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Factors that make Bariatric Surgery Technically Challenging: A Survey of 370 Bariatric Surgeons

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Abstract

Background

There is no published data on the factors bariatric surgeons think make bariatric surgery challenging. This study aimed to identify factors that bariatric surgeons feel and increase the technical complexity of bariatric surgery.

Methods

Bariatric surgeons from around the world were invited to participate in a questionnaire-based survey on Survey Monkey®. An Average Weighted Score was calculated for each factor. A score of < 1.0 meant that the factor was perceived to make surgery technically easier.

Results

Three hundred seventy bariatric and metabolic surgeons from 59 countries completed the survey. The top 10 factors that our respondents felt were most important for determining the technical difficulty of a procedure were inappropriate trocar placement (AWS 3.44), BMI above 60 (AWS 3.41), open bariatric surgery (AWS 3.26), less experienced bariatric anesthetist (AWS 3.18), liver cirrhosis (AWS 3), large liver (AWS 2.99), less experienced bariatric assistant (AWS 2.97), lower surgeon total bariatric surgery volume (AWS 2.95), lower surgeon specific procedure volume (AWS 2.85) and previous laparotomy (AWS 2.83), respectively. Respondents also felt that the younger patients (AWS 0.78), dedicated operating team (AWS 0.67), BMI less than 35 (AWS 0.54), and French position (AWS 0.45) actually make the surgery easier.

Conclusion

This survey is the first attempt to understand the factors which make bariatric surgery more difficult. Knowing the factors made the operation more challenging, led to better scheduling the potentially difficult patients to reduce the complications.

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References

  1. Griffiths EA, Hodson J, Vohra RS et al (2019) Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy. Surg Endosc 33(1):110–121

    Article  Google Scholar 

  2. Kang SB, Park JS, Kim DW, Lee TG (2010) Intraoperative technical difficulty during laparoscopy-assisted surgery as a prognostic factor for colorectal cancer. Dis Colon Rectum 53(10):1400–1408

    Article  Google Scholar 

  3. Partelli S, Ricci C, Rancoita PMV et al. (2020) Preoperative predictive factors of laparoscopic distal pancreatectomy difficulty . HPB (Oxford), S1365–182X (20)30124–6

  4. Liu P, Li Y, Ding HF et al (2020) A novel preoperative scoring system to predict technical difficulty in laparoscopic splenectomy for non-traumatic diseases. Surg Endosc. https://doi.org/10.1007/s00464-019-07327-3

    Article  PubMed  PubMed Central  Google Scholar 

  5. Fujiwara Y, Lee S, Gyobu K et al (2019) Predictive factors of difficulty of thoracoscopic esophagectomy in the left decubitus position. Esophagus 16(3):316–323. https://doi.org/10.1007/s10388-019-00663-2

    Article  PubMed  Google Scholar 

  6. Russolillo N, Maina C, Fleres F, Langella S, Lo Tesoriere R, Ferrero A (2020) Comparison and validation of three difficulty scoring systems in laparoscopic liver surgery: a retrospective analysis on 300 cases. Surg Endosc. https://doi.org/10.1007/s00464-019-07345-1

    Article  PubMed  Google Scholar 

  7. Radak D, Tanaskovic S, Neskovic M (2019) The obesity-associated risk in open and endovascular repair of abdominal aortic aneurysm. Curr Pharm Des 25(18):2033–2037

    Article  CAS  Google Scholar 

  8. Kula AO, Riess ML, Ellinas EH (2017) Increasing body mass index predicts increasing difficulty, failure rate, and time to discovery of failure of epidural anesthesia in laboring patients. J Clin Anesth 37:154–158

    Article  Google Scholar 

  9. Eldar SM, Heneghan HM, Brethauer SA et al (2012) Laparoscopic bariatric surgery for those with body mass index of 70–125 kg/m2. Surg Obes Relat Dis 8(6):736–740

    Article  Google Scholar 

  10. Morales MP, Wheeler AA, Ramaswamy A, Scott JS, de la Torre RA (2010) Laparoscopic revisional surgery after Roux-en-Y gastric bypass and sleeve gastrectomy. Surg Obes Relat Dis 6(5):485–490

    Article  Google Scholar 

  11. Bouchard P, Demyttenaere S, Court O, Franco EL, Andalib A (2020) Surgeon and hospital volume outcomes in bariatric surgery: a population-level study. Surg Obes Relat Dis 16(5):674–681

    Article  Google Scholar 

  12. Barbat SD, Thompson KJ, Raheem E, Mckillop IH, Dugan N, Nimeri A (2020) Bariatric surgery outcome when assisted by fellows and; An MBSAQIP analysis of 477,670 patients. Surg Obes Relat Dis. https://doi.org/10.1016/j.soard.2020.01.019

    Article  PubMed  Google Scholar 

  13. AlSabah S, Al Haddad E, Khwaja H (2018) The prevalence of musculoskeletal injuries in bariatric surgeons. Surg Endosc. https://doi.org/10.1007/s00464-018-6460-1

    Article  PubMed  Google Scholar 

  14. Carmona J, Higuerey J, Gil D, Castillo M, Escalona V (2018) Physical and mental impact of laparoscopic sleeve gastrectomy on the surgeon: French vs. American positions. A randomized and controlled study. Obes Surg. https://doi.org/10.1007/s11695-018-3496-1

    Article  Google Scholar 

  15. Nguyen N, Longoria M, Gelfand D, Sabio A, Wilson S (2005) Staged laparoscopic roux-en-Y: a novel two-stage bariatric operation as an alternative in the super-obese with massively enlarged liver. Obes Surg 15(7):1077–81

    Article  Google Scholar 

  16. Artuso D, Wayne M, Kaul A, Bairamian M, Teixeira J, Cerabona T (2004) Extremely high body mass index is not a contraindication to laparoscopic gastric bypass. Obes Surg 14(6):750–754

    Article  Google Scholar 

  17. Major P, Stefura T, Waledziak M, Janik M, Pedziwiatr M, Wysock M et al (2019) What makes bariatric operations difficult-results of a national survey. Medicina 55:218. https://doi.org/10.3390/medicina55060218

    Article  PubMed Central  Google Scholar 

  18. Mahawar KK, Parmar C, Graham Y, Abouleid A, Carr WR, Jennings N, Schroeder N, Small PK (2016) Routine liver biopsy during bariatric surgery: an analysis of evidence base. Obes Surg 26(1):177–181

    Article  Google Scholar 

  19. Mumtaz K, Lipshultz H, Jalil S, Porter K, Li N, Kelly SG et al (2020) Bariatric surgery in patients with cirrhosis: careful patient and surgery-type selection is key to improving outcomes. Obes Surg. https://doi.org/10.1007/s11695-020-04583-4

    Article  PubMed  Google Scholar 

  20. Goh GB, Schauer PR, Mccullough AJ (2018) Considerations for bariatric surgery in patients with cirrhosis. World J Gastroenterol 24:3112–3119. https://doi.org/10.3748/wjg.v24.i28.3112

    Article  PubMed  PubMed Central  Google Scholar 

  21. Younus H, Sharma A, Miquel R, Quaglia A, Kanchustambam S, Carswell K et al (2019) Bariatric surgery in cirrhotic patients: is it safe? Obes Surg. https://doi.org/10.1007/s11695-019-04214-7

    Article  Google Scholar 

  22. Hanifah Z, Punchai S, Mccullough A, Dasarathy S, Brethauer S, Aminian A et al (2018) Bariatric surgery in patients with cirrhosis and portal hypertension. Obes Surg. https://doi.org/10.1007/s11695-018-3372-z

    Article  Google Scholar 

  23. Aelfers S, Janssen I, Aarts E, Smids C, Groenen M, Berends F (2018) Inflammatory bowel disease is not a contraindication for bariatric surgery. Obes Surg 28(6):1681–1687. https://doi.org/10.1007/s11695-017-3076-9

    Article  PubMed  Google Scholar 

  24. Raul Rosenthal, Bashankaev B, Wexner S (2009) Laparoscopic management of inflammatory bowel disease. Digest Diseases 27:560–4. https://doi.org/10.1159/000233298

    Article  Google Scholar 

  25. Karip B, Altun H, Iscan Y, Bazan M, Çelik K, Özcab Y (2014) Difficulties of bariatric surgery after abdominoplasty. Case Rep Surg. https://doi.org/10.1155/2014/620175

    Article  PubMed  PubMed Central  Google Scholar 

  26. Hrabe J, Sherman S, Charlton M, Cromwell J, Byrn J (2014) Effect of BMI on outcomes in proctectomy. Dis Colon Rectum 57:608–615

    Article  Google Scholar 

  27. Bouwman F, Smits A, Lopes A, Das N, Pollard A, Massuger L et al (2015) The impact of BMI on surgical complications and outcomes in endometrial cancer surgery-an institutional study and systematic review of the literature. Gynecol Oncol 139:369–376

    Article  Google Scholar 

  28. Katkhouda N, Moazzez A, Popek S et al (2009) A new and standardized approach for trocar placement in laparoscopic Rouxen-Y gastric bypass. Surg Endosc 23:659–662

    Article  Google Scholar 

  29. Clapp B (2018) Optimal initial trocar placement for morbidly obese patients. J Soc Laparoendosc Surg. https://doi.org/10.4293/JSLS.2017.00101

    Article  Google Scholar 

  30. Boules M, Corcelles R, Guerron AD, Dong M, Diagle C, El-Hayek K et al (2015) The incidence of hiatal hernia and technical feasibility of repair during bariatric surgery. Obes Surg 158:00535–8. https://doi.org/10.1016/j.surg.2015.06.036

    Article  Google Scholar 

  31. Kothari V, Shaligram A, Reynoso J et al (2012) Impact on perioperative outcomes of concomitant hiatal hernia repair with laparoscopic gastric bypass. Obes Surg 22(10):1607–1610. https://doi.org/10.1007/s11695-012-0714-0

    Article  PubMed  Google Scholar 

  32. Aridi D, Tamim H, Mailhac A, Safadi B (2016) Concomitant hiatal hernia repair with laparoscopic sleeve gastrectomy: analysis of the ACS-NSQIP database. Surg Obes Relat Diseases. https://doi.org/10.1016/j.soard.2016.09.037

    Article  Google Scholar 

  33. Korenkov M (2012) Technical variations and complications. Bariatric surgery. Springer, Berlin

    Google Scholar 

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Authors and Affiliations

  1. Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran

    Shahab Shahabi & Amir Hossein Davarpanah Jazi

  2. Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Calle Estacion, Valladolid, Spain

    Miguel Carbajo

  3. Bariatric Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA

    Abdelrahman Nimeri

  4. Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

    Mohammad Kermansaravi & Abdolreza Pazouki

  5. Bariatric Unit, Sunderland Royal Hospital, Sunderland, UK

    Kamal Mahawar

  6. Department of Surgery, Shariati Hospital, Isfahan, Iran

    Amir Hossein Davarpanah Jazi

Authors
  1. Shahab Shahabi
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  2. Miguel Carbajo
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  3. Abdelrahman Nimeri
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Correspondence to Amir Hossein Davarpanah Jazi.

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Conflict of interest

Drs Shahab Shahabi, Mohammad Kermansaravi, Amirhossein Davarpanah Jazi, Miguel Carbajo, Abdolreza Pazouki, Abdelrahman Nimeri, and Kamal Mahawar have no conflict of interest or financial ties to disclose. There was no funding issue in this paper.

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Shahabi, S., Carbajo, M., Nimeri, A. et al. Factors that make Bariatric Surgery Technically Challenging: A Survey of 370 Bariatric Surgeons. World J Surg 45, 2521–2528 (2021). https://doi.org/10.1007/s00268-021-06139-8

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  • DOI: https://doi.org/10.1007/s00268-021-06139-8

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