Australia has traditionally showed reluctance to adopt the more complex bariatric procedures such as gastric bypass and malabsorptive procedures. In New Zealand bypass features more prominently but in terms of overall volume NZ performs considerably less than 10% of the total bariatric caseload in this region.
Our recent love affair with gastric banding has now given way to a major shift towards sleeve gastrectomy, which in 2017 will constitute over 80% of our bariatric work load. Bypass is used as a primary option in less than 10% of our bariatric cases and Fellowship training in this complex technical procedure is hard to obtain locally.
This shift from band to sleeve is essentially on the back of patients and surgeons observing excellent short term outcomes with minimal maintenance and an acceptable risk profile.
However recently published long term data reveals an overall failure rate of close to 50% with revision rates around 25%. We have unanswered questions regarding the incidence and management of Barrett’s oesophagus after sleeve and the legacy of the “irreversible bypass” which will constitute most of our sleeve revisions.
Overall, what does the long term sleeve pathway look like for the 130,000 patients who will adopt this procedure over the current decade in Australia & NZ? Have we found the perfect operation for our patients without the need for high volume training or experience in the more technically challenging bypass and malabsorptive options or have we been blinded by our focus on short term outcomes?