IFSO Statement: Credentials for Bariatric Surgeons 2015 - Springer Link

OBES SURG (2015) 25:394–396 DOI 10.1007/s11695-014-1553-y

IFSO Statement: Credentials for Bariatric Surgeons 2015

Published online: 27 January 2015 # Springer Science+Business Media New York 2015

Maurizio De Luca, Jacques Himpens, Rudolf Weiner, Luigi Angrisani These guidelines have been written by a working group formed by members of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) and have been discussed and approved by the Executive Board of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Maurizio De Luca, Department of General Surgery Montebelluna Treviso Hospital - Italy Jacques Himpens, Université Libre de Bruxelles, The European School of Laparoscopic Surgery, Brussels, Belgium Rudolf Weiner, Sana Klinikum Offenbach GmbH Starkenburgring- Offenbach am Main, Germany Luigi Angrisani, General and Endoscopic Surgery Unit, San Giovanni Bosco Hospital, Naples, Italy The purpose of the 2015 IFSO Statement is to identify minimal requirements for surgeons to obtain credentials from their local institutions and Medical Directors to perform bariatric and metabolic surgery. IFSO acknowledges the special circumstances existing in different nations worldwide, and consequently recommends the following “minimal requirements” for General Surgeons to perform Bariatric and Metabolic Surgery. The IFSO statement should be read in conjunction with local national or regional guidelines, where they exist, and should not be seen to replace such documents; consequently, national societies’ executive boards can adapt these criteria according to their specific local needs and resources. We wish to thank the members of the Executive Board, the Board of Trustees and the members of the Committees of IFSO for their valuable contribution to this important document.

History In 1997, IFSO issued the Statement on Bariatric Surgery Qualifications [1] with the intent of guiding surgeons

interested in bariatric surgery to understand minimal requirements considered acceptable from the international community of bariatric surgeons. In an effort to improve the quality of care offered to bariatric patients worldwide, in 2007 the IFSO Council approved a document, which identified an international board that advised and endorsed national and regional Centers of Excellence (COE) programs. The main purpose was to create guidelines to be applied to different global areas and to define surgeons’ credentials and institutional requirements for safe and efficient management of morbidly obese patients. The implementation of the guidelines, and their evolution to Centers of Excellence programs in different countries, was the responsibility of the IFSO Accreditation Council in collaboration with IFSO regional chapters or national societies. The 2007 document stated the institutional requirements in order to prepare new centers of bariatric surgery (Primary Bariatric Institutions, PBIs); to improve both the quality and the performance of existing bariatric institutions (BIs), and to upgrade some bariatric centers to the level of excellence (Center of Excellence Bariatric Institution, COEBI), thus optimizing patient outcomes. In the same document, IFSO Council defined surgeons’ credentials related to different types of Bariatric Centers - PBIs, BIs or COEBI [2]. Before 2012, with the implicit goal of ensuring that surgeons have met minimum criteria to safely perform bariatric surgery, three national surgery associations (American Society for Metabolic and Bariatric Surgery (ASMBS), American College of Surgeons (ACS) and the Society for American Gastrointestinal and Endoscopic Surgeons (SAGES)) had independently created credentialing guidelines to guide hospitals and institutions in the credentialing process for bariatric surgery [3–5]. Under the leadership of the ASMBS, a joint Task Force with representation of the ACS, SAGES, Michigan Bariatric Surgery Collaborative (MBSC) and the Society for Surgery of the Alimentary Tract (SSAT), created and approved the general Recommendations for Credentialing of Bariatric

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Surgeons [6]. In addition, in 2012, the ASMBS and the ACS unified all of their accredited programs into a new Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) and the recommendations for credentialing of bariatric surgeons approved by the joint Task Force were adopted as part of the required standards for the MBSAQIP [7].

Updated IFSO Statement The 2015 IFSO Statement for bariatric surgeons include the following minimal standards: I) Requirements to become a bariatric surgeon a) A bariatric surgeon must be fully accredited, i.e., have completed an accredited General Surgery or Gastrointestinal Surgery Residency. b) IFSO strongly encourages bariatric surgery certification to be granted by one of IFSO adhering national bariatric societies c) For bariatric fellowship trained surgeons: the fellowship must comprise all aspects of bariatric surgery including patient education, support group participation, experience with different surgical techniques, post- operative follow-up, monitoring of outcomes, diagnosis and treatment of complications such as leaks, bleeding and intestinal obstruction; regular exposure to endoscopy and interventional radiology should be available. IFSO acknowledges the variations in practices throughout the world, hence can only provide general guidelines that may not be suitable for all countries. Here again IFSO encourages certification to be granted by the regional/national IFSO adhering societies. Taking into account the aforementioned limitations, in terms of numbers of procedures, a fellow may be assumed to have experience in bariatric surgical techniques when capable to provide evidence that he/she has participated in 100 weight loss operations, a majority of which were performed with the fellow as leading surgeon. Along the same lines, the fellow should provide evidence of having performed as leading surgeon different types of weight loss operations, including bypass and restrictive procedures, as well as revisional procedures performed for weight loss issues and for severe complications such as internal hernia, intussusception and anastomotic ulcer. d) For non-fellowship trained surgeons, documented training in an approved Bariatric Center is mandatory. An approved Bariatric Center is a COEBI IFSO Center [2], an IFSO Adhering National Bariatric

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Society’s Center or a Bariatric Center able to certify 200 yearly bariatric surgical procedures of different types including bypass and restrictive operations, and 5 or more years experience in the field of bariatric surgery. The bariatric surgeon in charge of resident and fellow training must ascertain that the surgeontrainee has demonstrated sufficient experience with advanced laparoscopic procedures, see e), before initiation of the bariatric training program. e) IFSO considers laparoscopic bariatric operations as advanced laparoscopic procedures that require comparable skills as for laparoscopic hiatal hernia repair, laparoscopic gastrointestinal resection/anastomosis and laparoscopic splenectomy, providing evidence of at least 100 total cases, with at least 25 cases over the previous year. The surgeon must have acquired experience as leading surgeon in non-bariatric advanced laparoscopic procedures before engaging into laparoscopic bariatric operations f) The qualification of bariatric surgeon implies that the surgeon can demonstrate ability to perform different bariatric surgical procedures, with at least one that involves gastrointestinal stapling or suturing. II) Instructions for good bariatric practice a) The bariatric surgeon should be involved in a structured interdisciplinary bariatric program. b) Early re-operative bariatric operations should be performed by a fully credentialed bariatric surgeon. c) The bariatric surgeon should have a baseline knowledge in the science of the obesity disease and in bariatric surgery by attending bariatric meetings and conventions and by regularly reading up in specialized journals such as Obesity Surgery and/or Surgery for Obesity And Related Diseases. The bariatric surgeon should minimally collect 15 CME accrediting hours per year. d) The bariatric surgeon should engage in obtaining institutional support for data management, personnel, equipment, facilities and support systems that are adequate for the comfort, safety and dignity of bariatric patients. e) The bariatric surgeon should keep digital patient records and feed all data into a database organized by a local/national IFSO linked bariatric organization. Comparing patient outcomes to local/national data should allow the bariatric surgeon to critically evaluate his/her own clinical performance hence to improve patient care f) The bariatric surgeon should organize lifetime patient follow-up by ensuring continuity of the bariatric center i.e., by training junior surgeons and staff members. g) The local/national credentialing committee should verify every 3 years that the above mentioned criteria have been met.

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This IFSO Statement regarding Credentials for Bariatric Surgeons 2015 pertain to the following open and laparoscopic operations that are recognized as qualified procedures: 1. 2. 3. 4. 5.

Adjustable gastric banding Sleeve gastrectomy Gastric bypass Biliopancreatic diversion with or without duodenal switch Revisional surgery of previous bariatric procedures

References 1. Cowan GSM. The Cancun IFSO statement on bariatric surgeon qualifications. Obes Surg. 1998;8:86.

2. Melissas J. IFSO Guidelines for safety, quality, and excellence in bariatric surgery. Obes Surg. 2007;9:11. 3. American Society for Metabolic and Bariatric Surgery, Guidelines for granting privileges in Bariatric Surgery, October 2005. 4. American College of Surgeons Bariatric Surgery Center Network Program Manual, V 4.03-01-11. 5. Clements R, Saber A, Teixera J, et al. Guidelines for institutions granting bariatric privileges utilizing laparoscopic techniques. Society of American gastrointestinal and endoscopic surgeons guidelines committee. Surg Endosc. 2011;25:671–6. 6. Inabnet WB, Bour E, Carlin AM, et al. Joint task force recommendation for credentialng of bariatric surgeons. Surg Obes Relat Dis. 2013;9:595–7. 7. Resource for optimal care of the metabolic and bariatric surgery patient 2014. MBSAQIP. Accessed online: http://www.mbsaqip.org/wpcontent/uploads/2014/03/Resources-for-Optimal-Care-of-the-MBSPatient.pdf, p 17.