Obesity Fitness Expo 2017: Four decades of bariatric surgery in a community hospital of Spain- Aniceto Baltasar- Alcoy Hospital, Spain

Introduction: Bariatric surgical practice changes in the community setting may be under-reported. We present the developments in a Spanish bariatric surgical practice in the community setting of Alcoy from its origin in 1977 through the present. Method: Bariatric surgical techniques employed in a country community setting over the course of nearly four decades are reviewed retrospectively and qualitatively. Results: Surgeons and medical professionals from Alcoy, Spain were involved in the evolution of bariatric surgery patient management and surgical technique from 1977s through 2017. During the last 40 years, 1,475 patients were treated in our clinics. Spanish bariatric surgeons contributed to advances in gastric bypass in the 1970s, vertical banded gastroplasty in the 1980s, bilio-pancreatic diversion/duodenal switch in the 1990s and innovations associated with laparoscopy from the 1990s onward. Outcomes and approaches to prevention and treatment of bariatric surgical complications are reviewed from a community perspective. Contributions to the bariatric surgical nomenclature and weight-loss reporting are noted. Conclusion: The practice of bariatric surgery in the community setting must be updated continuously, as in any human and surgical endeavor. Medical professionals in community bariatric practices should contribute their experiences to the field through all avenues of scientific interaction and published papers. This is a review article on the surgical changes made in four decades in the practice of bariatric surgery in a community hospital in Spain. Morbid obesity is a pandemic disease that affects humans from all countries, races and continents. The cause is multifactorial and one of the most influential factors is the changes in the environment and lifestyle that support the consumption by humans of more calories than they use. When BS is used to treat obesity, stomach and small intestine disease, the digestive tract organs are healthy and are not the direct cause of the disease. The term, BS, comes from the Greek "baros", which means "weight" and "iatrein", which means "treatment"- the treatment of the general etiology of obesity by surgery. In order to influence the weight of a patient, a bariatric surgeon can operate on the stomach to reduce caloric intake (restriction), and or on the small intestine, to cause malabsorption of nutrients by shortening the length of intestine (without intestine) removal). In mixed media, restrictive and poorly absorbent components are combined. The term "Metabolic Surgery" (MS) represents an extension of the concept of BS to reflect its management of metabolic conditions, such as high cholesterol or diabetes. Setting: The county of Alcoy is located in the province of Alicante, in the south-east of Spain, near the Mediterranean Sea. The city's population is 60,000 and the county's population is 140,000. Alcoy has a state-of-the-art National Health Service (NHS) 300-bed facility, the Virgen de los Lirios District Hospital, which includes an intensive care unit and an operating room with three-dimensional laparoscopic facilities, computerized tomography and radio magnetic scanners, a blood bank, standard and interventional radiology, an explant transplant center and a smaller private facility, the San Jorge Clinic. All of the patients mentioned in the summary studies were treated by the same primary surgical staff. Over the past 4 decades, from our community practice setting, we have followed changes in BS practice around the world and participated in the evolution of the field. It has been extremely important and satisfying to continually share and discuss the evidence with our peers through the scientific literature and in person, in local national and international interactions and meetings. We believe that small institutions can provide high quality bariatric surgical care to patients and make important scientific contributions in the field.