Background: The American Society for Metabolic and Bariatric Surgery (ASMBS) Fellowship Certificate was created to ensure satisfactory training and requires a minimum number of anastomotic cases. With laparoscopic sleeve gastrectomy becoming the most common bariatric procedure in the United States, this may present a challenge for fellows to obtain adequate numbers for ASMBS certification. Objectives: To investigate bariatric fellowship trends from 2012 to 2019, the types, numbers, and approaches of surgical procedures performed by fellows were examined. Setting: Academic training centers in the United States. Methods: Data were obtained from Fellowship Council records of all cases performed by fellows in ASMBS-accredited bariatric surgery training programs between 2012 and 2019. A retrospective analysis using standard descriptive statistical methods was performed to investigate trends in total case volume and cases per fellow for common bariatric procedures. Results: From 2012 to 2019, sleeve gastrectomy cases performed by all Fellowship Council fellows nearly doubled from 6,514 to 12,398, compared with a slight increase for gastric bypass, from 8,486 to 9,204. Looking specifically at bariatric fellowships, the mean number of gastric bypass cases per fellow dropped over time, from 91.1 cases (SD = 46.8) in 2012-2013 to 52.6 (SD = 62.1) in 2018-2019. Mean sleeve gastrectomy cases per fellow increased from 54.7 (SD = 31.5) in 2012-2013 to a peak of 98.6 (SD = 64.3) in 2015-2016. Robotic gastric bypasses also increased from 4% of all cases performed in 2012-2013 to 13.3% in 2018-2019. Conclusions: Bariatric fellowship training has seen a decrease in gastric bypasses, an increase in sleeve gastrectomies, and an increase in robotic surgery completed by each fellow from 2012 to 2019. (c) 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Laparoscopic sleeve gastrectomy (LSG) has become the most common bariatric procedure due to the technical ease and weight loss success of the operation. However, there has been concern that LSG contributes to gastroesophageal reflux disease (GERD) postoperatively with a proportion of patients requiring conversion to a Roux-En-Y Gastric Bypass (RYGB). The objective of this study was to characterize the patients who underwent revision in our hospital system and to better understand pre-operative predictors of GERD and revision. After IRB approval, a retrospective review was conducted assessing for patients who had conversion of LSG to RYGB at three hospitals within the University of Pennsylvania Health System from January 2015 to December 2021. The patients’ charts were then reviewed to evaluate for demographics, BMI, operative findings, imaging and endoscopic reports, and post-operative outcomes. 97 patients were identified who underwent conversion of LSG to RYGB between January 2015 and December 2021. The cohort was predominantly female (n = 89, 91.7

Alexandra Strauss: NO financial relationship with a commercial interest | Jenny Shao: YES financial relationship with a commercial interest;Vicarious Surgical:Consulting;Intuitive Foundation:Grant/Research Support | Francis Rosato: NO financial relationship with a commercial interest | Kristoffel Dumon: NO financial relationship with a commercial interest | Noel Williams: No Answer. | David Wernsing: YES financial relationship with a commercial interest;Baxter:Speaking and Teaching;Medtronic:Speaking and Teaching | Matt Kirkland: NO financial relationship with a commercial interest | Kristle Lynch: YES financial relationship with a commercial interest;Medtronic:Speaking and Teaching;Lucid:Advisory Committees or Review Panels;Takeda:Advisory Committees or Review Panels | Gary Falk: NO financial relationship with a commercial interest | Gregory Ginsberg: No Answer. | Daniel Dempsey: No Answer. | Joseph Triggs: No Answer.

Sleeve Gastrectomy is currently the most commonly performed bariatric surgical procedure in the US. Enhanced Recovery after Surgery (ERAS) Pathways have been successfully used in colorectal surgery with improved overall outcomes. ASMBS released a sleeve specific enhanced recovery pathway (ENERGY) for limited participation.

Bariatric surgery is the most effective and durable treatment for morbid obesity, however co-morbidities associated with severe obesity are also associated with increased surgical risk. Multidisciplinary committees (MC) to determine candidacy and develop care plans are common practice for other areas of surgery, but the only published data on MC and bariatric surgery candidates with high-risk psychiatric profiles found as few as 11.2% of those presented undergo surgery1. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) center accreditation requires regular reactive committee review of adverse events and subsequent quality improvement but not proactive review of high risk candidates. The use and collateral implications of a proactive MC in a collaborative specialty such as bariatric surgery are not well understood.