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European Obesity Summit

High volume fast track surgery course at IFSO-EC

high volume fast track metabolic surgery course will feature live surgery and demonstrate some of the benefits of enhanced recovery

At the European Obesity Summit in June in Gothenburg, Sweden, Dr Hjortur Gislason, Lead Metabolic Surgeon in Aleris Hospital, Kristianstad, Sweden and Oslo, Norway, will host a high volume fast track metabolic surgery course, which will feature live surgery and demonstrate some of the benefits of enhanced recovery.

Bariatric News: What roles does surgery have in combatting the obesity epidemic?

“The obesity epidemic calls for increased use of surgery since no other treatment can achieve significant and lasting weight loss. Good results can be expressed in terms of therapeutic success i.e. weight loss, resolution of comorbidity, QOL, and very importantly, patient safety as well the optimum use of available resources. We have to live within limited economic recourses and make the most of them as large numbers of patients needing treatment. It is our obligation to secure a good use of these recourses by treating as many patients as possible to a low cost and with high quality. Over the last 10 - 20 years there have been continuous developments in surgical and anaesthesia techniques with a shift towards less invasive and less traumatic treatment. Minimally invasive surgery and especially the use of the laparoscopic technique have been proved as safe when associated with enhanced recovery.”

Hjortur Gislason

Bariatric News: What do you mean by enhanced recovery?

“The term now refers to a multimodal package of techniques, which aim to decrease post-surgical organ dysfunction, improve postoperative recovery and reduce complications. Another and not less important issue for patient safety is the teaching and training aspects of new surgeons as well as of the whole surgical team. The use of short-acting opioids and lower dose of propofol only in the induction of anaesthesia are useful to ensure quicker emergence from anaesthesia. Results can be improved by conducting medical audit and standardise all aspects of the treatment process. Continuously entering own data to a database increases awareness of the results. Good logistics are also a key element in order to streamline the work and secure maximal use of the recourses, improve patients care and for good long-term results. Economical awareness is especially important and easily incorporated in the treatment process without compromising with patient safety and quality of care. Outcome of treatment is measured in hospital stay, rate of re-admissions and complications, economical aspects and long-term results on weight and co-morbidity”.

Bariatric News: How have these principles been applied in your practice?

“The group that I lead has performed over 8,000 gastric bypasses between 2005 and 2013. We use the Lanroth method, antecolic, antegastric and linear staplers. We close the mesenteric defects with staplers (hernia-staplers). Standardisation of the procedure makes the operation safer, performed in the same manner by all the surgeons of the team. In the first three year of this period, the median total operating time 102 minutes and in the last three years of the period it was reduced to 49 minutes. The median surgical time (”skin to skin”) was reduced from 59 minutes to 36 minutes in the same period. It is vital to keep the turn over time in theatre as low as possible”.

Bariatric News: How will you demonstrate these fast track principles on the course?

“We will demonstrate this by live operating on three patients over a two to three hour period in a single theatre. The first will be a standard Lonroth Roux en Y gastric bypass, followed by a sleeve gastrectomy and we will end with a long limb gastric bypass in a superobese patient. We will demonstrate our technique and how we streamline the work in theatre. It is important for metabolic surgeons, whether in private or government hospitals, to understand the principles of fast track surgery in high volume centres.”

The European Obesity Summit will be in Gothenburg, Sweden, 1-4 June 2016. Participants of the pre-congress course must be registered for the EOS 2016 Summit.

In you are interested in any of the IFSO-EC Pre-Congress Courses, please contact Ms Gabriela Habartova at: habartova@guarant.cz

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