Developing a service fit for the future
Education & Training Workshop
Glasgow 2013
A BOMSS training day was held in Glasgow prior to the Scientific Meeting with the theme of ‘Developinga service fit for the future’ and involving surgical trainees, dietitians and specialist nurses. Mr Sean Woodcock (BOMSS Council),who lead the organisation of the Training Day, welcomed delegates to the Radisson Blu Hotel and described the programme.
The first session of the day revolved around a series of video presentations of bariatric techniques with questions and answers. Prof Duff Bruce talked through a LAGB operation, giving useful hints and tips on techniques and approaches. Mr Alan Osborne then showed a gastric band operation using single incision and discussed the pros and cons of the technique versus multi-port laparoscopic surgery. He pointed out that it proved to be a popular option for some patients and that, after a learning curve of around 30 patients, it could be completed in about 60 minutes.
Mr Simon Dexter presented on gastric bypass, again answering questions and offering advice during the video, for example, on the best operating positions and optimal port positions. Mr Woodcock showed his technique for a gastric bypass procedure, described how to test for leaks and discussed how much bowel to bypass. Mr Woodcock added that he had a policy of not operating on smokers and said that his unit tests people on the day and cancels the operation if positive for nicotine.
Completing this session withlaparoscopic sleeve gastrectomies, Mr Marco Adamo described the operation as undertaken at UCLH and discussed outcomes compared with bypass. He also described possible complications and commented on the need to pay attention to detail. He said that, in his practice the volume of sleeve surgery was increasing while the volume of gastric band surgery was decreasing.
In the following Audio-visual Prize sessionsome of the Bariatric Fellows presented operative videos for discussion with the winning presentation coming from Mr Nick Carter from UCLH who described a gastric band revision on a woman who had progressive dysphagia and included hiatus hernia repair. He described removing the existing band and revision to a gastric bypass.
Clinical specialist dietician and BOMSS Council member Ms Mary O’Kane gave an illuminating talk after lunch entitled ‘Managing the patient with weight gain.’ She started off by saying that there is generally a gap between expectations and reality using the example that while 53% of patients thought that they would stop snacking after surgery, 70% of them actually carried on snacking. She said that professionals were generally getting better at talking to patients and that the next challenge is to “get patents to think long-term and see the benefits of sticking to their diets; even though they might start to put weight back on they will still be in a better position than before surgery.” She also recommended that delegates encourage their patients to be physically active and cautioned them to find out what “physical exertion”meant to different patients – one person might be walking five miles a day while another thinks a quick trip to the corner shop counts as “active.”
Weight regain is a very topical issue and Ms O’Kane talked through various strategies for motivating patients including self-monitoring, weekly weighing, continuous contact with health professionals and physical activity goals. She also reflected that for many patients weight loss becomes weight maintenance and urged delegates to ensure that this transition is sensitively managed and that patients don’t feel they have failed when weight loss slows, adding: “We have to know how to give information and advice in a positive way. Keep talking and listening to your patient.” Surgeons were encouraged to be careful with communication as many patients see their referral to the dietitian as “punishment” for failure to lose weight.
In the afternoon, delegates enjoyed five breakout sessions -
During the gastric band simulators, delegates compared the Ethicon and Allergan bands and practiced access port techniques including “difficult port positions” on five different manikins.
Various dissection instruments and energy sources were also compared using animal stomachs for a sleeve gastrectomy model.
In the stapling session Taskit simulators were used to compare stapling devices while again performing sleeves and banding of artificial stomachs.
The bariatric radiology session returned after receiving the top feedback last year and Dr Dympna Mcateer from NHS Grampian delivered another excellence session.
In AHP Patient Supportsession Mr Ken Clare proved incredibly useful and informative about the patients’ perspective and needs during their bariatric surgery journey.
This day was completed by a Bariatric MDT ‘meet the experts’ session on managing the needs of bariatric patients.
In the evening there was a drinks reception at the spectacular Glasgow City Hall followed by the training day dinner which included the Training Day Quiz – questions on topics from the day with the highest score receiving the Training Day Prize – won by Mr James Young, Ethicon Bariatric Fellow.
The next morning two fascinating talks rounded off the Training programme. Mr Peter Small, BOMSS Council Member and consultant surgeon at Sunderland Royal Hospital gave the Annual Trainees’ lecture on ‘The Logistics of Follow-up.’
He started by telling delegates that they could take a long-term view of bariatric surgery, saying: “Obesity is not going away.” He also warned them to set up and run very efficient services as the number of patients on the books - new patients and patients requiring follow-up - would increase year-on-year.
He then talked then through practical tips for running a bariatric service including examples of specialist equipment necessary for an effective service and offered practical tips: “Get yourself a ground floor clinic.” He also urged them to consider running clinics at community locations rather than asking patients to travel long distances to a central hospital point which has been found to affect attendance rates adversely and discussed their research showing how a greater distance travelled to out-patients can result in reducedweight loss.
Lindes Callejas Diaz then spoke on ‘The Role of the Bariatric Pharmacist,’ which she said was important “both pre-and post-operatively.”Ms Diazis working on guidelines to steer pharmacists, doctors and patients through drug regime changes / adaptations required before and after bariatric surgery. She outlined the likely medicines which may be needed post-operatively and said delegates should choose sugar-free medication where possible and that staggering doses throughout the day would be helpful.
She gave a case study of a female patient, aged 41, who was on 14 medications a day pre-operatively and took the room through the options available for one - no change, disperse in water, sprinkle contents of a capsule onto food, change from tablet to sachet or stop a medication.
Following a lively Q&A session, the Training Day was concluded by Mr Woodcock who stated “we look forward to seeing you next year in Leamington Spa.”
Mr Sean Woodcock, Mr Simon Dexter,Professor Duff Bruce,Mr Marco Adamo, Mr Peter Small,Ms Mary O’Kane, Mr Ken Clare,Ms Carol Craig
Education & Training Committee for Glasgow 2013