Benchmarking Best Practices in Weight Loss Surgery: A Commentary

by Alan A. Saber, MD, FACS

Dr. Saber is Associate Professor in the  Department of Surgery, Case Western Reserve University, Case Medical Center in Cleveland, Ohio.

Bariatric Times. 2010;7(6):32–33

In the February 2010 issue of Current Problems in Surgery, Drs. Robert Lim, George Blackburn, and Daniel Jones from the Beth Israel-Deaconess Medical Center in Boston, Massachusetts, contributed a masterful article entitled, “Benchmarking Best Practices in Weight Loss Surgery.”[1] It is a comprehensive systematic literature review of 386 articles.

Due to recent advances in surgical management of weight reduction surgery and the demonstration that such surgery has multiple additional health benefits, there has been a virtual explosion in the number of these procedures being performed; currently there are nearly a quarter of a million weight loss operations performed each year. As a result, most healthcare providers are either currently treating or will eventually treat patients who have had weight loss surgery.

In order for all healthcare providers to deliver the latest, evidence-based treatment and meet the best interests of their patients, they must be familiar with the basics of the weight loss surgical procedures, weight loss devices, anatomical changes, nutritional needs, and early signs and symptoms of common complications. The Lim et al article provides an excellent resource for any healthcare provider. It delivers comprehensive and concise information that can serve as the basis for prompt and accurate diagnosis and effective action for treating weight loss surgery patients.

The information in the Lim et al article is based on the 2009 Lehman Center Expert Panel report. The material that is presented addresses a wide range of issues associated with weight loss surgery. It includes an overview of the types of procedures that are currently being performed in addition to those that have been phased out over time. The objective of the article is to improve patient safety by providing a means for developing an evidence-based, best-practice standard of care. The resulting document does just that. Its recommendations will influence healthcare policy and medical practice in the United States and abroad.

The Lim et al article gives an in-depth discussion of the different types of weight loss procedures and the common complications associated with them; it reviews the initial management of complications for nonspecialists who may encounter such patients in the emergency room or clinics, possibly even years after weight loss surgery. It describes what the nonspecialist can expect to see and how he or she can best deal with unexpected consequences of weight loss surgery. Procedures, complications, and special situations are all summarized in considerable detail. The latest data on exercise, pre- and postoperative diet recommendations, eating strategies, and nutrition complications are also provided.

In addition to discussing primary procedures, revisional bariatric surgery procedures are also reviewed; both indications for revisional procedures and outcomes of such procedures are covered. Investigational approaches that were covered included intraluminal approaches, weight loss surgery to treat diabetes in patients with body mass index (BMI) less than 35 and candidates for transplant surgery who are obese. The importance of multidisciplinary approaches to weight loss surgery is discussed. The article included benefits of weight loss surgery.

The text is written in such a way that readers from a wide spectrum— from residents to attending physicians—are able to easily read and understand the material covered. It is well-written, nicely presented, and easy to digest. The overall design and quality of the paper is of the highest standard.

This thorough review should become an essential resource for all physicians caring for weight loss surgery patients. In addition to the wealth of detailed information, several colored illustrations are included in the electronic version of this magnificent review. The quality of illustrations is superb. These illustrations reinforce the techniques and complications described in the text.

Lim, Blackburn, and Jones are to be congratulated for their relevant and efficient work. I highly recommend this article to all healthcare providers, surgical trainees, and surgeons who wish to optimize their patient outcomes. This article would be a valuable addition to any medical library with either an established or developing bariatric program; it would be a valuable tool for both the medical and surgical arms of such a program.

References
1.    Lim RB, Blackburn GL, Jones DB. Benchmarking best practices in weight loss surgery. Curr Probl Surg. 2010 Feb;47(2):79–174.

Category: Commentary, Past Articles