoing commitment to the field.
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Clements RH, Leeth RR, Vickers SM, Bland KI. Incorporating laparoscopic fellowship does not increase morbidity or mortality in a university-based bariatric practice. J Am Coll Surg 2007; 204:824-8; discussion 828-30. [PMID: 17481492 DOI: 10.1016/j.jamcollsurg.2007.01.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2006] [Accepted: 01/16/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Minimally invasive surgery (MIS) fellowship is one of the most sought-after positions after residency. The increased use of bariatric operations has provided an abundance of advanced cases. The aim of this article is to determine if the addition of an MIS fellowship program has any impact on morbidity and mortality in a university-based bariatric program. STUDY DESIGN Data from all laparoscopic gastric bypasses (LGBs) performed by one surgeon (RHC) from September 2001 until June 2006 were prospectively entered into a database, which was reviewed for morbidity and mortality before (group 1) and after (group 2) development of the MIS program. Mean operative time, length of hospital stay, anastomotic leaks and strictures, gastrointestinal bleeds, internal hernia, and mortality were compared between the two groups of patients using t-tests with significance of p = 0.05. RESULTS A total of 761 (group 1, n = 397; group 2, n = 364) LGBs were performed. For the total population, operating room time was 104 +/- 24 minutes and length of hospital stay was 2 +/- 0.3 days. Incidences of morbidities are as follows: leaks, 0.53%; marginal ulcer, 5.0%; anastomotic stricture, 6.7%; incarcerated internal hernia, 2.2%; gastric outlet obstruction, 0.53%; gastrointestinal bleed, 0.09%; and mortality, 0.13%. Comparing groups 1 and 2, mean operating room time was longer in group 2, but there was no marked difference between any of the other variables. CONCLUSIONS Addition of an MIS fellowship does not change the morbidity and mortality of LGB when developed in the context of a university-based bariatric practice that uses a systematic approach to preoperative evaluation, operative technique, and postoperative management.
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Affiliation(s)
- Ronald H Clements
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294-0016, USA.
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Abstract
The increasing prevalence of morbid obesity in North America combined with the refinement of laparoscopic techniques for the performing these operations has contributed to the exponential growth of bariatric surgery over the last 10 years. There are many important considerations for the internist who is referring a patient for bariatric surgery.
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Affiliation(s)
- Daniel Leslie
- Section of Gastrointestinal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
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30
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Abstract
Obesity constitutes a major health problem with serious social and economic consequences worldwide. In North America, nearly one third of the population is obese, and this figure includes children and adolescents who are likely to become obese adults. Obesity carries a great financial impact on society; consequently, treating morbidly obese patients with surgery may offer substantial economic savings. This article summarizes the financial burdens of obesity and the economics of treating obesity in North America. It addresses the medical effectiveness and cost-effectiveness of bariatric surgery and the new regulations and accreditations for bariatric surgery programs.
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Affiliation(s)
- Kinga A Powers
- Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
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Cottam D, Holover S, Mattar SG, Sharma SK, Medlin W, Ramanathan R, Schauer P. The mini-fellowship concept: a six-week focused training program for minimally invasive bariatric surgery. Surg Endosc 2007; 21:2237-9. [PMID: 17436043 DOI: 10.1007/s00464-007-9354-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Revised: 01/09/2007] [Accepted: 01/22/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To devise a six-week hands-on training program customized to meet the needs of practicing general surgeons. The aim of this program is to provide the required training experience that will bestow the knowledge and skill necessary to implement a successful practice in laparoscopic bariatric surgery. METHODS Ten board-certified/board-eligible practicing general surgeons with no prior hands-on or formal training in laparoscopic bariatric surgery. We report on the participants training experience and the impact that the program had on their subsequent laparoscopic bariatric clinical activity. RESULTS Ten surgeons completed training programs from 9/01 to 3/03. None of the trainees had prior experience in laparoscopic bariatric surgery. Program operative experience averaged 42 cases (range 29-66). Trainees were integrated into all preoperative and postoperative hospital and outpatient care on the service, including workshops and seminars. Seven graduates are in practice performing laparoscopic bariatric surgery and three are implementing new bariatric programs. The active surgeons report performing an average of 101 laparoscopic bariatric procedures (range 18-264) over a mean practice period of 10 months (range 4-16) CONCLUSION A six-week focused mini-fellowship with hands-on operative and clinical participation enables practicing surgeons to acquire the skill and experience necessary to successfully implement a laparoscopic bariatric surgical practice.
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Gonzalez R, Nelson LG, Murr MM. Does establishing a bariatric surgery fellowship training program influence operative outcomes? Surg Endosc 2006; 21:109-14. [PMID: 16960670 DOI: 10.1007/s00464-005-0860-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 04/03/2006] [Indexed: 12/12/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) has a long learning curve that may be reflected in operative outcomes. This study sought to assess whether training a fellow has an impact on the operative outcomes of the training program. METHODS Prospectively collected data on 150 consecutive patients were compared before (group 1) and after (group 2) establishment of a fellowship-training program. RESULTS A greater number of patients underwent laparoscopic RYGB (LRYGB) in group 2 than in group 1 (63% vs 46%; p = 0.01). The group 2 patients were similar to the group 1 patients in terms of age, gender, length of stay, and complication rate. However, they had a higher body mass index (BMI) (median 50 kg/m2; range, 39-64 kg/m2 vs median, 46 kg/m2; range, 38-56 kg/m2; p = 0.01) and a higher incidence of prior abdominal procedures (21% vs 7%; p = 0.006). In addition, operative time was significantly shorter for the patients who underwent open RYGB (ORYGB) (median, 150 min; range, 65-280 min vs median, 110 min; range, 50-210 min; p < 0.001) and LRYGB (median, 202 min; range, 105-450 min vs median, 134 min; range, 50-191 min; p < 0.001) in group 2 than for the patients in group 1. The patients who underwent ORYGB in groups 1 and 2 had similar characteristics and outcomes. Increasing experience with both ORYGB and LRYGB correlated with a decrease in operative times for group 2 (p < 0.001), but not for group 1. CONCLUSION Establishment of a fellowship program shortens the operative times for both open and laparoscopic RYGB and expands the scope of bariatric practice by compounding the experience of the operating team without increasing complications.
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Affiliation(s)
- R Gonzalez
- Interdisciplinary Obesity Treatment Group, Department of Surgery, University of South Florida College of Medicine, c/o Tampa General Hospital, P.O. Box 1289, Tampa, FL 33601, USA
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Abstract
Bariatric surgery is currently a rapidly growing subsection of general surgery, with exponential expansion over the past decade. Many residency programs lacked sufficient experience in bariatrics, necessitating established surgeons to consider re-training and re-vamping of their practice to enter the field. The addition of bariatric surgery to a general surgery practice can present economic consequences, which are both positive and negative. Positive consequences include a potential new revenue source with a large population base. Negative consequences include increased employees, required paper-work and office resources, increased malpractice premiums, difficulties with appropriate reimbursement, and limitations on access to appointment time for non-bariatric cases. This paper reviews the potential economic impact of bariatric surgery on a general surgery practice and possible alternatives to manage these efficiently.
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Buchwald H, Williams SE. Bariatric surgery training in the United States. Surg Obes Relat Dis 2006; 2:52-5; discussion 55-6. [PMID: 16925319 DOI: 10.1016/j.soard.2005.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2005] [Revised: 09/28/2005] [Accepted: 09/29/2005] [Indexed: 11/22/2022]
Abstract
BACKGROUND To provide evidence of the status of bariatric surgical education in the accredited surgery training programs in the United States. METHODS A questionnaire was sent by mail to the 251 accredited surgery residency training programs, including the 48 minimally invasive surgery fellowship programs, in the United States. RESULTS There was a 100% response to the questionnaire. Of the 251 surgery residency training programs and 48 minimally invasive surgery fellowship programs, 185 (73.7%) and 43 (89.6%) performed bariatric surgery, respectively. The open Roux-en-Y gastric bypass was the dominant procedure (85.1%), followed by laparoscopic Roux-en-Y gastric bypass (60.9%), in the residency programs; the laparoscopic Roux-en-Y gastric bypass was the dominant procedure (70.1%) in the minimally invasive fellowship programs. CONCLUSIONS Bariatric surgery has been mainstreamed into accredited training programs in the United States.
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Affiliation(s)
- Henry Buchwald
- Department of Surgery, University of Minnesota, Minneapolis, 55455, USA.
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McIntyre T, Jones DB. Training methods for minimally invasive bariatric surgery. Surg Technol Int 2005; 14:57-60. [PMID: 16525955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
It is well-established that laparoscopic Roux-en-y gastric bypass is a technically challenging operation that requires a long learning curve. With the demand for bariatric surgery, particularly laparoscopic bariatric surgery on the rise, the focus has changed to ensure those performing this difficult procedure are trained appropriately. The ideal training would emphasize two things: (1) acquisition of advanced laparoscopic skills and intraoperative techniques, and (2) knowledge of preoperative and postoperative care of the bariatric patient. The current models for training for laparoscopic bariatric surgery fall into several categories: no training, formal courses, mini-fellowships, and formal minimally invasive surgery/bariatric fellowships. Each of these training paradigms is examined, as well as the available data that compare their effectiveness.
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Affiliation(s)
- Thomas McIntyre
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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