Bariatric surgery
Care pathway in bariatric surgery
About In 2017, 68,000 people underwent bariatric surgery (by-pass, sleeve or gastric band) to treat people with the most severe forms of obesity. A figure which , according to a study by the Department of Research, Studies, Evaluation and Statistics (DREES), has been multiplied by 4.5 in ten years (15,000 patients operated on in 2006) and by more than twenty in twenty years (2,800 in 1997).
Obesity is a chronic disease , and can, especially when severe or massive, lead to difficulties in day-to-day life. It can also threaten health and cause chronic metabolic diseases such as diabetes, arterial hypertension, dyslipidemia, dysmetabolic steatopathy, sleep apnea syndrome, etc. These diseases are chronic diseases that progress to other pathologies such as cardiovascular disease.
Obesity surgery allows major and lasting weight loss, an improvement in chronic pathologies associated with obesity, an improvement in life expectancy and quality of life. In addition, it reduces the incidence of chronic diseases associated with obesity. Nevertheless, having surgery is an important decision and requires good preparation in compliance with national indications and contraindications, as well as lifelong care. The doctors of the Pitié-Salpêtrière Hospital nutrition department are involved in writing and updating recommendations for the management of patients with severe obesity (including bariatric surgery) for the High Authority for Health. ).
It is therefore essential to provide adequate and multidisciplinary preparation for this intervention, and to be able to guarantee lifelong follow-up for these patients. Indeed, the management of bariatric surgery is a permanent process, which involves informing, evaluating and supporting patients throughout this process.
The IHU-ICAN a complete multidisciplinary care pathway
The management of patients in the context of bariatric surgery is carried out within multidisciplinary teams (doctors, surgeons, anesthesiologists, nurses, dieticians, psychologists, physical activity educators and a coordinator), in conjunction with the attending physician. This support is part of a personalized project for the patient as described in the following figure.
1- Patient information and assessment
The first appointment is used to research and assess whether patients meet the criteria for indications and contraindications to bariatric surgery to ensure the relevance of care. A HDJ is organized at the beginning of the course to assess, inform and, in the end, offer the patient a personalized preparation course that will allow him to make an informed and motivated decision.
During this exchange are discussed:
- The different surgical techniques: their principle, their benefits, their risks and disadvantages, the limits of surgery;
- The need for a change in eating behavior and lifestyle (need for regular physical activity) before and after the intervention;
- The need for lifelong medical and surgical follow-up and the potentially serious consequences of the lack of follow-up;
- The possibility of resorting to reconstructive surgery after bariatric surgery.
2- Assess and manage the patient before the intervention
It is necessary to carry out a medico-surgical but also dietary and psychological evaluation to limit the operative risks and ensure the long-term success of the intervention.
This preoperative medical and surgical assessment includes:
- An assessment and management of comorbidities (cardiovascular, metabolic, respiratory, etc.);
- An assessment of eating behavior and management of a possible eating disorder (ED);
- A nutritional and vitamin balance sheet and a correction of any deficits, an evaluation of chewing abilities;
- The establishment of a therapeutic education program in terms of diet and physical activity is recommended from the preoperative period.
- Psychological and psychiatric assessment
This step is essential, because at the end of these examinations, a discussion and a consultation of the multidisciplinary team will determine the possibility of operating or not the patient. As our service specializes in severe, complex and even rare cases of obesity, patient files must sometimes be discussed several times to analyze and establish the best diagnostic and therapeutic strategies.
The conclusions of this consultation must be: formalized and transcribed in the patient’s file; communicated to the patient, to all members of the multidisciplinary team and to the attending physician. They will be used to establish the request for reimbursement by social security of the surgical procedure.
3- Postoperative follow-up
Obesity being a chronic disease, and because of the risk of late complications (surgical or nutritional, some of which can lead to serious neurological damage), follow-up and care of the patient after the intervention must be ensured for life.
The follow-up is closer in the first year with in particular a consultation plan, the programming of a day hospital at 3 and 12 months. The follow-up will then be annual in consultation except for a day hospital every 5 years in order to take stock of the medical, nutritional and dietary aspects.
A course of bariatric surgery care dedicated to adolescents with obesity is offered by ICAN specialists in order to meet their specificities.
Useful links
nutrition service
https://www.aphp.fr/service/service-59-066
French Association for Study and Research on Obesity
http://www.afero.fr/
National collective of obese associations
https://www.facebook.com/CNAObesite/
Find out more
Patient information
Obesity surgery
Patient Journey Booklet n°1
Bariatric surgery
adult
Patient Journey booklet n°2
Bariatric surgery
teenager
Patient Journey booklet n°3
Bariatric surgery
teenager
Patient Journey booklet n°4
Bariatric surgery
adult
Summary of good dietary practices
Bariatric surgery
adult
Argument of good food practices
Bariatric surgery
