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June 29, 2016

Obesity surgery abroad leads to follow-up care problems

Niamh Mullen speaks to Cork-based obesity consultant Mr Colm O’Boyle about the developing specialty of laparoscopic bariatric surgery

Up to 60,000 Irish people could now be eligible for obesity surgery. Consultant laparoscopic and bariatric surgeon at the Bon Secours Hospital in Cork, Mr Colm O’Boyle, said between one and two per cent of the UK population was morbidly obese.
If the Irish figure was the about the same, it means up to two per cent of Ireland’s adult population of approximately three million – that is 60,000 — could be a candidate, he estimated.
According to the SLÁN 2007 report, around 38 per cent of Irish adults were overweight, while 23 per cent were obese. Also worrying is the fact that one in four boys (23 per cent) and more than one in four girls (28 per cent) are either overweight or obese, according to figures in the Health Status of the Population of Ireland report 2008.
Mr O’Boyle said people were often not aware of bariatric surgeons operating in reputable hospitals in Ireland. As a result, some patients opted to attend a cosmetic surgery clinic. He warned he has had to correct a number of procedures carried out at such clinics.
“There are misconceptions about bariatric surgery. The public thinks fat people should be able to stop eating and therefore should not require surgery. However, eating is an addiction they can’t overcome and all of them have tried everything before they come to me.”
He pointed out that obesity was the second leading cause of death in the US, after tobacco use. Furthermore, obesity-related diseases cost $147 billion a year, or 10 per cent of all medical spending. “Economically, bariatric surgery makes huge sense. The only thing left to cure these people is surgery and within two-to-four years of doing it, the costs are recouped and this saving is recurring over the patients’ lifetimes,” he said.
This is because gastric bypass surgery can cure or significantly improve diabetes in at least 60 per cent of patients and up to 90 per cent. It can also improve high blood-pressure, arthritis and other common conditions in obese people, such as sleep apnoea. There is also published evidence that cancer risk is considerably reduced in morbidly obese patients who have surgery.
In the UK, there were only about six laparoscopic bariatric surgeons working in 1998 but that figure has soared to around 150, said Mr O’Boyle. He believes Ireland needs to train more bariatric surgeons to prepare for the future.
“In this country, we need to train surgeons. It’s a big area that needs to be addressed. Junior doctors aren’t being switched on to it. I don’t even know if anyone is training in it in Ireland,” he said.
Mr O’Boyle said he attempted to set up a group for the bariatric surgeons working in Ireland but said there were just not enough of them. He said Ireland also needs an obesity society f0r patients.
If we did not have enough surgeons, others would come from abroad and take patients elsewhere for the operation. That could lead to problems with follow-up care and Irish surgeons could be left to pick up the pieces, he said. “Surgeons are flying into Ireland, seeing patients in temporary clinics and persuading them to fly abroad for surgery. This is leading to problems with follow-up care. I’ve seen more than five patients operated on abroad [band and bypass] with problems. This will be on the increase if we cannot provide the service here ourselves.”
Mr O’Boyle worked in the Castle Hill Hospital in Hull in the UK as a bariatric surgeon from 1998. He started work at the Bon Secours in Cork in January 2008 and did his first bariatric surgical procedure there in June 2008.
So far he has done 36, including four sleeve gastrectomies, 31 gastric by-passes and one intragastric balloon. The hospital also offers gastric banding. Mr O’Boyle informs patients of other options i.e. duodenal switch, biliopancreatic diversion and intragastric balloon. All patients are seen by a multidisciplinary team. After surgery, Mr O’Boyle continues to see his patients for life.
Gastric banding
It costs E15,000 for a gastric band, E12,000 for a sleeve gastrectomy and E10,000 for gastric banding. The prices include follow-up during the first year. Mr O’Boyle added it was important that patients knew Irish insurance companies were covering part or all of the cost of the surgery subject to conditions.
The sleeve gastrectomy is often followed by a gastric bypass or duodenal switch once the patient has lost weight. However, Mr O’Boyle said it was becoming increasingly popular in Europe as one operation on those with lower BMIs (but with a BMI of over 35).
Data emerging from Europe also indicates bariatric surgery could cure or reduce the severity of diabetes in patients who were not obese, he added.