Abstract:

Bariatric surgery in the United Kingdom dates to the early 1970s, and early pioneers made international contributions. This article gives a personal perspective on historical development from their work through the introduction of laparoscopic and revisional techniques to the present day. Bariatric surgery is becoming recognized in the United Kingdom as a cost-effective force for health improvement, but is hampered by restricted National Health Service prioritization and lack of insurance support. The British Obesity and Metabolic Surgery Society represents an active bariatric clinical community and holds its own scientific meetings. High quality is fostered by a multidisciplinary and team approach in specialized units with adequate volume. Significant advances have been made in professional recognition, science, innovation, guideline development, and health-economic validation. Challenges remain in equity of access, service capacity, reimbursement, and clinical quality assurance. The recent establishment of a National Registry will help to overcome these obstacles.

Authors:

Alberic Fiennes, BSc, MS, FRCS, President, British Obesity & Metabolic Surgery Society, Chairman, National Bariatric Surgery Registry Data Committee, Late, Director of Bariatric Surgery, University College London Hospitals NHS Trust

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Abstract:

Originally, sleeve gastrectomy (SG) was part of biliopancreatic diversion (BPD), which is the most effective bariatric procedure for super obese patients. As BPD is a complex procedure with substantial morbidity and mortality, attempts were undertaken to split the procedure into two steps. SG became the first step in a staged BPD procedure assuming that this less-invasive operation would reduce the surgical risk in super obese patients. The second step - the duodenal switch - was thus postponed until after a major weight loss. Several studies have since been published showing data that, besides the successful weight loss, the procedure itself had a positive effect on obesity-associated comorbidities. Sleeve gastrectomy has gained widespread acceptance as a primary and definite bariatric procedure. SG has become an innovative tool in the battle against obesity. Although several variations of SG have been described, standardization is paramount for optimal results. Of particular interest are: the minimally invasive access, the dissection, preservation of the antrum, position of staple-line and buttress material, as well as the size of the bougie and the extent of fundal resection. This article describes the different procedural and technical aspects of the operation. In addition, it will line out how we transferred our skills and experience in single incision laparoscopic surgery (SILS) from cholecystectomy and sigmoid resection to sleeve gastrectomy.

Authors:

Silke Mueller, MD, Senior Physician, Black Forrest Hospital, Villingen, Germany, Norbert Runkel, MD, FACS, Professor of Surgery, Head of Department of General and Visceral, Surgery, Black Forrest Hospital, Villingen, Germany, Rainer Brydniak, MD, Senior Physician, Department of Bariatric Surgery, Black Forrest Hospital, Villingen, Germany

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