P-B03 Gastric Band Tubing Causing Small Bowel Obstruction

Background Laparoscopically adjustable gastric bands (LAGB) have been widely employed as a means of weight loss in bariatric surgery over the past two decades. Although now largely superseded by other bariatric surgical techniques, complications from gastric bands continue to be encountered in surgical practice. We report an unusual case of small bowel obstruction due to an internal hernia caused by gastric band tubing resulting in closed loop small bowel obstruction. This is not commonly encountered and emergency general surgeons need to have a high index of suspicion for this condition as a possible cause for small bowel obstruction. Methods A 40 year old male presented with abdominal pain, vomiting and failure to open bowels or pass flatus for nine days. Twelve years previously (2008) he had had Roux n Y gastric bypass (RYGB), followed by by laparoscopic gastric banding of the RYGB about two years later (2010) also in the private sector. He had a soft but distended abdomen, and empty rectum on rectal examination. CT scan abdomen reported as: Multiple loops of distended small bowel demonstrated. No air seen in rectum, indicative of small bowel obstruction. No pneumoperitoneum. There is dilatation of the mid and distal small bowel seen to an apparent transition point in the mid abdomen where a loop is noted associated with the tubing for the inflation device for the gastric band. This appears to be centred on the cause of obstruction and appears tied around the base of mesentery and may be creating a closed loop obstruction, by having created an internal hernia. This patient had an internal hernia around loop of the gastric band tubing with resultant closed loop small bowel obstruction. The patient underwent diagnostic laparoscopy with ileo-caecal resection and primary anastomosis. He made successful recovery. Deflated gastric band remains in-situ. Results While small bowel obstruction is most commonly due to adhesions in individuals who have had previous laparotomy, it is important to bear in mind other causes such as internal hernias particularly in cases of those with history of previous gastric banding or Roux n Y gastric bypass. Early intervention may be necessary to reduce the likelihood of bowel ischaemia and bowel resection. Laparoscopy is a useful tool in the management of small bowel obstruction. Keywords: gastric band, small bowel obstruction, closed loop, emergency surgery, laparoscopy Conclusions Connection tubing causing small bowel obstruction and colonic erosion as a rare complication after laparoscopic gastric banding: a case report. Liza BK Tan, Jimmy BY So, and Asim Shabbir - J Med Case Reports. 2012; 6: 9. Acute small bowel obstruction due to the connecting tube of a gastric band. Federico Oppliger, M.D. Gonzalo Wiedmaier, M.D. Juan. Published April 07 2017. https://doi.org/10.1016/j.soard.2014.03.021 An unusual complication of gastric banding: recurrent small bowel obstruction caused by the connecting tube. M A Zappa, E Lattuada, E Mozzi, M Francese, I Antonini, S Radaelli, G Roviaro. Obes Surg . 2006 Jul;16(7):939-41. doi: 10.1381/096089206777822250 Total small bowel herniation through the space between the connecting tube of gastric band and abdominal wall: A case report of a surgical emergency. Tarek Hashem, Soliman M Soliman, Sherif Wagih 2. Int J Surg Case Rep. 2017;30:66-68. doi: 10.1016/j.ijscr.2016.11.021. Epub 2016 Nov 17

O-B06 The Impact of Covid-19 on Bariatric surgery in England during 2020

Background The Covid-19 pandemic had a significant impact on NHS services across England. Due to the significant rise in demand for beds in both ward and ITU environments, trusts were forced to reduce the number of operations carried out to help reduced the burden on secondary care services. Whilst efforts were made to preserve operations where possible, the Covid-19 burden has had a significant impact on bariatric surgery throughout 2020. The following research looks at the true impact of Covid-19 on bariatric surgery in England and analyses this in relation to the Covid-19 burden. Methods Data relating to operation numbers was taken from The Surgical Workload Outcomes Audit (SWORD) database. The SWORD database was interrogated for the years 2017 – 2020. A mean number of operations was calculated using the 2017-2019 data and compared to data from 2020 for gastric bypass, sleeve gastrectomy, gastric banding and biliopancreatic diversion. Operations performed and other demographic data was analysed regionally and compared to Covid-19 deaths throughout England. Covid-19 data was obtained from the national government dashboards. Results The results of the study show that Nationally there was a significant decline in bariatric surgery operations carried out throughout 2020 due to the Covid-19 pandemic. Overall there was a 53.5% reduction in bariatric surgery operations carried out in 2020. Looking at the individual operation types, there was a 50.7% reduction in gastric bypass surgery, a 50% reduction in biliopancreatic diversion and a 51.9% reduction in sleeve gastrectomy. There was a greater reduction in gastric bands, with a 78.1 % reduction in procedures which may also reflect changes in current practice with regards to the use of gastric bands. On reviewing data at a local level, all trusts were significantly impacted by the pandemic with the reduction in services ranging from 50% to 100% reduction in operations performed. Conclusions Overall, despite national efforts to preserve as many operations as possible, there was a significant reduction in the delivery of bariatric surgery services throughout England during the Covid-19 pandemic. Due to this reduction in service provision, it is likely that there are now much larger waiting lists which will need to be addressed as we recover from the Covid-19 pandemic. Whilst there was a similar reduction in services across most trusts due to the elective nature of the operations, variation should be further analysed to allow for better planning and resource allocation for futor future waves or future pandemics.