Complications following treatment abroad

There has been a significant and concerning increase in presentations of bariatric surgery complications following surgery abroad, at St Vincent’s University Hospital in Dublin, the 2023 Irish Society of Gastroenterology Summer Meeting heard.

A prospective study calculating the estimated costs of caring for these patients was presented at the meeting. Some 30 patients (26 female and four male) presented with bariatric surgery-related complications over 34 months (from 2020) related to sleeve gastrectomy (n=22, 73 per cent), gastric bypass (n=2, 6.6 per cent), intragastric balloon placement (n=2, 6.6 per cent), and gastric band (n=1), with many needing revision surgery as well as treatment for infection and pain.

The most frequent surgery destination was Turkey (n=17, 56 per cent), among seven other countries (Malaysia, Brazil, Spain, Poland, Prague, Belgium, and UK).

A total of 24 patients required admission, with an average length-of-stay (LOS) of 18.6 days. A longer LOS was noted in patients with staple line leak, average 55.5 days. Nine patients underwent gastroscopy (30 per cent) with three patients requiring OVESCO clip (10 per cent) and four requiring oesophageal stent (13 per cent). Five patients required complex revisional surgery.

The cost of treatment data was available for 19 patients, costing the hospital a total of €356,545.

Services that provide this emergency care to patients should be adequately resourced, the study authors said, pointing out that at least six Irish patients have died in recent years following bariatric surgery abroad. While bariatric surgery is undoubtably cheaper and easier to access abroad, the risks can be substantial, the meeting heard. A lively discussion ensued about what could be done to address the issue, following the presentation of the study, with clinicians pointing out there are similar issues in other parts of the country, including Galway.

They expressed concern about patient safety as well as the extra burden being placed on Irish healthcare services to care for these patients.

Meanwhile, a separate study presented at the conference showed that resistance rates in Ireland have reached significant levels for all major classes of antibiotics used for the treatment of H. pylori. In recent years, H.pylori eradication has fallen, likely due to increasing antibiotic resistance. Speaking to the Medical Independent at the meeting, HSE/RCPI National Clinical Lead in Gastroenterology and Hepatology, Prof Colm O’Morain, confirmed the situation, and said that first-line clarithromycin triple therapy can no longer be recommended, so quadruple therapy (proton pump inhibitor, tetracycline, metronidazole and a bismuth salt) is now needed.