Introducing “Checklists in Bariatric Surgery”— A Column Aimed at Helping Bariatric Surgeons Quickly Review the Reasons for Potential Problems When Caring for Bariatric Patients

| September 18, 2012

Dear Friends,

By the time you read this editorial,  we might be at the American College of Surgeons Clinical Congress in Chicago, Illinois. If you have not done so yet, I suggest that you plan to attend the sleeve gastrectomy course on Saturday, September 29th, at the Marriott Hotel in downtown Chicago. I am sure you will enjoy the excellent program put together by Drs. Dan Herron and Ninh Nguyen.

Since we heard the good news that the Centers for Medicare and Medicaid Services (CMS) was covering laparoscopic sleeve gastrectomy (LSG), many questions have arisen from peers and patients. Dr. John Morton, chairperson of the American Society for Metabolic and Bariatric Surgery (ASMBS) Access to Care Commite, together with the ASMBS Executive Council, has been negotiating with CMS. In this issue of Bariatric Times, Dr. Morton presents an exclusive report covering the frequently asked questions and answers regarding the CMS decision on laparoscopic sleeve gastrectomy. The report includes a list of resources and a reader handout of medicare administrative contractors by jurisdiction.

Gentles et al present a review on the use of robots in bariatric surgery. As I am sure you know by now, I am not a fan of robots, but I respect those who perform robot-assisted procedures under an institutional review board (IRB) and explain to patients that there are no clinical advantages but potential for longer operating room times and higher costs. In most institutions, the surgeons who are trying to perform robotic surgery are the rookies who are coming out of training. In my opinion, it should be the senior attending surgeons performing these procedures with the robot after they have done hundreds of surgeries with a laparoscope. How can you properly and efficiently direct a machine to do what you have not done many times ?

In this issue, we wrap up the Metabolic Applied Research Strategy (MARS) series. We thank Drs. Kaplan, Seely, and Harris for their contribution to our journal and their knowledge on bariatric and metabolic surgery.

In this month’s installment of “Anesthetic Aspects of Bariatric Surgery,” Dr. Margarson presents an update from the United Kingdom on anesthesia care of patients with obesity. I am sure you will find it to be an interesting read.

Sleeve gastrectomy is becoming the most popular bariatric procedure worldwide, and I believe that it is always helpful to publish standard techniques on how to get the job done with minimal morbidity and excellent outcomes. In this month’s “Surgical Pearls: Techniques in Bariatric Surgery,” Dr. Jossart, a United States-based surgeon with vast experience with LSG, shares his approach to performing the procedure. We thank Dr. Jossart for his contribution to the column and hope that you will enjoy it.

Weight regain after bariatric procedures has been always a big issue since it is, for many, a symbol of failure. In this month’s installment of “Hot Topics in Integrated Health,” Ms. Aquavella provides advice on how to tackle this problem with a team approach. Weight regain is a natural result of humans having to eat in order to survive after undergoing surgery that restricts food intake. The key aspect or solution to this conundrum is, in my opinion, to tackle this problem early on. Poor follow up as well as reduced attendance to support groups are crucial factors that need to be addressed. I wish insurance companies would mandate patients to attend at least four support groups on a yearly basis, and if they do not, coverage for surgical intervention should be restricted. Obviously, there is no magic in follow up or support groups for those patients who have gigantic pouches, large sleeves, or poorly adjusted bands due to errors in judgment or technique from the surgeon who performed the primary procedure. Nevertheless, group therapy is an important part of the weight loss surgery journey.

Drs. McVay and Friedman present a review on the benefits of cognitive behavioral therapy (CBT) groups for bariatric surgery patients. In this article, the authors outline the difference between support groups and CBT groups. Bariatric surgery support groups vary widely: they can be patient-led or provider-led, and they can range from highly structured meetings to free-flowing discussions. CBT groups are typically guided by licensed mental health professionals. CBT is a psychotherapeutic modality that addresses dysfunctional emotions, behaviors, and cognitions through a goal-oriented, systematic process to help patients identify and change thoughts that negatively influence mood and behavior. For example, CBT might be benefical to bariatric patients in regard to adherence to dietary and exercise plans pre- and postoperatively.

To conclude my editorial, I would like to introduce you to a new column titled “Checklists in Bariatric Surgery.” I have been working on the development of this column for a long time. I believe that this kind of column might be of help to residents and fellows as a quick guide. If you have any comments or suggestions or you would like to add to it, please send to us for review.

Sincerely,

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

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