by Geoffrey P. Kohn, MBBS, FRACS; Stephen P. Haggerty, MD, FACS; D. Wayne Overby, MD; Robert D. Fanelli, MD, FACS, FASGE; and Timothy M. Farrell, MD, FACS

Drs. Kohn, Overby, and Farrell are from the Department of Surgery, University of North Carolina at Chapel Hill, North Carolina; Dr. Haggerty is from the Department of Surgery, North Shore University Health System, Evanston, Illinois; and Dr. Fanelli is from the Department of Surgery, Berkshire Medical Center, Pittsfield, Massachusetts.

Introduction
Obesity may be the most significant disease epidemic affecting Western nations in the 21st century. Morbid obesity and its associated comorbidities threaten the lives of millions of Americans. However, medical therapies have been demonstrated to not achieve persisting weight loss or comorbidity resolution. Three minimally invasive surgical procedures have emerged as viable treatment options for morbid obesity—Roux-en-Y gastric bypass (RGB), adjustable gastric banding (AGB), and biliopancreatic diversion with duodenal switch (BPD-DS), though there remains a marked paucity of comparative data.

We participated in developing the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Guideline for Clinical Application of Bariatric Surgery, and in doing so reviewed the literature and made best-evidence recommendations to allow selection of the type of bariatric operation most appropriate to specific patients’ requirements.[1] This article summarizes our clinical practice guideline.

A search of the literature was performed, using both electronic and physical resources. Inclusion of a study required focus on at least one of the following categories of information: surgical outcomes, guidelines, healthcare economics, or quality of life. Search terms used were therefore combinations of obesity surgery, bariatric surgery, gastric bypass, gastroplasty, gastric band, biliopancreatic diversion, duodenal switch, sleeve gastrectomy, reoperation, revision, laparoscopic, diabetes, hypertension, hyperlipidemia, sleep apnea, nutrition, and complications.

Manual reference checks of published review articles were performed to supplement the above electronic searches. The articles were graded on level of evidence and recommendations were made. Read the rest of this article »

by J.K. Champion, MD, FACS

Dr. Champion is Director of Bariatric Surgery, Northside Hospital, Atlanta, GA and Clinical Professor of Surgery, Mercer University School of Medicine, Macon, Georgia.

Introduction
Bariatric surgery—no matter the procedure, no matter the surgeon with however much experience—will result in complications and surgical emergencies. The average incidence of in-hospital complications after bariatric surgery, as reported by Livingston,[1] is approximately 10 percent, and the American Society for Metabolic and Bariatric Surgery Centers of Excellence program (ASMBS SRC) reports a 90-day incidence of readmissions of 4.7 percent and a reoperation rate of 2.6 percent in its initial review of the first 106 centers approved. Read the rest of this article »

by Susan Gallagher Camden, RN, MSN, MA, WOCN, CBN, PhD

Safety initiatives seem to transcend every aspect of healthcare. The Surgical Review Corporation Centers of Excellence (COE) efforts have integrated safe patient handling either directly or indirectly into at least three of the 10 requirements for status as a COE. Safety standards have affected not only care of larger patients, but patients of all sizes. Read the rest of this article »

by Susan Gallagher Camden, RN, MSN, MA, WOCN, CBN, PhD

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by Jane A. Alston and Giselle G. Hamad, MD, FACS

Ms. Alston is from University of Pittsburgh School of Medicine.
Dr. Hamad is with University of Pittsburgh Department of Surgery, Division of Minimally Invasive Bariatric and General Surgery.

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by Roseann DeLuca, BSN, RN

Roseann is the Bariatric Coordinator, Good Samaritan Hospital Medical Center, West Islip, New York.

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by Tracy Martinez, RN, BSN

Ms. Martinez is Program Coordinator of Wittgrove Bariatric Center, La Jolla, California.

Introduction
Morbid obesity is a chronic disease for which we have no cure. However; bariatric surgery is the most effective and powerful intervention currently known in medicine. Postoperative weight gain, however, is possible and will be seen by every practitioner in every program.
Weight loss results are individual, but different bariatric surgical procedures have ranges of expected weight loss. Laparoscopic adjustable gastric banding (LAGB) weight loss is 61.6 percent, standard gastric bypass is 68.2 percent, and biliopancreatic diversion is 70 percent. Weight loss is also dependent on patient selection, education, and long-term follow-up.1 (Figure 1. The Clinical Pathway at Wittgrove Bariatric Center.)

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by Dave Fouts

Dave Fouts is the corporate chef for Western Bariatric Institute (www.westernbariatricinstitute.com) and Imetobolic. You can visit www.chefdave.org for free recipes, grocery shopping planning lists, weekly meal planners, and more.

Introduction

“Eating out saves time and works well within my schedule.” I challenge this statement all the time; however, there are pros and cons to eating out. If a patient thinks that driving to the restaurant, waiting to order, waiting for your food to be served, then waiting to pay saves you time, not to mention the drive back, I’m not convinced. Aside from the time factor, when dining out, most restaurants are not taking the needs of your patients into consideration. Most foods are high in calories and portion sizes can be overwhelming. I’m not totally certain that all restaurants who claim to have light or low calorie dishes are being truthful. This can cause your patients to hit plateaus and even gain weight. However, the pro to eating out is that it can be a time saver if you have a place that has quick, healthy, already prepared foods, such as a Whole Foods Market or a Boston Market. These foods are made to meet the needs of the health conscious and are normally prepared in a way that gets the customer in and out in less than five minutes. The key is keeping one’s hands out of the food until he or she gets home. Also, the food that is already prepared costs less than going to a restaurant in most cases, but is still priced high for the convenience.

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