With nearly 40,000 operations per year in France, four times more than in Germany or Great Britain, obesity surgery is developing very rapidly in our country. Perhaps too quickly according to the National Academy of Surgery, which denounces a lack of postoperative follow-up.
“In its recommendations dating from 2009, the Haute Autorité de santé underlined the importance of careful and multidisciplinary postoperative follow-up, organized upstream of the intervention, and extended for life. But in the field, the practices in term follow-up remain very heterogeneous. Rare are the centers which still follow more than half of their patients beyond the second postoperative year. With soon more than 200,000 people operated in France, it seems urgent to be concerned “underline the medical authorities in a report that has just been made public.
How to organize the follow-up of operated patients?
In this report, the Academy describes the various difficulties which have made postoperative follow-up the “Achilles heel” of bariatric surgery.
Difficulties related to doctors: surgeons have neither the time nor the skills to follow these
patients. Most endocrinologists are busy caring for other patients in their specialty, and
little available to follow bariatric surgery. Nutritionists are not in sufficient number and insufficiently
paid for necessarily long consultations but requiring few technical acts. And paramedical consultations, especially dieticians, are not covered by health insurance.
Difficulties related to patients: weight gain after surgery is often perceived, for lack of sufficient upstream information, as a personal failure. This situation often discourages patients from seeing the bariatric team or general practitioner.
Difficulties related to the number of operations: As the number of bariatric procedures in France has more than doubled in 5 years, the number of patients who now need to be regularly monitored has increased exponentially. In most centers, the exhaustive follow-up of these large cohorts of patients is not in line with the available resources.
The National Academy of Surgery is therefore making several proposals to improve this situation. In particular the establishment of certified centers, organized to ensure the follow-up of operated patients; collaboration with patient associations to promote postoperative follow-up with operated patients and a revaluation of follow-up by Health Insurance.
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