Bariatric surgery in a public hospital: a 10‐year experience

Abstract

Introduction: Obesity is common and adversely impacts quality-of-life and healthcare cost. In Australia, less than 10% of bariatric surgeries are performed in the public sector. This study reports our 10-year experience from a high volume public bariatric service which delivers multi-disciplinary care for primary and revisional procedures with mid-to longterm follow-up. Methods: A prospectively maintained database of all patients who underwent bariatric surgery from January 2010 to January 2020 at a tertiary metropolitan hospital was analysed. We analysed patient demographics, comorbidities, perioperative outcomes, 2-and 5-year weight loss as well as comorbidities reduction. Results: A total of 995 patients underwent 1086 (674 primary and 412 revisional) bariatric procedures with mean age of 46.9 years, mean BMI of 49.6 AE 9.1 kg/m 2 and 92% patients with ≥1 obesity-related co-morbidity. Length-of-stay was longer for revisional than primary surgery (5.6 vs. 3.5 days). Major complication rate was 4.2%. Overall, % Total body weight loss (%TBWL) for primary surgeries at 2 years was 26.2%, and for revision surgery was 17.4%. At 2 years follow-up, treatment was ceased or reduced in 65% of diabetics, 29% of hypertensive patients and 69% of sleep apnoea patients. Conclusion: This study confirms that bariatric surgery in Australia can be delivered effectively in resource constrained public health system with outcomes similar to private sector.

Incidence and management of choledocholithiasis on routine intraoperative cholangiogram: a 5‐year tertiary centre experience

“…With the increasing prevalence of obesity and rising rates of bypass procedures being performed (up to 12% rise over the past decade), this emphasizes the importance of maintaining laparoscopic BDE skills. 13 Our institution's TCBDE success rate is 83%, in line with the 71%-91.9% success rates quoted in the literature. 14,15 With the increasing number of surgeons successfully performing TCBDE as well as studies showing no significant differences in complications between lap BDE and ERCP, 16,17 TCBDE remains a favoured option where possible.…”

“…Prior surgical history such as having a Roux‐En‐Y gastric bypass procedure is also important to consider as this would preclude the patient from receiving endoscopic bile duct clearance. With the increasing prevalence of obesity and rising rates of bypass procedures being performed (up to 12% rise over the past decade), this emphasizes the importance of maintaining laparoscopic BDE skills 13 . Our institution's TCBDE success rate is 83%, in line with the 71%–91.9% success rates quoted in the literature 14,15 .…”

Long-Term Trajectories in Weight and Health Outcomes Following Multidisciplinary Publicly Funded Bariatric Surgery in Patients with Clinically Severe Obesity (≥ 3 Associated Comorbidities): A Nine-Year Prospective Cohort Study in Australia

“…There are approximately one million adults in Australia with severe levels of obesity, namely clinically severe obesity, which is defined as class III obesity alone or a BMI of ≥ 35 kg/m 2 with major obesity-related comorbidities. In an effort to address this epidemic, several health departments of Australian states and territories have launched multidisciplinary specialist obesity services (i.e., specialist hospital-based multidisciplinary healthcare services for the management of obesity and its associated medical conditions), with a few successfully establishing publicly funded bariatric surgery services to manage socioeconomically disadvantaged and highly complex patients with clinically severe obesity [ 1 , 2 , 3 ]. However, the vast majority of bariatric procedures (93.9%) were performed in private hospitals, with critically low access in the resource-constrained public healthcare system [ 4 ].…”

“…However, these reports do not include the widely accepted, stand-alone bariatric operations that are gaining popularity and acceptance among bariatric surgeons: sleeve gastrectomy (SG) and one anastomosis gastric bypass (OAGB). There are continued gaps in evidence about the long-term effectiveness and sustainability (i.e., > 5 years) of these newer operations that have supplanted other procedures [ 3 , 17 , 18 ]. Besides temporally, there is also significant variability in outcome measures within different study populations; highly severe populations remain precluded and largely unexplained.…”

“…It is important to understand whether remission and improvement in obesity-related comorbidities are sustainable over time, and whether there are worsening or emergent incident conditions after surgical treatments. Many previous studies have not reported progressive and combined measures (both medication use and blood tests) of obesity-related comorbidities over a long-term period [ 3 , 20 , 21 ]. A recent systematic review showed that the effects of bariatric surgery on mental health conditions are contradictory [ 22 ].…”