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Panel report: best practices for the surgical treatment of obesity

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Abstract

Background

Bariatric surgery is a rapidly growing field. Advances in surgical technologies and techniques have raised concerns about patient safety. Bariatric surgeons and programs are under increased scrutiny from regulatory agencies, insurers, and public health officials to provide high quality and safe care for bariatric patients at all phases of care.

Methods

During the 2009 annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), a panel of experts convened to provide updated information on patient safety and best practices in bariatric surgery. The following article is a summary of this panel presentation.

Results and Conclusions

Weight loss surgery is a field that is evolving and adapting to multiple external pressures. Safety concerns along with increasing public scrutiny have led to a systematic approach to defining best practices, creating standards of care, and identifying mechanisms to ensure that patients consistently receive the best and most effective care possible. In many ways, bariatric surgery and multidisciplinary bariatric surgery programs may serve as a model for other programs and surgical specialties in the near future.

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References

  1. Kelly J, Tarnoff M, Shikora S, Thayer B, Jones DB, Forse RA, Fanelli R, Lautz D, Buckley F, Munshi I, Coe N (2005) Best care recommendations for surgical care in weight loss surgery. Obes Res 13:227–233

    Article  PubMed  Google Scholar 

  2. Buchwald H, Oien DM (2009) Metabolic/bariatric surgery worldwide 2008. Obes Surg 19:1605–1611

    Article  PubMed  Google Scholar 

  3. Suter M, Calmes JM, Paroz A, Giusti V (2006) A 10-year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates. Obes Surg 16:829–835

    Article  PubMed  CAS  Google Scholar 

  4. Peters JH, Fried GM, Swanstrom LL, Soper NJ, Sillin LF, Schirmer B, Hoffman K, SAGES FLS Committee (2004) Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgery. Surgery 135:21–27

    Article  PubMed  Google Scholar 

  5. Hayden MJ, Dixon JB, Dixon ME, Shea TL, O’Brien PE (2010) Characterization of the improvement in depressive symptoms following bariatric surgery. Obes Surg 2010 Jun 18 [Epub ahead of print]

  6. Betsy Lehman Center Weight Loss Surgery Expert Panel, Commonwealth of Massachusetts, Betsy Lehman Center for Patient Safety and Medical Error Reduction (2009) Expert panel on weight loss surgery: executive report: update 2007. Obesity 17:839–841

    Google Scholar 

  7. Colquitt JL, Picot J, Loveman E, Clegg AJ (2009) Surgery for obesity. Cochrane Database Syst Rev 15(2):CD003641

    Google Scholar 

  8. Wee CC, Pratt JS, Fanelli RD, Samour PQ, Trainor LS, Pasche-Orlow MK (2009) Best practice updates for informed consent and patient education in weight loss surgery. Obesity (Silver Spring) 17(5):885–888

    Article  Google Scholar 

  9. Sabin J, Fanelli R, Flaherty H, Istfan N, Mariner W, Barnes JN, Pratt JS, Rossi L, Samour P (2005) Best practice guidelines on informed consent for weight loss surgery patients. Obesity Res 13(2):250–253

    Article  Google Scholar 

  10. Wee CC, Jones DB, Davis RB, Bourland AC, Hamel MB (2006) Understanding patients’ value of weight loss and expectations for bariatric surgery. Obes Surg 16(4):496–500

    Article  PubMed  Google Scholar 

  11. Vgontzas AN, Bixler EO, Chrousos GP (2005) Sleep apnea is a manifestation of the metabolic syndrome. Sleep Med Rev 9(3):211–224

    Article  PubMed  Google Scholar 

  12. Rasheid S, Banasiak M, Gallagher SF, Lipska A, Kaba S, Ventimiglia D, Anderson WM, Murr MM (2003) Gastric bypass is an effective treatment for obstructive sleep apnea in patients with clinically significant obesity. Obes Surg 13(1):58–61

    Article  PubMed  Google Scholar 

  13. Serafini FM, MacDowell Anderson W, Rosemurgy AS, Strait T, Murr MM (2001) Clinical predictors of sleep apnea in patients undergoing bariatric surgery. Obes Surg 11:28–31

    Article  PubMed  CAS  Google Scholar 

  14. Sareli AE, Cantor CR, Williams NN, Korus G, Raper SE, Pien G, Hurley S, Maislin G, Schwab RJ (2009) Obstructive sleep apnea in patients undergoing bariatric surgery—a tertiary center experience. Obes Surg 2009 Aug 11 [Epub ahead of print]

  15. Schuster R, Alami RS, Curet MJ, Paulraj N, Morton JM, Brodsky JB, Brock-Utne JG, Lemmens HJ (2006) Intra-operative fluid volume influences postoperative nausea and vomiting after laparoscopic gastric bypass surgery. Obes Surg 16(7):848–851

    Article  PubMed  Google Scholar 

  16. (2006) A report by the American Society of Anesthesiologists Task Force on perioperative management of patients with obstructive sleep apnea practice guidelines for the perioperative management of patients with obstructive sleep apnea. Anesthesia 104:1081–1093

  17. Kamelgard JI, Kim KA, Atlas G (2005) Combined preemptive and preventive analgesia in morbidly obese patients undergoing open gastric bypass: a pilot study. Surg Obes Relat Dis 1(1):12–16

    Article  PubMed  Google Scholar 

  18. Benotti PN, Still CD, Wood GC, Akmal Y, King H, El Arousy H, Dancea H, Gerhard GS, Petrick A, Strodel W (2009) Preoperative weight loss before bariatric surgery. Arch Surg 144(12):1150–1155

    Article  PubMed  Google Scholar 

  19. Becouarn G, Topart P, Ritz P (2010) Weight loss prior to bariatric surgery is not a pre-requisite of excess weight loss outcomes in obese patients. Obes Surg 20(5):574–577

    Article  PubMed  Google Scholar 

  20. Schweiger C, Weiss R, Berry E, Keidar A (2010) Nutritional deficiencies in bariatric surgery candidates. Obes Surg 20(2):193–197

    Article  PubMed  Google Scholar 

  21. Hutter MM, Jones DB M, Riley S Jr, Snow RL, Cella RJ, Schneider BE, A Clancy K (2009) Best practice updates for weight loss surgery data collection. Obesity (Silver Spring) 17(5):924–928

    Article  Google Scholar 

  22. Surgical Review Corporation (2010) BSCOE requirements: provisional status. http://www.surgicalreview.org/pcoe/tertiary/tertiary_provisional.aspx. Accessed January 6, 2010

  23. American College of Surgeons Bariatric Surgery Center Network Accreditation Program (2010) Bariatric accreditation program manual. http://www.acsbscn.org/Public/ProgramStandards.aspx. Accessed January 6, 2010

  24. Pratt GM, Learn CA, Hughes GD, Clark BL, Warthen M, Pories W (2009) Demographics and outcomes at American Society for Metabolic and Bariatric Surgery Centers of Excellence. Surg Endosc 23(4):795–799

    Article  PubMed  Google Scholar 

  25. Smith J, Cianflone K, Biron S, Hould FS, Lebel S, Marceau S, Lescelleur O, Biertho L, Simard S, Kral JG, Marceau P (2009) Effects of maternal surgical weight loss in mothers on intergenerational transmission of obesity. J Clin Endocrinol Metab 94(11):4275–4283

    Article  PubMed  CAS  Google Scholar 

  26. Anderson SE, Whitaker RC (2009) Prevalence of obesity among US preschool children in different racial and ethnic groups. Arch Pediatr Adolesc Med 163(4):344–348

    Google Scholar 

  27. Freedman DS, Khan LK, Serdula MK, Dietz WH, Srinivasan SR, Berenson GS (2005) The relation of childhood BMI to adult adiposity: the Bogalusa Heart Study. Pediatrics 115(1):22–27

    PubMed  Google Scholar 

  28. Pratt JS, Lenders CM, Dionne EA, Hoppin AG, Hsu GL, Inge TH, Lawlor DF, Marino MF, Meyers AF, Rosenblum JL, Sanchez VM (2009) Best practice updates for pediatric/adolescent weight loss surgery. Obesity (Silver Spring) 17(5):901–910

    Article  Google Scholar 

  29. (1992) Gastrointestinal surgery for severe obesity: National Institute of Health Consensus Development Conference statement. Am J Clin Nutr 55:615s–619s

  30. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292(14):1724–1737

    Article  PubMed  CAS  Google Scholar 

  31. Ippisch HM, Inge TH, Daniels SR, Wang B, Khoury PR, Witt SA, Glascock BJ, Garcia VF, Kimball TR (2008) Reversibility of cardiac abnormalities in morbidly obese adolescents. J Am Coll Cardiol 51(14):1342–1348

    Article  PubMed  Google Scholar 

  32. Schwimmer JB, Burwinkle TM, Varni JW (2003) Health-related quality of life of severely obese children and adolescents. JAMA 289(14):1813–1819

    Article  PubMed  Google Scholar 

  33. Ukleja A, Afonso BB, Pimentel R, Szomstein S, Rosenthal R (2008) Outcome of endoscopic balloon dilation of strictures after laparoscopic gastric bypass. Surg Endosc 22(8):1746–1750

    Article  PubMed  Google Scholar 

  34. Thaler K (2009) Treatment of leaks and other bariatric complications with endoluminal stents. J Gastrointest Surg 13(9):1567–1569

    Article  PubMed  CAS  Google Scholar 

  35. Escalona A, Yáñez R, Pimentel F, Galvao M, Ramos AC, Turiel D, Boza C, Awruch D, Gersin K, Ibáñez L (2010) Initial human experience with restrictive duodenal-jejunal bypass liner for treatment of morbid obesity. Surg Obes Relat Dis 6(2):126–131

    Article  PubMed  Google Scholar 

  36. Moreno C, Closset J, Dugardeyn S, Baréa M, Mehdi A, Collignon L, Zalcman M, Baurain M, Le Moine O, Devière J (2008) Transoral gastroplasty is safe, feasible, and induces significant weight loss in morbidly obese patients: results of the second human pilot study. Endoscopy 40(5):406–413

    Article  PubMed  CAS  Google Scholar 

  37. Liu S, Hou X, Chen JD (2005) Therapeutic potential of duodenal electrical stimulation for obesity: acute effects on gastric emptying and water intake. Am J Gastroenterol 100(4):792–796

    Article  PubMed  Google Scholar 

  38. De Castro ML, Morales MJ, Del Campo V, Pineda JR, Pena E, Sierra JM, Arbones MJ, Prada IR (2010) Efficacy, safety, and tolerance of two types of intragastric balloons placed in obese subjects: a double-blind comparative study. Obes Surg 2010 Apr 15

  39. Poulose BK, Holzman MD, Zhu Y, Smalley W, Richards WO, Wright JK, Melvin W, Griffin MR (2005) National variations in morbid obesity and bariatric surgery use. J Am Coll Surg 201(1):77–84

    Article  PubMed  Google Scholar 

  40. O’Brien PE, Dixon JB, Laurie C, Skinner S, Proietto J, McNeil J, Strauss B, Marks S, Schachter L, Chapman L, Anderson M (2006) Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med 144(9):625–633

    PubMed  Google Scholar 

  41. Jamal MK, DeMaria EJ, Johnson JM, Carmody BJ, Wolfe LG, Kellum JM, Meador JG (2006) Insurance-mandated preoperative dietary counseling does not improve outcome and increases dropout rates in patients considering gastric bypass surgery for morbid obesity. Surg Obes Relat Dis 2(2):122–127

    Article  PubMed  Google Scholar 

  42. Cremieux PY, Buchwald H, Shikora SA, Ghosh A, Yang HE, Buessing M (2008) A study on the economic impact of bariatric surgery. Am J Manag Care 14(9):589–596

    PubMed  Google Scholar 

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Disclosures

Dr. Gould serves as a speaker for Covidien. Dr. Ellsmere serves as a consultant for Ethicon. Dr. Fanelli is a consultant and a speaker for Ethicon, is on the surgeon advisory board and provides research support for RTI Biologics, serves on the medical advisory board for Polytouch Medical, is a consultant and provides research support for Bracco Diagnostics, and serves as a consultant and receives a royalty stream from Cook Medical. For New Wave Surgical he is an owner, serves on the Board of Directors, and the Medical Advisory Board. Dr. Pratt serves as a consultant for Covidien and as a Scientific Advisor for Boston Scientific. Dr. Schauer is a consultant, a research grant recipient, and serves on the Scientific Advisory Board for Ethicon. He serves on the Board of Directors for Remedy MD. He has received an Educational Grant and serves on the Scientific Advisory Board for Stryker. He is a consultant, a research grant recipient, and serves on the Scientific Advisory Board for Bard-Davol. He is a consultant and the recipient of a research grant from Gore. He has received an educational grant from Baxter. He serves on the Scientific Advisory Board for Barosense, Surgiquest, and Cardinal/Snowden Pencer. He has received educational grants from Covidien and Allergan. He is also on the Board of Directors for Surgical Excellence LLC. Dr. Schwaitzberg serves as a consultant for Olympus, Stryker, Surgiquest, Cambridge Endoscopy, Endocore, and Acuity Bio. Dr. Daniel Jones serves as a consultant for Olympus, Allergan, Stryker, and Surgiquest; he is the recipient of training grants from Ethicon and Covidien, and he receives book royalties from Cinemed. Drs. Hutter, Stephanie Jones, and Schirmer have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. University of Wisconsin School of Medicine, 600 Highland Avenue, H4/726 Clinical Science Center, Madison, WI, 53792, USA

    J. Gould

  2. Division of General Surgery, Dalhousie University, Halifax, NS, Canada

    J. Ellsmere

  3. Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA

    R. Fanelli

  4. Department of Surgery, Harvard Medical School, Boston, MA, USA

    M. Hutter

  5. Department of Anesthesia, Beth Israel Deaconess Medical Center, Boston, MA, USA

    S. Jones

  6. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA

    J. Pratt

  7. Department of Surgery, Cleveland Clinic, Cleveland, OH, USA

    P. Schauer

  8. Department of Surgery, University of Virginia, Charlottesville, VA, USA

    B. Schirmer

  9. Department of Surgery, Cambridge Health Alliance, Cambridge, MA, USA

    S. Schwaitzberg

  10. Section of Minimally Invasive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA

    D. B. Jones

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  1. J. Gould
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  2. J. Ellsmere
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  3. R. Fanelli
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  4. M. Hutter
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  6. J. Pratt
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  7. P. Schauer
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  8. B. Schirmer
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  9. S. Schwaitzberg
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  10. D. B. Jones
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Corresponding author

Correspondence to J. Gould.

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Gould, J., Ellsmere, J., Fanelli, R. et al. Panel report: best practices for the surgical treatment of obesity. Surg Endosc 25, 1730–1740 (2011). https://doi.org/10.1007/s00464-010-1487-y

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  • DOI: https://doi.org/10.1007/s00464-010-1487-y

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