Joon K Shim MAJ, MD, MPH, FACS, Ryan K Lehmann MAJ, DO, FACS. Blanchfield Army Community Hospital
Objectives: The Department of Defense healthcare systems offer comprehensive surgical weight loss program for all Tricare eligible dependents of active duty service members as well as military retirees and their spouses. As the incidence of obesity in the United States continue to rise, and more patients are undergoing bariatric surgical procedures, this presents a unique challenge to our military system. In this study, we aim to report a 33 month experience of two bariatric surgeons at a small army community hospital.
Methods: 135 morbidly obese patients underwent laparoscopic roux-en-y gastric bypass (LGB), laparoscopic sleeve gastrectomy (LSG), adjustable LAP-BAND (LAGB) placement or conversion from LAGB from Jan 2012 – Sept 2014 at our small army hospital. The percent excess body mass index loss (%EBMIL), a value for expressing weight loss outcomes in bariatric surgery, was assessed at 5 follow-up times.
Results: Mean age was 36 years (SD = 9.41, range = 19 – 62 years) and mean initial BMI was 42.83 kg/m2 (SD = 4.97, range = 32 – 56). A total of 36 patients underwent LSG, 83 underwent LGB, 7 underwent LAGB, and 9 underwent conversion from LAGB to a different procedure. There were no deaths, no leaks, and 2 patients out of 135 required return to the OR in the first 30 days. Scheduled follow up was performed at 3 months, 6 months, 9 months, 12 months, and 18 months, with mean %EBMIL of 49.76, 69.65, 80.43, 85.85, 86.16, respectively for all procedures.
Conclusion: There are barriers to providing high quality bariatric care by military bariatric surgeons. Military bariatric surgeons have frequent deployments, performing trauma surgery rather than laparoscopic surgery for extended periods of time. Long-term follow up can be difficult due to frequent patient relocation. Two surgeons in a small army community hospital were able to overcome obstacles and provide bariatric care to morbidly obese patients with emphasis on quality outcomes and patient safety. Careful patient selection, appropriate determination, and close monitoring for complications were all important contributors to positive patient outcomes.