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Is it time for emergency bariatric surgery services?

St George's Hospital in south London, the home of Mr Omar Khan's emergency service. Photo: Peter Trimming.
London hospital's informal bariatric service performs 12 out-of-hours emergency operations in a year
"I think networks of surgeons are going to be the answer in the future" says emergency surgeon

Large NHS hospitals will in the future provide round-the-clock on-call emergency bariatric surgery services for networks of smaller centres, according to one surgeon speaking about his experience offering an informal emergency service from his hospital.

Speaking at the British Obesity and Metabolic Surgery Society meeting in Glasgow, Scotland, Mr Omar Khan of St George’s Hospital, London, said that the future of bariatric surgery provision would routinely involve formalised systems, with emergency bariatric cases being referred to centres where surgeons will be available 24 hours a day to perform complex operations.

“I suspect in the future it’s going to be formal, and it’s going to be something that commissioners are going to need to be aware of,” Khan told Bariatric News. “They’re going to be asking questions about small centres, saying that they’re doing 100 bariatric operations in a year - what’s their provision for emergencies? If they don’t have that answer, there are going to have to be changes, like this configuration.”

Khan, along with his colleagues Mr Marcus Reddy, Mr Andrew Wan, and Mr George Vafilikostas, ran an informal emergency service at St George’s, operating a rota to ensure that one surgeon was always available to perform operations on severe complications.

“These are true emergencies,” said Khan. “Some people say most general surgeons should manage bariatric emergencies. We’d agree with that. Simple band deflations or a bit of abdominal pain after surgery – we don’t deal with that. They’re managed by the general take."

Over the course of a year, the service saw 35 cases, most of which were referred to them by other hospitals. Of the 35 cases, 12 required out-of-hours interventions.

“The cases we had were problematic bariatric patients,” said Khan. “The vast majority required quite complex surgery, like band removal, repair of internal hernia, a few leaks that required stenting. They required a specialist surgeon, basically.”

Khan said that 23 of the cases involved emergency CT scans, showing that emergency services require not just surgeons but also other specialists. As part of a large teaching hospital, he had access to other specialists including on-site radiologists and endoscopists, whom he said were “quite happy and geared up to managing bariatric patients”.

Formalising the system

As the number of emergency referrals was so small, there has so far been no need for a formalised system. “We tend to get phone calls from surgeons from other centres saying can you take X, Y, or Z,” said Khan. However, he expects that as the population of bariatric patients continues to rise, more formalised systems will need to be put in place.

“We had 35 admissions in a year, and it’s not huge,” he said. “Once a month we’re being called in to do an emergency out-of-hours operation, and that’s manageable. When that starts becoming once a week, or more frequently than that, it’ll have to be formalised.

“Even if we do 400 cases a year, the emergency pool is going up because those 400 stay around – they don’t tend to move – and then next year you do another 400, and then another 400.”

Khan added that this type of service would have implications beyond his own specialty. “I think networks of surgeons are going to be the answer in the future – not just in bariatrics,” he said. “You’ll probably get specialist centres that deal with upper GI cancer emergencies.”

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