Bariatric Surgeon vs the General Surgeon

I was in my office the other day when a patient arrived for a consultation for a laparoscopic ventral hernia repair.  She reported that having had a gastric bypass in the past, she went to another local bariatric surgeon for a hernia repair.  She was informed that “HE was a bariatric surgeon, and HE would refer her to the local referral center for an appropriate general surgeon.”  News flash, ALL bariatric surgeons are General Surgeons first and foremost. Bariatric surgeons go through a standard general surgery residency that lasts 5 – 6 years, some learn bariatric surgery as a preference on their own post-residency, and some go to a specialized fellowship program to learn bariatrics from an established bariatric program. I am a bit of an exception because I was performing bariatrics before bariatric fellowships were even offered. Regardless, any bariatric surgeon should be able to fix a ventral hernia.

I believe that if a prior bariatric patient presents with a general surgery problem, even as common as an appendectomy, a cholecystectomy, or a ventral hernia, they are best treated by a bariatric surgeon. It gives that surgeon an opportunity to survey the prior bariatric procedure. Adhesions, scar tissue, internal hernias through gaps of omentum or mesentary should be searched for and repaired if found in all prior bariatric patients. Who better to survey the abdomen than a surgeon that performs the operation on a regular basis and knows what and where to look. The above patient represented a missed opportunity for that surgeon in question to prevent a potentially catastrophic complication that can easily occur and possibly be missed by a “general surgeon.”  Some doctors like to place themselves in specialized categories. It may be prestige, ego, or  limit one's practice. Experience, compassion, knowledge, and results separate those who are successful.