Chirurgie bariatrique à la Réunion, place du médecin généraliste : analyse de la prise en charge au centre hospitalier de Saint-Paul et du suivi sur deux ans postopératoires associée à une enquête auprès des médecins traitants

Abstract : The development of bariatric surgery (BS), recognized as effective in treating morbid obesity, requires a reflection on the general practitioner's role in the follow-up, considering the risk of late complications and of loss of sight, in particular on Reunion, where no study has yet been carried out. Objective: to study the role of the general practitioner in the care plan of a BS. Methods: this is a monocentric, retrospective study, including BS surgery patients in Saint-Paul, between 01/01/13 and 06/30/15. It describes the surgery results and the hospital follow-up over two years, together with a questionnaire survey among their referring physicians about their role in the follow-up. Results: out of 103 patients, there were 72% bypasses and 28% sleeves, with an average BMI loss of 29.6% after one year, 4.6 visits with the surgeon, 4.2 with the dietitian, and 2.1 with the endocrinologist over two years, and 43% lost from sight. Out of 38 questionnaires, the practitioners have been following 2.8 operated patients and saw them regularly (≤3 times / year for 55.2% of them). Being consulted prior to the decision to operate was necessary for 76%. Only 45% found the provided information satisfactory. For 76%, the follow-up was part of their role together with the surgical team, but only 61 % were satisfied with their current role. The rate of ignorance of the recommendations was 66%, and 58% did not feel trained enough. The practices were variable (95% weight control, 68% investigation into complications 76% into nutritional deficiencies, 63% therapeutic modifications, 37% test prescriptions and 68% vitamin supplementations). For 95%, they favor the creation of a protocol defining the respective roles and 82% a follow-up logbook. Conclusion: Reunion's general practitioners are actors in the follow-up of BS, but coordination improvement would allow to include them as real partners in care, by offering a follow-up adapted to the issues of the BS.
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Master Thesis
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Léa Guittard. Chirurgie bariatrique à la Réunion, place du médecin généraliste : analyse de la prise en charge au centre hospitalier de Saint-Paul et du suivi sur deux ans postopératoires associée à une enquête auprès des médecins traitants. Médecine humaine et pathologie. 2018. ⟨dumas-01972411⟩

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