TELL US ABOUT THE ROLES AND RESPONSIBILITIES OF THE LEAD STAFF AT YOUR FACILITY.
The Metabolic Surgery Center at Baptist Hospital currently has four surgeons, four nurses, and 11 staff members. Surgeons include Albert T. Spaw, MD, and Charles E. Morton, III, MD, who serve as co-medical directors, and George B. Lynch, MD, and James G. McDowell, Jr., MD. Each surgeon has a nurse who practices with them out of the center. The center is led by Director of Bariatric Services, Cylinda V. Phillips, RN, MBA, who is responsible for operations of the practice, strategic planning, business development, marketing, community outreach, patient education, consultation, and support group facilitation.

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Manish Parikh, MD; and Michel Gagner, MD, FRCSC, FACS

Department of Surgery, Mount Sinai Medical Center, Miami Beach, Florida

Objective. To report preliminary outcomes after laparoscopic conversion of gastric bypass to biliopancreatic diversion with duodenal switch for weight loss failure.
Design. Retrospective chart review.
Setting. Academic tertiary referral center.
Participants. Twelve patients with weight loss failure after gastric bypass.
Measurements. Age, body mass index, excess weight loss, type of primary gastric bypass, type of revision procedure performed (if applicable), method of gastrogastrostomy, intraoperative and perioperative data, and morbidity and mortality rates.
Results. All patients lost dramatic weight after conversion to duodenal switch: Mean excess weight loss (EWL) was 63 percent at 11 months, representing an average
11-point BMI decrease. There were no mortalities or leaks. Stricture at the gastrogastrostomy was the most frequent complication, which was usually amenable to endoscopic dilation.
Conclusions. Laparoscopic conversion to duodenal switch from failed gastric bypass is highly effective with an acceptable morbidity

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by Merle C. Goldberg, LCSW; and Heidi M. Limbrunner, PsyD

Merle Goldberg is in private practice in Silver Spring, Maryland, and is co-author of Weight Loss Surgery: Is It Right For You and My Thin Excuse: Understanding, Recognizing and Overcoming Eating Disorders.
Heidi M. Limbrunner, PsyD, is with Southeast Psychological Services in Charlotte, North Carolina.

Introduction
In our previous article in the November/December issue of Bariatric Times, we reviewed the rationale for using a cognitive behavioral model (CBT) traditionally used for eating disorder treatment for the bariatric surgery population. In this issue, we will further discuss in detail the topics and goals for each of the CBT groups (Table 1. Finally, we will review future considerations in the continued use of this model.

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