Candidates for gastric banding are very carefully selected, one surgeon explains to Michelle McDonagh
THE SURGICAL treatment of obesity attracted much negative publicity last year when an Irish mother-of-six died after an abandoned gastric banding procedure at a private Dublin clinic. However, for some morbidly obese patients, explains general surgeon Oliver McAnena, surgery may be the only option.
Galway-based McAnena currently provides gastric banding surgery, although he is keen to stress that he only deals with a carefully selected group of medical patients and is not involved in cosmetic surgery. A more drastic form of obesity surgery, the gastric bypass is offered at St Colmcille's Hospital in Loughlinstown Hospital.
Gastric banding involves the placement, through keyhole surgery, of an adjustable silicone band around the top part of the stomach with the aim of reducing a patient's appetite and food intake, resulting in significant weight loss. However, medics like McAnena point out that the surgery is far from a quick fix or magic wand - having the band fitted is actually the easy part, the follow-up is lifelong.
Surgical treatment for obesity is widespread in the US and other European countries but to date, there has been relatively little demand for surgeries such as gastric banding and gastric bypass in Ireland. However, with the rising rates of obesity, McAnena expects demand to increase.
"There is already a huge demand for this procedure and it is going to increase. Obesity has reached epidemic proportions in this country. Loughlinstown is overworked with bypass surgery and we (UHG and the Galway Clinic) are the only hospitals in the country actively doing gastric banding. In this current climate, it is hard to get beds for this type of procedure," he says.
Celebrities who admit to having had gastric bands fitted in an effort to shed weight include UK TV presenters Fern Britton, Ann Diamond and Sharon Osbourne and actor Brian Dennehy.
The procedure attracted a lot of negative press attention last year when Bernadette Reid died on February 27th, 2007 after an abandoned gastric banding procedure at the Advanced Cosmetic Surgery clinic in Dublin.
Surgeon Jerome Manuceau said he abandoned the procedure when he discovered cancer in her abdomen. Paris-based Dr Manuceau is currently suspended from working in Ireland, pending the outcome of a Medical Council inquiry. Worryingly, he told RTÉ in June that about 30 patients have travelled to his clinic for gastric banding surgery since he was suspended last year.
McAnena and his team have been carrying out medical gastric banding surgery at University Hospital Galway since 2003, and at the private Galway Clinic since 2004. The procedure, he explains, forms part of an overall management plan for patients with obesity in Galway and is considered a last resort in terms of treatment options.
Patients cannot just walk in off the street, they must be referred by the Obesity Clinic at UHG or by a GP. They must undergo extensive pre-operative assessment and counselling (which can take three to nine months) by a multidisciplinary team which, depending on the patient, can involve a general surgeon, an endocrinologist, a respiratory physician and in all cases, a psychologist.
Notably, one of the main criticisms of the Bernadette Reid case was the lack of pre-operative assessment and counselling she received.
Gastric banding is generally considered suitable in patients with a BMI of 40 or a BMI of between 35 to 40 in the presence of associated diseases (known to improve with weight loss) such as diabetes, high blood pressure, sleep disorders and arthritis.
McAnena explains: "The most important thing is to select the patient carefully. We are generally dealing with patients who, along with obesity, have other problems such as diabetes, high blood pressure, heart disease and arthritis. International evidence shows that when they get to that stage, surgery can in fact reverse high blood pressure, sleep disorders and type 2 diabetes. For patients like this, they know there is no other alternative and they are going down a very slippery slope."
The follow-up and management of patients, says Mc Anena is lifelong and very expensive.
"We get numerous calls about gastric banding, but the strict criteria puts most people off. The band itself is not a catch-all to cure the problem of obesity, it depends very much on the motivation of the patient after surgery. The aftercare is vital if the band is to work well. Patients need to be re-educated about their eating habits and exercise and their success depends very much on their own motivation at the end of the day," he says.
Founder and acting chief executive of the Galway Clinic, Dr James Sheehan, stresses that he does not offer cosmetic surgery. He is critical of other centres who fly surgeons in to perform various procedures.
"I am not in favour of 'the journeyman surgeon'. This is dangerous surgery which can involve a lot of stormy post-operative care and others are being left to clean up the mess that these people leave behind once they fly back to their own countries," he says.
Sheehan points out that the vast majority of obese patients are unsuitable for gastric banding surgery but for those who are, the procedure is life-changing.