Counting Down to Obesity Week 2013: We Hope to See You There

| September 23, 2013

Dear Readers:
Welcome to another exciting edition of our magazine. I just returned from the 18th World Congress of the International Federation for The Surgery of Obesity and Metabolic Disorders (IFSO) in Istanbul, Turkey, and I am pleased to report that, as in previous years, this was an excellent meeting. Despite the unstable political situation in that part of the world, the meeting was well attended and the organization was first-rate. I found that there were no new exciting developments regarding scientific content worthwhile sharing with our readers. I would like to congratulate Professor Mustafa Tasik on the meeting’s warm hospitality and organization. Dr. Rudolph Weiner was elected as the new President-Elect of IFSO. London was chosen as the meeting headquarters for 2016 after Vienna and Montreal. I wish Dr. Luigi Angrisani, incoming IFSO President, best of luck in this year.

Photos from IFSO 2013

In this issue of BT, Dr. John Morton reviews for us the upcoming changes that we will face once the Affordable Care Act goes into effect. In “The Hole in the Wall,” Dr. Mike Sarr, one of our world leaders in bariatric surgery, answers important questions related to the topic of ventral hernias and abdominal wall reconstruction. We wholeheartedly agree with Mike to tackle large asymptomatic ventral hernias after weight loss has achieved its nadir. In symptomatic patients, however, when forced to reduce and repair an abdominal wall defect, we favor sleeve gastrectomy. SG is the procedure of choice since it is clean when compared to gastric bypass, allowing you to implant synthetic meshes and also because it results in higher and faster excess weight loss (EWL) when compared to laparoscopic adjustable gastric banding (LAGB).

In this month’s installment of “Checklists in Bariatric Surgery,” we tackle the topic of postoperative tachycardia. My favorite question to ask students and junior residents is, “Can you name me the five most important differentials of tachycardia when called by the nurse in the postoperative period?” Pain, hypovolemia, hypoxia, fever, and cardiac etiologies are my favorite answers. In the bariatric patient, however, bleeding and leaks should always be at the top of their list. We looked into our tachycardia patients for a prolonged period of time and we were privileged to publish our clinical experience analyzing the difference of tachycardia between so-called “bleeders” and “leakers.” While the bleeding patient has a cyclic tachycardia, the leaking patient has a sustained one. Interesting wise, the most frequent reason for tachycardia in the postoperative period of bariatric patients was uncontrolled arterial hypertension. I hope you find our checklist useful.

In our column “Anesthetic Aspects of Bariatric Surgery,” Dr. Marilu Giacalone and colleagues review the new concept of “ultra fast-track” pathways in bariatric patients that will allow us to do same-day discharges. I could not agree more that patient and procedure selection are key components in the algorithm. I personally do not believe in 24-hour hospital stay when it comes to bariatric procedures. I could not agree more that patient and procedure selection are key components in the algorithm. The authors’ description of what is required to achieve these goals, such as adequate selection of patients, preoperative preparation, minimally invasive surgery, experienced team, dedicated facilities, possibility of follow up, as well as the application of several strategies which reduce surgical stress can not be more supportive of what we call a center of excellence or accredited bariatric program. This is certainly a timely article when we are awaiting the Centers for Medicare and Medicaid Services (CMS) decision on the National Coverage Determination (NCD) for Bariatric Surgery Facility Certification Requirements.

I am always stunned by how quickly time passes by, and we are just three months away from our first Obesity Week in Atlanta, Georgia. This month, Dr. Martin Binks gives us some insight into the event and Dr. Provost reviews our American Society for Metabolic and Bariatric Surgery (ASMBS) Foundation events. I would like to emphasize one more time how important it is for us at the ASMBS Foundation to see you all participating at our first L.E.A.D. Awards Luncheon. If you are a program director, get a table with others and invite your team members to join you. Not only with you contribute to your team and our noble mission to support research and education, but you will also join us to congratulate our awardees’ and celebrate the 20-year anniversary of laparoscopic gastric bypass with Dr. Alan Wittgrove, recipient of the Outstanding Achievement Award 2013. I look forward to seeing many of you at the 10th annual Bariatric Summit, September 21 to 22, 2013 in New Orleans, Louisiana, and/or at the Annual Clinical Congress of the American College of Surgeons (ACS), October 6 to 10, 2013 in Washington, DC.

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

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