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‘Returning to surgery’ – the views of bariatric and metabolic experts

Wed, 08/05/2020 - 08:52
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As bariatric and metabolic surgery restarts across the world, Bariatric News spoke to current IFSO-EC President, Gerhard Prager about how the bariatric community can safely resume surgery... 

1. Two of many key recommendations from a recent IFSO publication that you co-authored, 'How are We Going to Restart Elective Bariatric and Metabolic Surgery after the Peak of Covid-19Pandemic?’ concerned pre- and post-operative care consultations. Do you think hospitals and patients have the necessary infrastructure in place (technology, ability to home delivery medicines etc) to successfully enable this and do you foresee any problems not seeing your patients face-to-face?

Gerhard Prager
Gerhard Prager

I strongly believe that the COVID-19 crisis gave a tremendous push to telemedicine. Many Follow up visits but also preoperative dietitian and psychological counselling can be easily done by telemedicine - and I am convinced that this will not only stay but even increase after the COVID-19 crisis. As a surgeon you or somebody from your team must see the patient face to face before the operation at least one time.

Technology wise I do not see a problem as every smartphone can deliver the technology used - and in my experience patients want to undergo the pre-operative investigations/examinations as fast as possible, which means they were eager to adopt these new technologies very fast…

Another advantage is of course that people do not need to travel to see the doctor/dietitian/psychologist/bariatric nurse etc. which might play an even more important role in countries with huge distances...

Difficulties may arise with patients not speaking the particular language of the country… this is sometimes even hard when face to face - and could be solved by videoconferences with translators.

Hospitals must provide the infrastructure to enable telemedicine - in 2020 this is a condition sine qua non...

2. Another recommendation is, ‘Surgeon competency is crucial and only experienced surgeons should be operating in this time’, how does one define ‘experienced’ (eg. number of procedures etc)?

I would put this into perspective: When starting the program after COVID-19 lock down you want to avoid any problem/complication that can be avoided - so the most experienced team should treat the patient.

In terms of numbers I would consider somebody who has performed more than 300 procedures on his own, and a minimum of 50 procedures per year as experienced (of course you can attack this definition from both angels of view…)

3. During the recent COVID Roundtable, Professor Francesco Rubino has said the COVID-19 pandemic could be ‘the last chance’ for the bariatric and metabolic specialty to convince people of the importance of bariatric surgery. Do you agree with his sentiments?

I agree with him that the COVID-19 pandemic is an excellent chance to transport the message that metabolic surgery is NOT (pure) weight loss surgery, but that we treat and prevent many diseases (diabetes, NASH, cardiovascular disease, cancer etc…) that harm the patients severely or even lead to death. So, transporting the message puts metabolic surgery in one row with other parts of visceral surgery (like cancer surgery, vascular surgery etc) and prevents it from being postponed during the crisis.

I do not believe that this is the last chance to transport the message but an excellent chance - that we should not miss - and we should see the (excellent) Diabetes Surgery Summit (DSS) paper in that light (Rubino F, Cohen RV, Mingrone G, et al. Bariatric and metabolic surgery during and after the COVID-19 pandemic: DSS recommendations for management of surgical candidates and postoperative patients and prioritisation of access to surgery. Lancet Diabetes Endocrinol. 2020;8(7):640-648. doi:10.1016/S2213-8587(20)30157-1).

The 'Return to work' survey and interviews with bariatric and metabolic specialists were carried out in partnership with Medtronic Inc.