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Guidelines

American Society for Bariatric Surgery’s guidelines for grantingprivileges in bariatric surgeryASBS Bariatric Training Committee*

Surgery for Obesity and Related Diseases 2 (2006) 65–67

American Society for Bariatric Surgery, Gainesville, Florida

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Bariatric surgeons, like those in other subspecialty areasf surgery, should be responsible for demonstrating a de-ned experience and exposure to the discipline’s uniqueognitive, technical, and administrative challenges. The fol-owing guidelines define the degree of experience, expo-ure, and support considered to be minimally acceptableredentials for general surgery applicants to be eligible forospital privileges to perform bariatric surgery. Theseuidelines are intended to be an update of the originaluidelines enacted in 2003 [1]. The updated changes areased on recently published evidence from the medicaliterature, as well as the consensus expert opinion of ASBSembers of the Bariatric Training and Credentialing Com-ittee and the Executive Council.

ategories of procedures

For the purpose of this document, bariatric procedures areivided into procedures that involve stapling/division of theastrointestinal (GI) tract to achieve weight loss and proce-ures that do not involve stapling/division of the GI tract.

lobal credentialing requirements

To meet the global credentialing requirements in bariat-ic surgery, the applicant should:

● Have credentials at an accredited facility to performgastrointestinal and biliary surgery

● Document that he or she is working within an inte-grated program for the care of morbidly obese patientsthat provides ancillary services, such as specialized

*Reprint requests: American Society for Bariatric Surgery, 100 SW5th Street, Suite 201, Gainesville, FL 32607.

pe-mail: info@asbs.org

550-7289/06/$ – see front matter © 2006 American Society for Bariatric Surgeroi:10.1016/j.soard.2005.10.012

nursing care, dietary instruction, counseling, supportgroups, exercise training, and psychological assistanceas needed

● Document that there is a program in place to prevent,monitor, and manage short-term and long-term com-plications

● Document that there is a system in place to provideand encourage follow-up for all patients. Follow-upvisits should either be directly supervised by the bari-atric surgeon of record or other health care profession-als who are appropriately trained in perioperativemanagement of bariatric patients and part of an inte-grated program. Although applicants cannot guaranteepatient compliance with follow-up recommendations,they should demonstrate evidence of adequate patienteducation regarding the importance of follow-up, aswell as adequate access to follow-up.

xperience in bariatric surgery required to trainpplicants

For the purposes of this document, experienced bariatricurgeons serving as trainers for applicants should meetlobal credentialing requirements and have experience witht least 200 bariatric procedures in the appropriate categoryf procedure in which the applicant is seeking privilegesefore training the applicant.

efinition of operative experience

For the purposes of this privileging guideline, opera-ive experience is defined broadly to include not onlyrocedure performance, but also global care of the bari-tric patient that encompasses preoperative and postop-rative management. Specifically, preoperative manage-ent experience must include patient evaluation and

reparation for surgery. Postoperative management ex-

erience must include inpatient postoperative manage-

y. All rights reserved.

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66 ASBS Bariatric Training Committee / Surgery for Obesity and Related Diseases 2 (2006) 65–67

ent and outpatient management extending beyond the0-day global period (ie, 6-month and or annual fol-ow-up visits). Documentation of perioperative manage-ent should reflect “hands-on” experience in the outpa-

ient clinic or office as well as hospital wardorresponding to the same patients (or equivalent) thatnderwent surgery by the applicant. Procedure perfor-ance experience is defined as hands-on performance ofsignificant portion of the operation under the direct

upervision of an experienced bariatric surgeon as de-ned earlier.

pen bariatric surgery privileges involving stapling orivision of the GI tract

To obtain open bariatric surgery privileges, the surgeonust meet the global credentialing requirements and also

ocument an operative experience of 15 open bariatric pro-edures (or subtotal gastric resection with reconstruction)ith satisfactory outcomes during either general surgery

esidency or postresidency training supervised by an expe-ienced bariatric surgeon. Surgeons who perform primarilyaparoscopic bariatric surgery may obtain open bariatricurgery privileges after documentation of 50 laparoscopicases (see below) and at least 10 open cases supervised byn experienced bariatric surgeon.

aparoscopic bariatric surgery privileges forrocedures involving stapling or division of the GIract

To obtain laparoscopic bariatric surgery privileges thatnvolve stapling the GI tract, a surgeon must meet the globalredentialing requirements and:

● Have privileges to perform open bariatric surgery atthe accredited facility

● Have privileges to perform advanced laparoscopicsurgery at the accredited facility

● Document 50 cases with satisfactory outcomes duringeither general surgery residency or postresidencytraining under the supervision of an experienced bari-atric surgeon.

ariatric surgery privileges for procedures that do notnvolve stapling of the GI tract

To obtain laparoscopic bariatric surgery privileges forrocedures that do not involve stapling or division of the GIract, the surgeon must meet the global credentialing re-uirements and:

● Have privileges to perform advanced laparoscopicsurgery at the accredited facility

● Document 10 cases with satisfactory outcomes during

either general surgery residency or postresidency

training under the supervision of an experienced bari-atric surgeon.

ontinued assessment of outcomes

It is recommended that the local facility review theurgeon’s outcome data within 6 months of initiation of aew program and after the surgeon’s first 50 proceduresperformed independently), as well as at regular intervalshereafter, to confirm patient safety. In addition, the surgeonhould continue to meet global credentialing requirementsor bariatric surgery at the time of reappointment. Docu-entation of continuing medical education related to bari-

tric surgery is also strongly recommended.

isclaimer

The American Society for Bariatric Surgery (ASBS) isstablished as an educational professional medical society. It isot intended to be, nor should it be viewed as, a credentialingody. The foregoing recommendations are based on members’xperience and are offered only as guidelines and are specifi-ally not intended to establish a local, regional, or nationaltandard of care for any bariatric surgical procedure. Althoughhe ASBS views these guidelines as being important to suc-essful surgical outcomes, it does not warrant, guarantee, orromise that compliance with them ensures positive surgicalutcomes for any single procedure [2–22].

eferences

[1] American Society for Bariatric Surgery. Guidelines for granting priv-ileges in bariatric surgery. Obes Surg 2003;13:238–40.

[2] Cottam DR, Mattar S, Lord J, Schauer PR. Training and credentialingfor the performance of laparoscopic bariatric surgery. Soc LaparoscopSurg Rep 2003;2:15–21.

[3] Watson DI, Baigric R, Jamieson FG. A learning curve for laparo-scopic fundoplication: definable, avoidable, or a waste of time? AnnSurg 1996;224:199–203.

[4] Chevallier JM, Zinzindohoue, F, Elian N, et al. Adjustable gastricbanding in a public university hospital: prospective analysis of 400patients. Obes Surg 2002;12:93–99.

[5] O’Brien PE, Brown A, Smith PJ, McMurrick PJ, Stephens M. Pro-spective study of a laparoscopically placed, adjustable gastric band inthe treatment of morbid obesity. Br J Surg 1999;85:113–18.

[6] Favretti F, Cadiere GB, Segato G, et al. Laparoscopic banding:selection and technique in 830 patients. Obes Surg 2002;12:385–90.

[7] Schauer P, Ikramuddin S, Hamad G, Gourash W. The learning curvefor laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc2003;17:212–5.

[8] Higa KD, Boone K, Ho T, Davies OG. Laparoscopic Roux-en-Ygastric bypass for morbid obesity: technique and preliminary resultsof our first 400 patients. Arch Surg 2000;135:1029–33.

[9] DeMaria EJ, Sugerman HJ, Kellum JM, Meador JG, Wolfe LG.Results of 281 consecutive total laparoscopic Roux-en-Y gastric by-passes to treat morbid obesity. Ann Surg 2002;235:640–5.

10] Witttrove AC, Clark G. Laparoscopic gastric bypass: a five-yearprospective study of 500 patients followed from 3 to 60 months. Obes

Surg 1999;19:123–43.

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67ASBS Bariatric Training Committee / Surgery for Obesity and Related Diseases 2 (2006) 65–67

11] Oliak D, Ballantyne P, Weber P, Wasielewski A, Davies RJ, SchmidtHJ. Laparoscopic Roux-en-Y gastric bypass: defining the learningcurve. Surg Endosc 2003;17:405–8.

12] Park A, Witzke D, Donnelly M. Ongoing deficits in residents trainingfor minimally invasive surgery. J Gastrointest Surg 2002;6:L501–7.

13] Wolfe BM, Szabo Z, Morgan ME, Chan P, Hunter JG. Training forminimally invasive surgery: need for surgical skills. Surg Endosc1993;7:93–5.

14] Rossser JC; Rosser L, Savalgi RS. Skill acquisition and assessmentfor laparoscopic surgery. Arch Surg 1997;132:200–4.

15] Rosser JC, Rosser L, Savalgi RS. Objective evaluation of a laparo-scopic surgical skill program for residents and senior surgeons. ArchSurg 1998;133:657–61.

16] Mori T, Hatano N, Maruyama S, et al. Significance of “hands-on”

training in laparoscopic surgery. Surg Endosc 1998;12:256–60.

17] Joint Commission on Accreditation of Healthcare Organizations. The1995 Joint Commission Accreditation Manual for Hospitals. Oak-brook Terrace, IL: author; 1994.

18] Dent T. Training and privileging for new procedures. Surg Clin NorthAm 1996;76:615–21.

19] American Society for Bariatric Surgery, Society for American Gastro-intestinal Endoscopic Surgeons. Guidelines for laparoscopic and opensurgical treatment of morbid obesity. Obes Surg 2000;10:378–9.

20] American College of Surgeons. Recommendations for facilities per-forming bariatric surgery. Bull Am Coll Surg 2000;85:20–3.

21] Society for Laparoscopic Surgeons. Training and fellowship opportuni-ties. Available at: http://www.sls.org/services/fellowship.html#gen.

22] Society of American Gastrointestinal Endoscopic Surgeons. Avail-able fellowships in surgical endoscopy and laparoscopy. Available at:

http://www.sages.org/fellowships/index.php.