Bariatric surgery.

BACKGROUND: Bariatric surgery has increased in numbers, but the treatment of morbid obesity in Germany still needs improvement. The new interdisciplinary S3-guideline provides information on the appropriate indications, procedures, techniques, and follow-up care. METHODS: Systematic review of the literature, classification of the evidence, graded recommendations, and interdisciplinary consensus-building. RESULTS: Bariatric surgery is a component of the multimodal treatment of obesity, which consists of multidisciplinary evaluation and diagnosis, conservative and surgical treatments, and lifelong follow-up care. The current guideline extends the BMI-based spectrum of indications that was previously proposed (BMI greater than 40 kg/m(2), or greater than 35 kg/m(2)with secondary diseases) by eliminating age limits, as well as most of the contraindications. A prerequisite for surgery is that a structured, conservative weight-loss program has failed or is considered to be futile. Type 2 diabetes is now considered an independent indication under clinical study conditions for patients whose BMI is less than 35 kg/m(2) (metabolic surgery). The standard laparoscopic techniques are gastric banding, gastric bypass, sleeve gastrectomy, and biliopancreatic diversion. The choice of procedure is based on knowledge of the results, long-term effects, complications, and individual circumstances. Structured lifelong follow-up should be provided and should, in particular, prevent metabolic deficiencies. CONCLUSION: The guideline contains recommendations based on the scientific evidence and on a consensus of experts from multiple disciplines about the indications for bariatric surgery, the choice of procedure, techniques, and follow-up care. It should be broadly implemented to improve patient care in this field.

Four years of teaching principles in clinical trials--a continuous evaluation of the postgraduate workshop for surgical investigators at the study center of the German Surgical Society.

INTRODUCTION: Only a small part of the daily work in the field of surgery is based on high-level evidence. To improve the rate of evidence-based medicine (EBM) in surgery, more surgical, randomized controlled trials have been advocated. In addition, it has been recognized that educational issues that concern methods and techniques of clinical research are of similar importance. Therefore, a clinical investigator course focusing particularly on the issues of surgical trials was initiated in 2005. The structure of this course is demonstrated here as well as the results of its evaluation over the last 4 years. MATERIAL AND METHODS: All participants were invited to rate both the lecture and the teachers with the help of a standardized evaluation questionnaires (rating scale from 1 = excellent to 6 = insufficient). Lectures were evaluated via questions on content, comprehension, and learning effect. Teachers were evaluated in terms of rhetorical abilities, content, and presentation technique, respectively. Assessment of personal long-term learning effects was evaluated by an e-mail survey. RESULTS: Seventy-three participants were trained in a total of 4 courses. Participants in each course completed the evaluation questionnaires. In 2005, 20 of 21 (95.2%) participants completed the questionnaire; in 2006, 11 of 11 participants completed it (100%); in 2007, 19 of 22 (86.4%) participants completed it; and in 2008, 16 of 19 (84.2%) participants completed it. The overall evaluation of the course was graded 1.52 for content and 1.72 for clarity, and the learning effect was assessed at 1.60. The 16 lecturers came from different institutions involved in clinical research and evidence-based surgery. Besides classic lecturing, the current assembly of the course consists of 6 lectures designed as hands-on sessions. A survey (48.5% response rate) with a mean follow-up of 1.72 years (range, 6 months to 3 years) revealed that the enduring learning effect was rated 2.09, and 70.4% of former participants actually participated in randomized controlled trials. CONCLUSIONS: The development of a clinical investigator course tailored to the needs of surgeons provides hospitals with a key tool for promoting surgical interest in clinical trials.