LAUSR

The use of obesity and metabolic surgery is increasing worldwide, which means that our health-care systems are confronted with an increasing pool of patients requiring follow-up [1]. It is essential to provide followup after obesity and metabolic surgery, not only to detect surgical complications [2], but also because attendance at follow-up visits further increases weight loss in the long-term [3], improves comorbidities [4], and prevents nutritional complications [5]. For this reason, the provision of a structured follow-up by qualified staff is important today and will be even more so in the future. Follow-up is included in our daily work. As bariatric surgeons, we have an important relationship with our patients, and we are interested in the life-changing outcomes of our surgery. In some cases, we are confronted with poor patient compliance, and additional tools must be implemented to achieve a greater frequency of follow-up visits [6, 7]. The literature reports widely varying proportions of patients that are followed-up long-term, with between 25.5 and 74% attending 10 years post-surgery [8, 9]. Beyond doubt, the main problem in some countries, including Germany, is the absence of a structured follow-up program including qualified ambulant care and cost recovery from the health-care system. Since 2006, 58.664 bariatric surgeries have been performed in Germany, and in 2015, after only 10 years of performing this surgery, we had an exponential increase to 98.570 follow-up visits/year (Fig. 1). It is unrealistic for us surgeons to follow up 400 patients/day. Our bariatric centers will eventually collapse without a structured ambulant program and the assistance of skilled physicians. Other considerations are whether we perhaps need to question the time period of follow-up appointments, e.g., should we adapt the guidelines used for cancer surgery with B5-year survival^ being a breakpoint in surgical follow-up attendance? Can we take the responsibility of transferring our patients to the care of a general practitioner after 5 years when we are sure that the surgery was successful? * Sonja Chiappetta [email protected]