Canadian Trends in Bariatric Surgery

• Published in: Obesity (Silver Spring, Md.) Md.), 2022-11, Vol.30, p.283-284
• Main Authors: Jarrar, Amer, Hardy-Henry, Anne, Cottreau, Jonathan, Walsh, Caolan, Neville, Amy, Mamazza, Joseph, Kolozsvari, Nicole
• Format: Article
• Language: English
• Subjects: Gastrointestinal surgery
• ISSN: 1930-7381; 1930-739X

Background: This study describes the landscape of bariatric surgery in Canada, including procedural and technical variation. Methods: An online survey was included in the Canadian Association of General Surgeons (CAGS) newsletter. The survey topics included types surgical practice, fellowship training, bariatric surgical experience, types of procedures performed, preoperative workup and technical specifics for each procedure. Results: Twenty-three respondents indicated they performed bariatric surgery, representing 29.5% of the estimated 78 surgeons with bariatric practices in Canada. Sixteen (69.6%) practiced in an academic setting, 6 (26.1%) practiced in the community and 1 (4.3%) in the private sector. The majority of bariatric surgeons were fellowship trained. Academic surgeons were more likely to have bariatric surgery their main practice. Most surgeons performed more than the minimum 100 lifetime stapling procedures (91.3%) and minimum 25 yearly stapling procedures (87%) required for ASMBS bariatric certification. The most performed bariatric procedure was the RYGB: for 21 surgeons (91.3%) RYGB. SG was the next most common performed procedure. Only 3 surgeons (39.1%) performed duodenal switches. No one performed adjustable gastric banding. Perioperative work-up was similar across practice types. For RYGB, the majority of surgeons used a bougie to size the gastric pouch (n=18, 78%), with most using a 30-40Fr bougie (n=16, 69.6%). A combined stapler and hand-sewn gastrojejunostomy was the most common anastomotic technique (n=16, 69.6%). The majority routinely performed a leak test (n=22, 95.7%). Most surgeons did not use routine intraoperative gastroscopy (n= 17, 73.9%) and did not routinely leave a drain (n= 21, 91.3%). For SG, most surgeons used a bougie to size the sleeve (n=22, 96%), with majority using a 30-40Fr bougie (n=19, 82.6%). The majority did not routinely oversew the staple line (n=22, 95.6%) and did not routinely perform intraoperative gastroscopy (n=19, 82.6%). Approximately half routinely performed a leak test. Conclusions: While SG is now the most common bariatric surgery performed worldwide, the gold-standard RYGB remains the most common bariatric surgery performed in Canada. Surgeons performing bariatric surgery in Canada had similar training, experience and consistent practice patterns.