Irish patients who experience complications following bariatric surgery aboard are continuing to present in significant numbers to local services, heard delegates at the Irish Society of Gastroenterology (ISG) Winter Meeting 2023.
Since the onset of the Covid-19 pandemic, there has been a “concerning increase” in patients presenting with complications following these surgeries abroad, stated Prof Helen Heneghan, Professor of Surgery at University College Dublin and Consultant Bariatric and General Surgeon at St Vincent’s University Hospital, Dublin.
These presentations are placing additional pressure on already overburdened services. There is now an average of two such patients presenting weekly to St Vincent’s alone, representing an almost three-fold increase since the onset of the pandemic, Prof Heneghan told the ISG meeting.
These patients, the majority of whom are female, will often be experiencing severe pain and infection and will need investigation and treatment, as well as revision surgery in many cases.
Some of the patients may also have had gastric balloon procedures (no longer commonly performed in Ireland), which they are unhappy with and want removed.
They can have this situation addressed in the public system in Ireland if they present with pain that requires investigation as a possible emergency.
The risks associated with accessing bariatric surgery abroad can be substantial. Prof Heneghan explained that scheduled bariatric surgery is a multidisciplinary team effort, requiring considerable pre- and post-operative support, including psychology, dietetics, and regular medical follow-up. None of this is generally available with bariatric surgery carried out aboard and many of these patients would not be considered suitable candidates for bariatric surgery in Ireland.
Some Irish people have died following bariatric surgery abroad. There is no centralised register to record such deaths or serious complications, but there have been increased media reports in the past two years.
Prof Heneghan said she and other colleagues continue to engage with the health authorities to try to address the issue and inform patients about the risks of accessing bariatric surgery abroad. The RCSI has also published information and guidance for patients considering surgery abroad.
Prof Heneghan delivered the ISG Winter Meeting’s opening address, ‘Home and away – the bariatric surgery episode’. She outlined the many health benefits of bariatric surgery for patients who require it. Prof Heneghan said it remains the most effective treatment for severe obesity, with patients losing between 25-to-30 per cent of their pre-operative weight and seeing many associated improvements in co-morbid conditions.
Bariatric surgery techniques have advanced in recent years and a minimally invasive approach is now used (usually gastric bypass or sleeve gastrectomy) with an average length-of-stay of one-to-two days. The procedure (in carefully selected and prepared patients) also has low complication rates with a 30-day mortality rate of around 0.8 per cent.
Prof Heneghan acknowledged the long public waiting lists and rising demand for bariatric surgery in Ireland. Currently, it can take four-to-five years to be assessed, with over 5,000 people on the waiting list. However, significant efforts are being made to increase capacity.
She outlined the continuing development of bariatric services in Ireland, with an increase in surgeries performed in 2023 (approximately 200 bariatric surgeries took place in St Vincent’s and 50 in Galway). A new bariatric surgery service is due to come on stream in Cork and the goal is to have capacity for 1,200 cases annually by 2025, with 400 surgeries in each of the three centres.
This should enable a significant reduction in waiting times for patients, Prof Heneghan told the meeting.
The ISG Winter Meeting 2023 took place in the Killashee Hotel, Naas, Co Kildare, on 7-8 December. See the 19 December issue of the Medical Independent for full coverage or go to www.medicalindependent.ie/societies/isg/
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