Guidelines for Canadian bariatric surgical and medical centres: a statement from the Canadian Association of Bariatric Physicians and Surgeons

Garneau, Philippe; Glazer, Stephen; Jackson, Timothy; Sampath, Sharadh; Reed, Kenneth L.; Christou, Nicolas V.; Shaban, Joseph; Biertho, Laurent

doi:10.1503/cjs.020719

Cited by 9 publications

(7 citation statements)

References 10 publications

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“…In addition to SG, several other types of bariatric–metabolic procedures (including RYGB and one anastomosis gastric bypass) are performed at our institution. Based on the annual number of bariatric-metabolic procedures, our institution’s bariatric center is currently considered a Level II bariatric center [ 17 ]. Preoperatively, all patients underwent a standard workup, including history, physical examination, and an extensive laboratory/imaging evaluation (blood tests, esophagogastroduodenoscopy, polysomnography, abdominal ultrasound, heart ultrasound, etc.).…”

Section: Methodsmentioning

confidence: 99%

“…With the aid of the anesthesiologist, a bougie is then inserted trans orally, that will be used to guide the resection. Current consensus states that a 36 Fr size bougie is the most widely used [ 17 , 18 , 19 , 20 ], with multiple bougie sizes being reported as preferred in the literature. As standard practice, we used a narrower, 32 Fr bougie for the creation of the gastric sleeve.…”

Section: Methodsmentioning

confidence: 99%

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Risk Factors and Management Approaches for Staple Line Leaks Following Sleeve Gastrectomy: A Single-Center Retrospective Study of 402 Patients

Verras,

Mulita,

Lampropoulos

et al. 2023

JPM

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Sleeve gastrectomy (SG) has gained ever-increasing popularity among laparoscopic surgeons involved in bariatric surgery. This single-institution, retrospective cohort study aims to evaluate the prevalence of postoperative staple line leakage (PSLL) after LSG and identify risk factors for its development. We included patient data that underwent LSG at our institution for a span of 17 years—starting in January 2005 and ending in December 2022. We set the investigation of correlations of patient-related factors (age, weight, BMI, smoking status, presence of diabetes mellitus) with the occurrence of postoperative leaks. A total of 402 patients were included in our study. Of them, 26 (6.46%) developed PSLL. In total, 19 (73%) patients underwent percutaneous drainage and 14 patients (53.8%) were treated with intraluminal endoscopic stenting. Finally, five patients (19.2%) were treated with endoscopic clipping of the defect. Operative management was required in only one patient. There were no statistically significant differences in patient age, mean weight at the time of operation, and mean BMI. Abnormal drain amylase levels were associated with earlier detection of PSLL. More consideration needs to be given to producing a consensus regarding the management of PSLL, prioritizing nonoperative management with the combination of percutaneous drainage and endoscopic stenting as the safest and most efficient approach.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Risk Factors and Management Approaches for Staple Line Leaks Following Sleeve Gastrectomy: A Single-Center Retrospective Study of 402 Patients

Verras,

Mulita,

Lampropoulos

et al. 2023

JPM

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“…The results of this study have important clinical implications. First, these models will provide a clearer understanding of the role the exercise professional in the bariatric surgery setting provides and the value they bring to a multidisciplinary surgery team, including nurses (125,129,130). More practically, findings provide practical and useful information that could contribute in four major areas: 1) describing the roles and responsibilities exercise professionals are able to fill, helping create job descriptions, 2) developing CPT/billing codes for reimbursement (aligning with how cardiac rehab was developed), helping to spur other funding for positions, 3) credentialing exercise professionals in bariatric care and development of "core competencies" (119) and 4) helping to coordinate care of clinical exercise personnel, perhaps in a system of ExerciseCare.…”

Section: Issues In Bariatric Exercise Surveymentioning

confidence: 99%

Role of the exercise professional in metabolic and bariatric surgery

Stults‐Kolehmainen

Bond

Richardson

et al. 2023

Preprint

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Background: Physical activity (PA) is important for the long-term health and weight management of patients who undergo metabolic and bariatric surgery (MBS). However, the roles of exercise professionals in clinical MBS settings have not been systematically determined. Objectives: To investigate: (1) who are the professionals implementing PA programming in MBS clinical settings; and (2) what patient-centric tasks do they perform? Setting: Clinical and academic exercise settings worldwide. Methods: This is a multimethod study. A systematic literature review of all bariatric PA programs was conducted. Data about job tasks were extracted, reduced and provided to a panel of 10 experts to sort into categories. Cluster analysis was utilized to find the hierarchical structure of tasks. A Delphi process was used to agree on a final model, and then the literature was recoded for higher order job task categories. Results: The majority of PA professionals were exercise physiologists in the USA and physiotherapists or other types of exercise professionals elsewhere. Forty-three tasks were identified, the most reported being: supervision of exercise, fitness testing, and exercise prescription. Higher-order categories were: (1) Exercise-related health assessment, (2) Body composition and physical fitness assessment, (3) Lifestyle physical activity and sedentary behavior assessment, (4) Education, instruction, and prescription, (5) Exercise monitoring, (6) Behavioral counseling and psychosocial support, and (7) Dietary support. The most common skills reported in the literature were: supervision of exercise, fitness testing, exercise prescription, heart rate monitoring, and physical activity counseling. The following statements were rated an average of 9.0, indicating "imperative" was indicated by all respondents: 1) "Pre- and post-operative PA/exercise guidelines for bariatric surgery patients are needed", 2) "Bariatric surgery programs need to include PA/exercise as part of multidisciplinary care". Conclusions: Our expert group of bariatric exercise professionals, allied clinicians, and scientists reached a consensus on 7 major classifications of job tasks for the exercise professional. It is important for governing medical associations across the world to formally recognize experienced exercise professionals as playing pivotal roles in continuing, multidisciplinary care for bariatric surgery patients. These findings provide evidence-based guidance on how to solidify these positions within the greater context of healthcare.

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“…Thirteen sources reported study findings concerning the validity and/or accuracy of BMI as a measure of obesity [14][15][16][17][18][19][20][21][22][23][24][25][26] and are summarized in Table 2; 13 sources reported findings regarding the use of BMI as a surgical cut-off and are summarized in Table 3; [27][28][29][30][31][32][33][34][35][36][37][38][39] 5 reported ethical issues related to BMI [40][41][42][43][44] and are summarized in Table 4; and 3 guidelines were identified describing recommendations related to the use of BMI as a threshold or cut-off in determining eligibility for surgery (summarized in Table 5). [45][46][47] With regard to validity and/or accuracy, most of the included studies either compared BMI to other measures of obesity and/or adiposity, or investigated the effects of BMI cut-offs for surgical eligibility on surgical outcomes. Most studies either found discrepancies between BMI and other measurements or concluded that there was insufficient evidence to support BMI cut-offs for surgical eligibility.…”

Section: Annotated Reference List Overall Summarymentioning

confidence: 99%

Body Mass Index as a Measure of Obesity and Cut-Off for Surgical Eligibility

Khangura¹,

Severn²

2022

cjht

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This report sought to identify, list, and annotate sources that reported findings regarding the accuracy and/or validity of body mass index as a measure of obesity or a cut-off for surgical eligibility, including reported ethical issues. A limited literature search was conducted, and 35 eligible sources were selected and annotated. Most studies with relevant findings regarding validity and/or accuracy reported discrepancies between body mass index and other measurements of obesity, or highlighted concerns with current practices that limit surgical eligibility by body mass index for patients who may derive benefit that exceeds the risk of complications. Ethical issues reported included stigma, bias (particularly for racialized people), and the potential for body mass index and its use as a cut-off to create or exacerbate disparities in health care access. The guidelines identified made recommendations for the use of body mass index cut-off(s) for surgical eligibility, generally intended to limit the risk of post-surgical complications. Given the widespread use of body mass index as a measure of obesity and eligibility cut-off for surgical interventions, despite reported discrepancies in accuracy and validity, as well as ethical concerns, further consideration regarding its use is warranted.

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Guidelines for Canadian bariatric surgical and medical centres: a statement from the Canadian Association of Bariatric Physicians and Surgeons

Cited by 9 publications

References 10 publications

Risk Factors and Management Approaches for Staple Line Leaks Following Sleeve Gastrectomy: A Single-Center Retrospective Study of 402 Patients

Risk Factors and Management Approaches for Staple Line Leaks Following Sleeve Gastrectomy: A Single-Center Retrospective Study of 402 Patients

Role of the exercise professional in metabolic and bariatric surgery

Body Mass Index as a Measure of Obesity and Cut-Off for Surgical Eligibility

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