Bariatric Training and Education
Hallein Clinic, Austria
Karl Miller, MD, FACS
Obesity surgery is not only a craft but it also signifies consideration of the disease asa whole. An Operation Primer undertakes the task of communicating
basic surgical techniques. Only someone who knows all the technical possibilities andprocedures is in a position to react flexibly and adequately in different situations.
About 50 different surgical methods have been developed in obesity surgery in the past 50years. It is obvious from this that the optimal surgical method for the obese patient does
not exist. Experience has shown that peri- and postoperative complications can be reducedwith with simplified working steps. An Operation Primer is an ideal format forcommunicating new operative methods but it does not replace training by an experienced
surgeon. A surgeon cannot rest on his laurels but must always keep up with the latest
techniques. I would therefore like to take this opportunity to thank the Industry formaking Mental Training, training on the computer simulator and operations in thelaboratory possible. First-class surgery is possible only through careful acquisition ofknowledge, regular training and quality control. Additional mental training is aneffective way of optimizing the outcomes of further training for laparoscopic procedures.
It is associated with fewer costs and with better outcomes in some crucial assessment
scales than additional practical training.

Bariatric Surgery clinical fellowship in the USA

Seiichi Kitahama, MD
Minimally Invasive Surgery Fellow
Michael E. DeBakey Department of Surgery
Baylor College of Medicine, Houston, TX

Bariatric surgery has been gaining popularity worldwide.? It is still
not easy to master the comprehensive perioperative bariatric patientcare and advanced laparoscopic skills including intracorporeal hand-sewn
anastomosis.

Currently there are 62 bariatric surgery fellowship training programs in
the USA according to the Fellowship Council ([a:http://www.
fellowshipcouncil.org/]http://www.fellowshipcouncil.org).? The
organization monitors individual fellowship training and regulates thematching process to ensure high volume and high quality training. ?

I completed one year clinical laparoscopic bariatric surgery fellowship,
predominantly LRYGB and LAGB, with some LSG at Legacy Good Samaritan
Hospital in Portland, Oregon.? Subsequently I am undergoing anotherclinical MIS/bariatric surgery fellowship predominantly LRYGB and LSG,
with some LAGB at Baylor College of Medicine in Houston, Texas. ?Bothhospitals are accredited as Bariatric Surgery Center of Excellence by
Surgical Review Corporation.

I would like to share my experience with 7 bariatric surgeons anddiscuss the way to organize a bariatric training program.

Bariatric Fellowship in Australia
Dr Benjamin Woolven
St George Private Hospital
General Surgical Training in Australia requires a six year undergraduate or 4 year post
graduate medical degree and two years of post graduate experience before commencement.
General surgical training is undertaken over a minimum of 5 years and requires successful
completion of a two part clinical examination. Further post fellowship training is at thediscretion of the individual surgeon though non compulsory two year programs in uppergastrointestinal, colorectal and hepatobiliary surgery have been established. There is nocentrally administered training program in bariatric surgery though a number of individual
institutions offer one year fellowship programmes.
The authors experience is of a one year programme undertaken at St George Private Hospitalin Sydney in Upper Gastrointestinal and Bariatric Surgery. During the fellowship there
were 275 bariatric operations including 52 laparoscopic adjustable bands, 158 laparoscopic
sleeve gastrectomies, 29 laparoscopic gastric bypasses and 61 revisional operations. There
were 433 non bariatric operations. International candidates from Singapore, New Zealandand the United Kingdom have previously completed the programme. Future international
candidates are welcome to apply for the St George Fellowship program and other bariatrictraining programmes throughout Australia.

Bariatric Fellowship Training in a Center of Excellence, Taiwan Experience

1

Bariatric & Metabolic International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan.

2

Department of General Surgery, E-Da Hospital, Kaohsiung, Taiwan.

3

Department of Chemical Engineering, Institute of Biotechnology and ChemicalEngineering, I-Shou University, Kaohsiung, Taiwan.
Chi-Hsien Lo1, Chih-Kun Huang1,2,3

Background: Bariatric surgery has gained more popularity in Asia-Pacific area. But, themultiple co-morbidities of morbid obesity and steep learning curve make comprehensivetraining program to be looked-for in recent years. Hereby, we present the fellowshiptraining program in a unique International Bariatric Surgery Center of Excellence(BSCOE) in Taiwan.
Methods: From July 2009 to July 2010, fellowship training process, learning curve,
patients demographic data, operation time and surgical complications were all collectedfrom different stages of the learning. According to the bariatric training protocol ofthe institution, data was analyzed and compared.
Results: In this one-year period, totally 346 laparoscopic bariatric operations wereperformed in the BMI Surgery Center, E-Da Hospital. As a primary surgeon, the fellowshipperformed 169 bariatric cases independently after 43 assistance. Different type of
bariatric surgeries were performed, as gastric banding with or without gastric plication,
sleeve gastrectomy and Roux-en-Y gastric bypass. There were only 5 surgicalcomplications (3.55%). There was no mortality. In this journey, we reviewed different
stages of the fellowship training, as being from a mere assistant, progressed to primary
surgeon, and then supervisor.
Conclusion: Low complication rates came from excellent supervised bariatric training
program and we proposed a bariatric surgery training guideline in Asia-pacific area.