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Videosurgery and Other Miniinvasive Techniques
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4/2019
vol. 14
 
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abstract:
Original paper

Challenges associated with bariatric surgery – a multi-center report

Tomasz Stefura
1
,
Oksana Skomarovska
1
,
Michał Wysocki
2
,
Michał Janik
3
,
Marta Krzysztofik
1
,
Maciej Walędziak
3
,
Michał Pędziwiatr
2
,
Piotr Kowalewski
3
,
Piotr Małczak
2
,
Katarzyna Bartosiak
3
,
Mateusz Rubinkiewicz
2
,
Michał Orłowski
3
,
Maciej Matłok
4
,
Mateusz Wierdak
2
,
Katarzyna Major
5
,
Piotr Myśliwiec
6
,
Jacek Szeliga
7
,
Andrzej Budzyński
2
,
Piotr Major
2

1.
Students’ Scientific Group at 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
2.
2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
3.
Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
4.
Subcarpathian Obesity Treatment Center in the PRO-FAMILIA Specialist Hospital, Rzeszow, Poland
5.
Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
6.
Department of General and Endocrinological Surgery, Medical University of Bialystok, Bialystok, Poland
7.
Department of General, Gastroenterological, and Oncological Surgery Collegium Medicum, Nicolaus Copernicus University, Torun, Poland
Videosurgery Miniinv 2019; 14 (4): 526–531
DOI: https://doi.org/10.5114/wiitm.2019.81370
Online publish date: 2019/01/18
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Introduction
Due to the constantly growing demand for surgical treatment of obesity, it is necessary to create new bariatric centers and further improve presently active ones.

Aim
To identify which stages of conducting peri-operative care and organizing a modern bariatric center currently pose the greatest challenge.

Material and methods
An anonymous survey was designed and distributed to bariatric surgeons. Our questionnaire was divided into three parts: demographic characteristics, difficulties associated with peri-operative care for bariatric patients (assessed on a scale of 1–5) and difficulties associated with organization or running of bariatric centers in which participants are currently working (assessed on a scale of 1–5).

Results
Overall, 70 surgeons and surgical residents from 17 surgical centers participated in our survey. The most difficult element of the pre-operative care was compliance with the recommendation to cease smoking (3.47 ±1.28). The most difficult obstacle during the postoperative care period was implementation of the enhanced recovery after surgery (ERAS) protocol (2.27 ±1.31). Funding for the bariatric treatment was obtained exclusively from the National Health Fund by 60 (85.7%) respondents working in 15 different bariatric centers (88.2%). Among elements of bariatric infrastructure access to operating theater equipment sized for morbidly obese patients was reported to be the most difficult (3.8 ±1.68).

Conclusions
Pre-operative recommendations including smoking, physical activity or weight loss, as well as introducing ERAS protocol based peri-operative care, are difficult to execute in bariatric departments. Future specialized bariatric centers should be included in the centralized register and equipped with specialized infrastructure for morbidly obese patients.

keywords:

obesity, bariatric surgery, peri-operative care, enhanced recovery after surgery, organizational difficulties
  
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