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POSTOPERATIVE FOLLOW UP

A Bariatric Surgical intervention (mainly Sleeve Gastrectomy or Gastric Bypass) gives at short term excellent results, resulting in the majority of cases a weight loss of 50 to 70% for BMI indications between 35 and 45.

In the long term, on the other hand, a group of patients is identified in whom the results are much less satisfactory with progressive deterioration and weight gain from the 2nd postoperative year.

WHAT'S THE CAUSE?

THE MAJOR CAUSE: ABSENCE OF POSTOPERATIVE AND ESSENTIALLY NUTRITIONIST FOLLOW-UP !

The High Authority for Health, Social Security controls and the patients themselves who come back to consult too late notice and deplore this failure, so on average half of the patients no longer consult either the surgeon or the nutritionist they saw before the intervention !

This failure mainly for the patient but also for those around him, for the medical team and the Health Insurance Fund which finances this operation, the cost of which is around 10,000 euros, gives bariatric surgery a bad reputation. We therefore understand that the public authorities are questioning the merits of this surgery and regularly consider no longer reimbursing it or limiting it as much as possible (2 countries of the European Union ask the patient to pay for the intervention and reimburse them only gradually in light of the evidence of post-operative follow-up - 50,000 patients were operated on in France in 2017 and 9,000 in Germany).

What solution should be provided so that this postoperative follow-up is done in good conditions and in the interest of all?

  • In our opinion, it is during the PREOPERATIVE period that this follow-up is prepared, good contact with the entire medical team, respect for consultations and prescriptions, their understanding and a good will on the part of the patient augurs well for a desire, even a need for contact and communication with the medical team and this need for themselves will lead to good postoperative follow-up.
  • Meetings with Patient Groups, both before and after the procedure, allow patients to dialogue with each other and with the different specialists, they allow discussion about sometimes minor problems (loss of hair is always transient) or good organization.
  • The day before leaving the Clinic, a visit from the nutritionist can, if possible, specify the immediate postoperative dietary guidelines, but in any case the patient must receive written instructions on this subject.

From a distance, it seems logical to see the surgeon twice a year and the nutritionist 4 times per year, writing down its diet so that he can correct his mistakes.

Depending on the associated pathologies, personalized monitoring is essential: endocrinologist in the event of diabetes, cardiologist in the event of high blood pressure, pulmonologist in the event of sleep apnea, etc.

CONCLUSION:

Without postoperative monitoring the risk of failure is very important.

The 6 months of preparation before the operation are essential, (required by French Social Security and checked).