Buondonno Antonio, Avella Pasquale, Cappuccio Micaela, Scacchi Andrea, Vaschetti Roberto, Di Marzo Giancarlo, Maida Pietro, Luciani Claudio, Amato Bruno, Brunese Maria Chiara, Esposito Daniela, Selvaggi Lucio, Guerra Germano, Rocca Aldo
General Surgery Unit, A. Cardarelli Hospital, Campobasso, Italy.
Department of Medicine and Health Science, University of Molise, Campobasso, Italy.
Front Surg. 2022 Mar 24;9:855527. doi: 10.3389/fsurg.2022.855527. eCollection 2022.
Metabolic and bariatric surgery (BS) are considered life-changing and life-saving treatments for obese patients. The Italian Society of Obesity Surgery (SICOB) requires at least 25 operations per year to achieve the standard of care in the field. Despite the increasing need to treat obese patients, some small southern regions of Italy, such as Molise, do not have enough experience in bariatric procedures to be allowed to perform them. Therefore, our aim was to run a Hub and Spoke Program with a referral center in BS to treat obese patients and provide a proper learning curve in BS in Molise.
In 2020, the "A. Cardarelli Hospital" in Campobasso, Molise, started a formal "Learning Model of Hub and Spoke Collaboration" with the Hub center "Ospedale Del Mare", Naples. A multidisciplinary approach was achieved. Patients were supervised and operated under the supervision and tutoring of the referral center. We retrospectively reviewed our prospectively collected database from February 2020 to August 2021 in order to analyze the safety and effectiveness of our learning program.
In total, 13 (3 men and 10 women) patients underwent BS with the mean age of 47.08 years and a presurgery BMI of 41.79. Seven (53.84%) patients were the American Society of Anesthesiologist (ASA) II, and 6 (46.16%) patients were ASA III. Twelve (92.31%) procedures were laparoscopic sleeve gastrectomies, 1 (7.69%) patient underwent endoscopic BioEnterics Intragastric Balloon (BIB) placement. One (8.33%) sleeve gastrectomy was associated to gastric band removal. Mean surgical time was 110.14 ± 23.54 min. The mean length of stay was 4.07 ± 2.40 days. No Clavien-Dindo ≥ III and mortality were reported. The follow-up program showed a mean decrease of 11.82 in terms of body mass index (BMI) value. The last 5 procedures were performed by the whole equips from "A. Cardarelli" under external tutoring without any impact on complication rate.
The setup of a proper Hub and Spoke Program may allow to perform BS to provide the standard of care. This approach may reduce health costs and related patient migration.
代谢与减重手术（BS）被认为是肥胖患者改变生活和挽救生命的治疗方法。意大利肥胖外科学会（SICOB）要求每年至少进行25例手术才能达到该领域的护理标准。尽管治疗肥胖患者的需求不断增加，但意大利南部的一些小地区，如莫利塞，在减重手术方面没有足够的经验来开展此类手术。因此，我们的目标是开展一个“中心-辐条”项目，在一个减重手术转诊中心治疗肥胖患者，并在莫利塞提供适当的减重手术学习曲线。
2020年，莫利塞坎波巴索的“卡达雷利医院”与那不勒斯的“德尔马医院”中心启动了正式的“中心-辐条合作学习模式”。实现了多学科方法。患者在转诊中心的监督和指导下接受监督和手术。我们回顾性分析了2020年2月至2021年8月前瞻性收集的数据库，以分析我们学习项目的安全性和有效性。
共有13例（3例男性和10例女性）患者接受了减重手术，平均年龄为47.08岁，术前体重指数为41.79。7例（53.84%）患者为美国麻醉医师协会（ASA）II级，6例（46.16%）患者为ASA III级。12例（92.31%）手术为腹腔镜袖状胃切除术，1例（7.69%）患者接受了内镜下BioEnterics胃内气球（BIB）置入术。1例（8.33%）袖状胃切除术与胃束带取出术相关。平均手术时间为110.
