Justin D. T. Morgan

The Reporting of Gastric Band Slip and Related Complications; A Review of the Literature

Laparoscopic adjustable gastric banding is a safe and effective treatment for morbid obesity. Long-term complications include band slippage, gastric pouch dilatation and gastric erosion. Rates of band slippage reported in the literature range from less than 1% to over 20%. The aim of this review was to explore whether differences in the reporting of this complication contributed to the variability in this outcome measure. A full literature search was undertaken using EMBASE and MEDLINE search engines. Forty studies were selected for analysis based on inclusion and exclusion criteria. Each was scrutinised for outcome reporting methods and related fields. Accurate definitions for relevant terms were derived from the best available evidence. Considerable variations in device deployed, operative approach, band fixation technique, and outcome reporting mechanisms were seen between the studies. The explanation and definition of terms used within manuscripts were also seen to vary between studies. A consensus needs to be reached on how best to report complications such as gastric band slippage. We suggest which information should be included by authors to allow for accurate and reproducible reporting of such outcomes in the future.

Obesity Surgery Smartphone Apps: a Review

BackgroundThe purpose of this study are to review available smartphone applications (‘apps’) relating to weight loss surgery, and assess the level of medical professional involvement in their designMethodsSmartphone apps relating to weight loss surgery were identified by searching the three app stores: Apple’s App Store, Google Play (Android) and Blackberry AppWorld. A data search was undertaken using keywords and phrases relating to weight loss surgery. Apps designed for the non-surgical treatment of obesity were excluded.ResultsA total of 38 apps were identified (Google Play = 17, Apple App Store = 21, Blackberry World = 0). Ten of 38 apps were duplicated therefore 28 apps were reviewed. Mean app rating was 3.6/5 and mean app cost was £1.89. Twenty-six of 28 (92.9%) apps were designed for use by patients. Apps were categorised into the following categories: patient information (ten), patient support forums (six), patient record tools (six), weight loss clinic advertisements (four), a journal app (one) and a conference tool (one). Health professional involvement was evident in 12 of 28 (42.9%) apps.ConclusionsThis study has identified that the majority of available apps relating to weight loss surgery do not have health professional input. The establishment of a ‘quality stamp’ provided by an established bariatric surgical body could improve the confidence with which patients and clinicians use these new information sources. Weight loss surgery apps offer a unique opportunity to provide accurate and reliable patient information and their use as part of the informed consent process should be explored.

The Effects of Laparoscopic Adjustable Gastric Banding on Idiopathic Intracranial Hypertension

The purpose of this study was to determine whether laparoscopic adjustable gastric banding has a role in the treatment of idiopathic intracranial hypertension. This pilot study was undertaken in a single, tertiary referral centre. Data on all patients with idiopathic intracranial hypertension that have undergone laparoscopic adjustable gastric banding in our unit were collected from our prospectively maintained bariatric database. Additional information was obtained via telephone questionnaires and review of medical records. Four female patient with a mean age of 32xa0years (range 29–39xa0years) and mean pre-operative body mass index of 46.1xa0kg/m2 (range 38.2–54.0xa0kg/m2) underwent laparoscopic adjustable gastric banding between June 2006 and July 2009. At a mean follow-up of 19.8xa0months all four patients reported either total resolution of headache or significant improvement in headache, with a mean improvement in pain score of 76.3/100 (range 55–95) on a analogue pain score. Mean excess weight loss at follow-up was 64.1% (range 50.1–88.2%). There were no complications or mortality in this cohort. This study suggests that laparoscopic adjustable gastric banding represents an effective and safe treatment for idiopathic intracranial hypertension associated with morbid obesity. We have shown good results both in terms of symptom resolution and weight loss, whilst avoiding alimentary tract diversion procedures in these young female patients. A randomized, controlled trial can be justified on the basis of this initial pilot study.

An overview of the management of morbid obesity

Obesity is a modern-day epidemic with serious physical, psychological and economic implications for the patients. Tackling obesity is now a priority for most healthcare providers. Managing such patients can be complex, emotional, time consuming and often frustrating. Obesity surgery, in its various forms, has revolutionised this struggle. With appropriate selection of patients, adequate resources and a multidisciplinary team involvement, obesity can now effectively be “cured”. It is vital that those who deal with obese patients know how to access these services and understand the processes involved in the journey from initial assessment to postoperative follow-up. Obesity surgery has a major impact in reducing obesity-related comorbidities such as diabetes and hypertension and contributes to society by returning patients to work. Prevention must be at the heart of any strategy to manage obesity, but, for established cases, surgery is taking centre stage and will continue to flourish as new techniques and procedures are developed.

Is there a place for bariatric surgery in treating childhood obesity

#### Current NICE guidelines for surgery in adults and children Basic: adults and childrennn#### ChildrennnThe media has long been fascinated by the implications and newsworthiness of the current epidemic of childhood obesity in this country. The media response to the publication of the National Institute for Health and Clinical Excellence guidelines1 on obesity seemed to concentrate principally on the report’s directions regarding …

A survey of medical students to assess their exposure to and knowledge of renal transplantation

BackgroundWithin the field of renal transplantation there is a lack of qualified and trainee surgeons and a shortage of donated organs. Any steps to tackle these issues should, in part, be aimed at future doctors.MethodsA questionnaire was distributed to final year students at a single medical school in the UK to assess their exposure to and knowledge of renal transplantation.ResultsAlthough 46% of responding students had examined a transplant recipient, only 14% had ever witnessed the surgery. Worryingly, 9% of students believed that xenotransplantation commonly occurs in the UK and 35% were unable to name a single drug that a recipient may need to take.ConclusionsThis survey demonstrates a lack of exposure to, and knowledge of, the field of renal transplantation. Recommendations to address the problems with the recruitment of surgeons and donation of organs, by targeting medical students are made.

Shared Medical Appointments for Bariatric Surgery Follow-up: a Patient Satisfaction Questionnaire

BackgroundShared medical appointments (SMAs) are group clinics where practitioners see several patients, with common health needs, at once. There is a great financial strain on the National Health Service (NHS) to provide bariatric surgery. The aim of this study was to review patient satisfaction with the SMA that is the default means of following up patients after bariatric surgery at one particular NHS trust.MethodsA patient-validated questionnaire was designed and handed out at the end of the SMAs. Patients who attended an SMA earlier in 2011 were also retrospectively sent questionnaires via post.ResultsA total of 47 patients completed the questionnaire from seven different SMAs covering the period from January to July 2011. All patients underwent laparoscopic adjustable gastric banding. After attending an SMA, patients gave an overall mean satisfaction rating of 4.13u2009±u20090.163 (on a scale of 1 to 5, 1 = very poor and 5 = excellent) which represented an increase (pu2009<u20090.01) compared to preconceptions before the clinic (3.59u2009±u20090.175). A cost analysis estimated a yearly saving of £4,617 or 65.1% made by the SMAs compared to 1:1 appointments.ConclusionsThe bariatric surgery SMA demonstrates high levels of patient satisfaction and is cost-effective.

Ethnic Minorities Have Equal Access to Bariatric Surgery in the UK and Ireland

Under-representation of ethnic minority groups in bariatric surgery rates has been reported in the USA. Ethnic minorities form 7.9xa0% of the UK population, but comparable data on provision of bariatric surgery for these groups have not previously been reported in the UK. We calculated an estimate of rates of bariatric surgery amongst ethnic groups in the UK and Ireland using data from the National Bariatric Surgery Registry and census data from the UK and Ireland. The number of procedures recorded per 1,000 morbidly obese patients was 5.2 for Caucasian patients, 5.2 for Asian patients and 5.2 for Black patients. The identical rates across different ethnic groups suggest that bariatric services are provided equitably in the UK, with ethnic minority groups achieving equal access.

Exposure to the field of renal transplantation during undergraduate medical education in the UK

BackgroundThere is a lack of surgeons in the field of renal transplantation, with a predicted shortage of over 20 consultants by the year 2005. Early positive exposure to the field, commencing at undergraduate level, has been identified as being vital to improving rates of recruitment. This study was performed to assess the exposure of undergraduates to the field of renal transplantation during medical education in the UK.MethodsIn October 2004 a questionnaire was sent to the clinical deans of all UK medical schools regarding undergraduate exposure to renal transplantation.ResultsTwenty-five replies were received, giving a response rate of 96%. All but one school had a centre for renal transplantation in their region. Three schools (12%) gave no formal lecture or tutorial on the subject during the entire course. Of the remainder, between one to four formal sessions were provided, ranging from 15 minutes to 3 hours duration.Six medical schools (24%) provided no compulsory clinical exposure to renal transplantation, with a further five (20%) saying that students may receive exposure by chance. The average length of attachment was three weeks. Twenty-one medical schools (84%) provided between 1–10% of students a choice to study renal transplantation, as part of electives and special study modules.ConclusionThis study reveals a variation between, and within, medical schools in the levels of formal teaching. If the trends in recruitment to renal transplantation are to be reversed, we have an obligation to improve upon the medical education that students currently receive.

The Impact of Laparoscopic Adjustable Gastric Banding on an NHS Cohort of Type 2 Diabetics: a Prospective Cohort Study

BackgroundObesity is an independent risk factor for diabetes, which is associated with significant morbidity and premature death. This study aims to evaluate the impact of laparoscopic adjustable gastric banding (LAGB) on a cohort of morbidly obese diabetics.MethodsInclusion and exclusion criteria were applied to consecutive diabetic patients undergoing LAGB. Demographic and disease-specific data were collected at baseline and 6-monthly intervals corresponding to follow-up assessments. Minimum follow-up was 24xa0months. Normally distributed variables were assessed with one-way analysis of variance/t tests; proportions were analysed with chi-squared/Fisher’s exact tests. Follow-up was ≥90xa0% complete at each time point.ResultsOne hundred twenty patients with a median age of 43.3xa0years, mean (± standard deviation (SD)) pre-op body mass index (BMI) of 48.7 (±8) kg/m2, and HbA1c of 8.6 (±2)u2009% were included. BMI reduced significantly, with annual post-operative means of 41.4u2009±u20097.8, 39.9u2009±u20097.7, 39.5u2009±u20097.8, 39.3u2009±u20097.1 and 36.6u2009±u20095.4xa0kg/m2 (pu2009<u20090.001). Corresponding percentage excess body weight lost was 32.8u2009±u200918, 39.8u2009±u200921.4, 38.5u2009±u200921.3, 37.0u2009±u200922.3 and 43.1u2009±u200914.1xa0%. HbA1c was significantly lower at each time point until 30xa0months post-operatively (pu2009<u20090.001). Thereafter, differences were insignificant, and HbA1c was comparable to pre-operative levels by 5xa0years. Seventy-six (63xa0%) patients achieved an HbA1c <7xa0% at 30xa0months (pu2009<u20090.001). Twenty-six (23xa0%) patients achieved remission from diabetes. The cumulative 5-year cost saving from reductions in anti-diabetes medications was £1650/patient. There were no mortalities, and 18 device explants.ConclusionsModest but durable weight loss associated with significant improvements in glycaemic control and anti-diabetic medication use have been demonstrated. Peak effects occur within 24–30xa0months and diminish thereafter, possibly reflecting progression of pathological processes due to residual obesity.