Amount of public bariatric surgeries being carried out is ‘totally inadequate for demand’

Fewer than 100 bariatric surgeries are carried out in Irish public hospitals annually, when the number should be around 1,500 each year, one obesity surgery expert told the Irish Society of Gastroenterology (ISG) 2018 Annual Winter Meeting.

The ISG meeting, which took place in November, heard about the rise of obesity-related liver disease in Ireland, which is becoming a significant health issue, from a number of speakers.

Ireland is on track to become one of the most obese nations in the world if current trends continue, with approximately 39 per cent of Irish adults overweight and 18 per cent obese. This is leading to huge increases in diabetes, cancer and liver-related diseases (with non-alcoholic steatohepatitis becoming one of the leading indications for liver transplant), putting increased pressure on our health services, with inadequate awareness and dedicated resources to address obesity-related health issues, the meeting heard.

Bariatric surgery, including gastric banding or bypass, is only available publicly in Galway or Dublin, where the waiting lists are as long as four-to-five years, which is totally unacceptable, Mr Chris Collins, Consultant General and Upper GI Surgeon in Galway University Hospital, told the ISG meeting.

He said that the fewer than 100 surgeries a year being provided in the public system is nowhere near enough to meet growing demand. Given our current waiting lists and population size, Ireland should be carrying out 1,500 such surgeries a year in our public hospitals, but, according to Mr Collins, the capacity and beds to do this are not currently available.

However, following the work of the Taskforce on Obesity and the appointment of Prof Donal O’Shea to the role of HSE Obesity Lead, more dedicated funding for obesity services is due to be made available by the HSE next year.

This should lead to bariatric surgery being rolled-out in other regions, including Cork, Limerick and potentially Waterford, and an increase in the amount of operations being carried out to 150 next year, and up to 750 annually within the next five years, Mr Collins told the Medical Independent (MI).

During his presentation to the meeting, Mr Collins said that the current two preferred surgical choices in bariatric surgeries are sleeve gastrectomies, which remove part of the stomach, and the Roux-en-Y gastric bypass procedure, which involves creating a stomach pouch out of a small portion of the stomach and attaching it directly to the small intestine, bypassing a large part of the stomach and duodenum. “They both have benefits. The main benefit of the Roux-en-Y is for patients who have diabetes and they do better after surgery, and the main benefit of the sleeve gastrectomy from my point of view is, it is a shorter procedure with a lower complication rate… ” he told MI.

He added that the wide range of health risks of obesity are not discussed enough by clinicians, with many gastro complications, as well as sleep apnoea and fatty liver disease.

“When you look at the GI complications of obesity alone, they are quite significant; gastro-oesophageal reflux is significantly increased, the rate of oesophagitis is twice as common in obese patients. If you get Barrett’s oesophagus, you are two-and-a-half times more likely to develop oesophageal adenocarcinoma. Of course, these patients are then much more difficult to manage when it comes to considering surgery, as the risk of all their complications increase…

“These risks from obesity are carried into the stomach, with an increased risk of gastric cancer, and into the pancreas — you are more likely to get severe pancreatitis if you are obese… and into the colon. With every increase in BMI of five, your risk of colorectal cancer goes up by 18 per cent.”

Meanwhile, research presented at the meeting showed that alcoholic liver disease (ALD)-related hospital admissions in Ireland increased by 23 per cent over 10 years, while hepatocellular carcinoma (HCC)-related admissions increased by 300 per cent in the same period.

The full story on that research can be read on www.mindo.ie.