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Dr Michael Devadas – FRACS MBBS (Hons) BAppSc (NucMed) ANZGOSA

Dr Michael Devadas reviews the misconceptions regarding weight loss and metabolic surgery and the guidelines that the American Society for Metabolic and Bariatric Surgery have published.

There are many misconceptions from not only health professionals but also society regarding weight loss or metabolic surgery. Indeed bariatric surgeons may be seen as their own worst enemies for promising unrealistic expectations for patients and fostering the quick fix mentality.

For many years, even in the surgical community, bariatrics was seen as the ‘Dark Side’ with bariatric surgeons often regarded as money centric clinicians who exclusively worked in the private setting. It is now time to enhance the transparency and integrity of our discipline in the hope that we may emerge from the shadows.

The American Society for Metabolic and Bariatric Surgery has published guidelines for ‘Granting Privileges in Bariatric Surgery’ to define the experience and exposure required to conduct effective bariatric surgical services. These include working in an integrated program with specialised nursing, psychology, dietetic and exercise therapist input. Systems must be in place to deal with not only short term but also long term problems. Outcomes must also be reported in a transparent and meaningful way with long term follow up. As part of a global credentials process, surgeons must have experience with at least 50 laparoscopic and 10 open cases.

As a result of enforcing these guidelines and developing centres and surgeons of excellence, the safety profile of surgery has dramatically improved. In Australia and New Zealand the Bariatric Surgery Registry 6th Annual Report detailed that there were 51,277 procedures on 47,575 patients with a total of 46 deaths reported in the registry. This is probably an underestimation since not all surgeons who perform Bariatric surgery contribute to the registry. The 30 day mortality rate of 60,000 patients having surgery at ASMBS centres of excellence was 0.13% which is considerably lower than cholecystectomy or joint replacement surgery.

There is no doubt Lakeview Private hospital can be considered a high volume Bariatric surgical centre with a considerable number of cases performed annually. As a world class facility Lakeview Private also has well developed preoperative and postoperative protocols. Importantly, the nursing team is very familiar with caring for these patients. The most qualified Bariatric surgeons have formal training in upper gastrointestinal surgery and perform both open and laparoscopic techniques for both weight and oncological procedures.