A Surgeon’s Job Often Includes Fixing Complications During Surgery

| March 18, 2011

Dear Readers:

I would like to begin by congratulating Dr. Harry Frydenberg on a job well done as the outgoing President of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). I also wish good luck and success to Dr. Karl Miller, the new leader of IFSO. IFSO meetings have been growing on a yearly basis, and we are all looking forward to participating in the 2011 meeting this September in Hamburg, Germany. For a synopsis of the 2010 IFSO meeting, please read this issue’s Symposium Synopsis.

In this issue, we have Dr. Amir Mehran’s article on esophagogastroduodenoscopy (EGD), which is a timely topic after the controversial statement from one of our leading societies in the United States regarding the safety and credentialing of endoscopic procedures done by general surgeons. Ten years ago, following Dr. Ken Champion’s steady preaching about the importance of general surgeons performing their own endoscopies, I started performing my own EGDs intraoperatively. As I experienced three general surgical residencies in three different languages, I was exposed and trained to perform colonoscopies, esofagogastroccopies, coledochoscopies, mamoscopies, and many other endoscopic techniques. Short after starting these procedures in the operating room, the chief of gastroenterology in my hospital (without knowing my background)  wrote a letter to the administration stating that, “Dr. R has as a general surgeon a legal problem in performing endoscopies.” I quickly responded with a letter stating, “When Dr. X performs an endoscopy and perforates a hollow viscous or runs into a major bleeding, he calls the surgeon to fix the problem. When the surgeon performs an endoscopy and perforates or causes a bleeding, the surgeon fixes the problem him- or herself. So, who has a legal problem here?” I never heard back from either from the administration nor from the chief of gastroenterology. I personally believe that any physician performing invasive diagnostic and/or therapeutic procedures should be able to handle the complications of the procedure him- or herself to be considered competent. Dr. Mehran’s article emphasizes how important it is for us bariatric surgeons to assess the operative field endoscopically before performing bariatric procedures. In addition, with the advent of so many new endoscopic treatment options, we surgeons should be up to date in performing endoscopy.

Dr. Alexander’s article addresses another important topic on adherence to physical activities after bariatric procedures. Changes in lifestyle are key aspects in achieving long-term success after bariatric surgery, and they are not easy to implement. Psychological support after bariatric procedures is very important in keeping patients motivated and helping them maintain and implement dietary changes and exercise into their routines.

Dr. Rosko’s article on the use of psychiatric medications and weight gain is a must-read. Although the prescription of psychiatric medications is not my field of expertise, I believe the surgeon should keep a balance between the use of these medications and potential for weight gain. The multidisciplinary bariatric team should also be aware that the high incidence of depression and lack of energy in the bariatric patient might result in decreased physical activity and exercise. Preventing a patient from taking antidepressants that cause weight gain, thus allowing depression to progress, is definitely not a good option. I would rather the patient become more active and exercise at the expense of potential weight gainthat may be caused by taking an antidepressant to treat his or her depression.

Finally, in this month’s Nutritional Considerations in the Bariatric Patient, Nazy Zarshenas reviews the importance of screening and treating vitamin D deficiency, which can prevent serious complications, such as osteoporosis, hypocalcemia, hyperparatiroidism, and depression after bariatric operations.

I hope you enjoy reading this month’s issue and I look forward to seeing you at the 13th World Conference of The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), March 30 to April 2, in San Antonio, Texas.

Sincerely,

Raul J. Rosenthal, MD, FACS
Editor, Bariatric Times

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