BOMSS 2018 – Telford

Delegates gathered in Telford in January for the 9th BOMSS ASM and were treated to talks and lectures which raised spirits at a time of high pressure for NHS staff and services.

After a welcome from BOMSS President Shaw Somers which included an overview of the status of bariatric surgery, the first session focused on Obesity and Metabolism. Discussions ranged across the Tier 3 model, NAFLD / NASH and pharmacotherapy with contributions from Dr Carly Hughes, Prof François Patou and Prof Rachel Batterham.

Mr Somers said: “All bariatric surgeons are feeling the squeeze. There is a failure both politically and publically to understand that obesity is a diseased state, not a moral failing or a lifestyle choice.

“However, there is a wealth of data out there which shows what we do is necessary and worthwhile. Our patients do not shout about their problems because they feel stigmatised. So we have to do the shouting for them.

“At BOMSS we all feel very proud that we have become a vibrant, multi-professional specialist group. The MDT model is at the heart of what we do. In many ways, we are the envy of other specialist groups.”

A session on the Principles of Surgical Practice heard lectures on The gastric balloon as a defined bariatric treatment modality, The role of Single Anastomosis Gastric Bypass in Bariatric Surgery and How to optimise the long-term outcome of sleeve gastrectomy.

A session on Technical dilemmas in Bariatric Surgery posed some important questions about medico-legal controversies in bariatric practice, asked if the sleeve gastrectomy is safe in patients with Barrett’s oesophagus and discussed the role of the endoscopist as a primary bariatric therapist.

AHP representative Prof Batterham spoke on Harnessing the biology of the gut, saying: “In order to treat obesity we have to understand it. We need a polymodal approach post-surgery and, looking ahead, through the months and years our patients are likely to need more and different interventions. The pipeline for obesity drugs is very promising. The biggest problem we face is access to care.”

A key session at the ASM looked at the role of philosophy and psychology in bariatric interventions – recognising that for many of patients there are emotional factors in over-eating and they also pay a high emotional price because of obesity stigma. Consultation on clinical practice guidelines for assessing and managing psychological issues will help us move forward in this area.

Council member Mr Jim Bryne described the wealth of current UK trials and recommended studying them to get a fuller picture of the service, adding: “Well-designed multi-centre trials give us the best picture and can help us shape practice.” He also addressed the challenges of getting patients onto Tier 3 programmes and then into Tier 4 care.

In another talk on trials, Prof Jane Blazeby called on BOMSS members to work together to deliver trials, saying: “We will have the opportunity to think ‘what next’ once the By-Band-Sleeve closes to recruitment next year.”

Surgical and AHP Free Papers, Surgical DVD Presentations and parallel sessions added to the rich mix of the Meeting. With the growing demands of audit and the rising pressures in the healthcare service, sessions on the NBSR, a commissioning update, future trials and a report on IFSO were all well attended.

Mr Marco Adamo gave an NBSR update with the key date of April 1 when a new version of the Registry would come online and collect an enhanced range of information, including following the patient timeline over the years.

President-Elect Prof David Kerrigan gave a talk on the Regulation of Bariatric Practice which looked at ways to widen surgical access using the private sector. He said: “Bariatric surgery is so specialised that there is the option of the NHS contracting it out.

“We haver to get in front of the new STP commissioners and make the case. We also have to learn the costs of everything we do. Do it as a not-for-profit service and form Chambers. Solo practice is not the way forward.”

In a talk, A Kick up the Privates, Mr Somers also highlighted the fact that BOMSS Council is currently pushing forward to find ways to improve good provision of services saying that one way might be to offer guidance on services for self-funded patients.

He also emphasised the need to input data into the PHIN (Private Healthcare Information Network) and pointed out some shortcomings of the Network, for example, bariatric surgery currently comes under the heading of “other” procedures.

In a later session, Prof Kerrigan raised links between cancer and obesity as a way of moving public opinion in favour of bariatric surgery. He called for a well-funded RCT to see if BOMSS can help reduce the scourge of breast cancer, which affects 1 in 6 women in the UK.

The meeting was well supported by our partners in industry and, as always, the social programme including the annual dinner was a great success with lots of informal networking as well.

We look forward to BOMSS 2019 in Belfast.