Louise

Good morning everyone. I hope you're well and welcome to our webinar on weight loss surgery. Thank you for taking the time to join us today. My name is Louise and I’m your host. Our expert presenter is Mr Ahmed Hamouda, Bariatric Consultant Surgeon at Benenden Hospital. He is accompanied by Maria Duckworth, our experienced Surgical Care Practitioner.

This presentation will be followed by Q&A session. If you'd like to ask a question, please do so via the Q&A icon which is on your screen. This can be done with or without giving your name, by using the anonymous tick box. Just to remind you that the webinar is being recorded; although other attendees won't know that you're taking part, unless you give your name when asking a question. If you'd prefer not to be part of the recording now is your opportunity to leave.

I’ll hand over to Mr Hamouda and you'll hear from me again shortly. Thank you and enjoy.

Mr Hamouda

Thank you very much for joining us today, a warm welcome to everyone. We’d really like to introduce our bariatric service to you. I’ve been doing bariatric surgery for just over ten years now and, in that period of time, I’ve done up to around a thousand procedures.

I’m a member of the Bariatric Association of the UK and also I’m the lead bariatric surgeon as well as the MDT (multi-disciplinary team) lead at Benenden Hospital and we'll talk about the MDT shortly. I’d like to introduce a very critical member of my team, Maria, who will talk you through this slide.

Maria Duckworth

Good morning everyone and welcome. I’m Maria, I’m a Surgical Care Practitioner. I have a nursing background of approximately 30 years. I’ve been doing bariatric surgery now for five years, and I’m with you on your journey if you decide to come to us.

I’m the first point of contact for all balloon patients and I do the gastric band adjustments. I’ll hand back to Mr Hamouda now.

Mr Hamouda

So, we pride ourselves at the Benenden I n being a multi-disciplinary team. The journey is not just about the surgery itself, or the surgeon, it's about the whole team - a holistic approach – and, of course, it involves multiple members as you can see there in the presentation in front of you.

We meet once a month to discuss all our cases, but also to discuss the ones being prepared for surgery on a regular basis. We feel that this is one of the strengths of the service. There are many bariatric providers out there, and I think that you will find it's very rare for you to be able to meet members of the team face-to-face within the hospital environment.

So, moving on to what healthy weight means. BMI is a ratio of height to weight and ideal BMI is anywhere between 18 to 25. Above 25 to 30, individuals are considered to be overweight, and above 30 obesity sets in. Now, obesity is a condition that has been researched over many, many years and we know that there is a clear association between certain types of conditions and diseases that occur as a consequence of obesity. And that it also is a factor, in obviously being a risk factor, for things like COVID or breast and bowel cancer.

The three ones that I really want to talk about today are diabetes, sleep apnoea and high blood pressure - which is hypertension. And the reason I’d like to talk about these is because when we actually treat obesity by performing an effective operation or, in fact, if anybody loses weight of their own accord, these conditions can go into remission or become reversible.

So, we know from research that type 2 diabetics can go into remission two years after having surgery in 65 percent of cases. And that means either a complete reduction in their diabetic medication with no recurrence or, you know, they come off their medication completely.

Blood pressure is again something that can be effectively helped with surgery, so either a reduction of the medication or coming off the medication completely in some cases.

And sleep apnoea, there's about 60% chance that, with losing weight, people, individuals, no longer have the condition of sleep apnoea.

What is really useful to remember at the end of the slide is that - on average - with weight loss surgery and a reduction in obesity, the average life expectancy is improved by about seven to nine years.

So, moving on to our weight loss procedures. When you come and see someone like myself - a weight loss surgeon - what can I offer you?

I can offer you four tools. The tools are balloon, band, sleeve and a bypass. I call them tools because, at the end of the day, I want to give you a sense that it's really your responsibility at the end of the day. These are just tools which help weight loss, but a change in lifestyle and dietary patterns - as well as eating behaviour - has to go hand-in-hand with these tools, or else the chance of weight regain is always going to be a possibility.

So, we start with the most effective tool, the most powerful tool. And when I talk about power, it is how much weight you're going to lose with a tool and how sustainable the weight loss is going to be.

So, in terms of the four tools, the balloon is probably our first step, our first stage, and the weight loss is anywhere between 30 to 35 percent of the excess weight. With a band, it's about 50 percent of the excess weight being lost. With a sleeve it's 70% and with the bypass is 80 to 90 percent.

I’m just going to use my cursor to try and explain here on this diagram. So, what I do during surgery is I cut the stomach to make the stomach much smaller, into a small pouch the size, probably, of a thumb and then stitch the bowel. So, I cut the bowel lower down here and stitch it onto the stomach, so that you get a bypass segment of bowel which is this one - attaching to another segment of bowel where digestive juice runs through.

You only really start getting the richness out of your food when those two mix; food, as well as digestive food enzyme lower down here. So, you get, basically, with this operation two things: a restriction in volume, but also a reduction in absorption.

It works really well for people who are sweet-toothed, because it gives you something called dumping. And dumping is a condition where you get an insulin surge, hypo, and people become very cold, faint, clammy and sweaty whenever they eat something that's very rich or sweet.

So even though it sounds quite horrendous, we use it as a tool to prevent people who are very sweet toothed from having too much sweets.

Of course, because food isn't being absorbed as much as it was before, there is a requirement for multivitamin supplements on a daily basis and your GP will need to do almost yearly blood tests to check for things like vitamin B12, calcium and iron deficiency and top up if required. It needs a two-night stay in hospital, two weeks off work and it's, of course, a permanent procedure carried out under a general anaesthetic.

So, going on to the next one down the ladder, which is a 70% loss in excess weight, is a gastric sleeve. It’s a very popular operation because it's a natural procedure. And what I mean by natural, is that food and drink goes into the stomach after the operation has been done - and into the bowel, just as it was intended to do from before.

The whole essence of the procedure is to take away three quarters of the stomach, so - with a general anaesthetic – I go in, use a staple gun and I staple away this bit of stomach, leaving a quarter behind.

Now the effect of that is two things: restriction, of course, so only a quarter of the volume of the stomach is left behind - but also the bit of stomach that gets taken out of the body decreases ghrelin hormone. Ghrelin hormone is a hunger hormone that comes predominantly out of this area of the stomach called the fundus and, of course, what that means is that it reduces craving and appetite following surgery. And this is obviously a very useful effect in addition to the effect of restriction.

So normally we would keep you in in hospital one or two nights and, again, two weeks off work. A yearly blood test is required and, of course, we also give you multivitamins on a regular basis.

So, going on to the gastric band which we said before was 50% of the extra weight being lost. It's basically an operation with keyhole surgery - general anaesthetic - where I put a silicon doughnut around the top of the stomach, creating an hourglass - a partition. And so, you get two pouches; one which is very small above the band and of course the rest of the stomach below.

What this causes is that, when you're eating and drinking anything that's quite solid or dry, it sits above the band for a prolonged period of time before it mushes up with saliva and juice and then trickles through the stomach. So, in other words, what we're doing in this operation is decreasing portion size from being quite a large plate to a much smaller side plate. And it takes twice as long, maybe three times as long, to eat that amount of food.

But what is really important to remember is that the food that's going through, of course, if it's solid and dry food it stays above the band longer - but if it's very mushy stuff, soft food and slider foods it goes in through quicker. And if it's liquid calories such as chocolate or juice and smoothies, squash - obviously high caloric liquids - then this can of course lead to weight regain or failure to lose weight in the first instance.

It is a flexible procedure; and the reason it's flexible is because, using this access port here at the bottom, I can tighten or loosen the band. So, squeeze some liquid into it to make it tighter or looser.

And it's reversible so, if you decided 10 years down the line, that you no longer wanted this procedure, or wanted the band to be inside you, you could come back and have another general anaesthetic and take the band out. In which case, it's a return to normal - there's nothing that's been cut out of the body at all.

This operation can be done as day case surgery, so in and out on the day.

Going onto the balloon which is a very good option for people who want to trial weight loss procedures and see how it's going to affect them and what outcome they're going to have. It's a one-year balloon, so it sits there for one year. It goes in with a camera, under a sedative and throat spray - so no general anaesthetic is required. There are no cuts in the body, it is not surgery.

With the camera, I check that the stomach is absolutely fine - there's no ulcers as such - and then I put the balloon in and fill it with approximately about half a litre of saline with some blue dye. The balloon sits in the stomach; it's freely floating at the very top and it gives you a sense of bloating and fullness whenever you have a meal, so again it tends to reduce plate sizes, meal sizes and volume and can be done as a day case procedure.

So, when, and if, you decide to go ahead and come and talk to us about any of these procedures, what normally happens is you call the hospital, we book you an appointment with myself. It's normally about 20-30 minutes.

It's necessary that I go through all the medical history with yourselves, with the dietary history, find out a bit more about eating patterns, behaviours and then talk about the different options and individualise the treatment to yourself.

Now once that's done, it really goes back to yourself to decide whether you want to go ahead with any of these options. And we always leave you a two-week period to have a think about it, because it's really important that you are very settled in your decision-making process and that you are happy with what you will embark on.

This is a lifestyle change; it is not an easy path, so sometimes there will be struggles after surgery such as nausea, vomiting, a bit of regurgitation of fluid. And certainly, there will be a regimented way of follow-up after the surgery. So, once you decide to go ahead, you call the hospital and then we book you in for a range of appointments and that obviously includes the operation, as well as the follow-up.

And I’m going to hand over to Maria to talk to us a bit more about what happens there.

Maria Duckworth

Okay, once you've seen Mr Hamouda, and you decide that you want to proceed, then your first point of call is usually with me on the pathway. We have a what we call a ‘one stop’, which is where one day you come and spend at the hospital and you see myself, the dietitian, the psychologist and the anaesthetist. So, it's only one trip to the hospital, which is important if you're coming from a fair way.

And when you see me, I take your full history again and ask you lots of questions and I arrange blood tests and things like that. And then I give you my contact details, which is a direct dial number, which has an answer service, and my email. So, I’m a point of contact for everyone with any worries or concerns, once they've committed to their journey. That's pre-, during and post.

You can consider yourself lucky or unfortunate, but you get to see me the entire journey and that includes in theatre when you come to theatre on the day for surgery.

The dietitians will talk to you about the pre-op diet, about the liver shrinkage, and go into details about that and what to expect after the operation. And they follow you up at two weeks and as needed; you have their contact details as well.

Mainly after the surgery, you're on a liquid diet for two weeks and then you go to sloppier food and then you gradually build up to a normal diet. Sometimes you might need a little bit longer than two weeks, but we work with it.

All post-operative appointments are usually with myself or Mr Hamouda, the dietitian - we have two dietitians and you'll stay with the same one for your pathway - and we're here for an entire year to follow. Your package includes a year of care post-procedure.

I’ll hand you back to Ahmed.

Mr Hamouda

So, really the whole ethos of the surgery is that it is a lifestyle change. It's going to change you, it's going to be a commitment for the long-term and, of course, the whole team - including myself, Maria, dietitians, psychologists - work towards that goal in the year after the surgery.

So, it's really about developing those healthy eating habits; looking at your food consistency, looking at your portions - you know - making sure that you're eating the right things and that you have the advice. Because sometimes people will come back to us after surgery and they'll say well, actually, you know what - I don't have a tolerance to this particular food anymore, so we try other things.

We give you advice about how to eat out, how to maybe trial different types of food etc. and that really is the domain of the Nutritionists and the Dietitians. And they, I think, are probably more important than myself after the surgery has been done. And Maria is probably the most important part of this pathway, because she is the point of contact and she is the support for everyone coming through.

And what we really focus on, apart from - you know - we differ from other providers. we focus on giving you a journey. We want you to have the best experience during that one year, so it's not just about doing the surgery or trying to get the weight down, it's about the experience coming through the pathway.

So, I’ll hand back to Maria just to talk about our patients.

Maria Duckworth

We have – I don't know if you can see - we had three patients here that are on the screen. Phil was one of them, who's going back some years now. He was the first one I learned and assisted with Mr Hamouda. He's had a fantastic result and his life's changed totally; he's exercising, he's running, and I see him quite regularly and he's doing amazing.

Emma is another lady, and she didn't realise how large she was until she was at a wedding and saw photos of herself, and it really upset her and that's when she changed. And now, she went, after her surgery she did couch potato to 5k and now she's amazing - she's flying.

And the last one, are a husband and wife, and the wife had a sleeve procedure and the husband had the balloon. And the lady - the wife - had the sleeve first and did remarkably well, and then the husband felt that he was being left behind because she was able to do so much more than he was. And he opted for the balloon and he had an amazing result with the balloon; and now they have a love of roller coasters and so they can both fit on the roller coasters and their lives have changed.

I’ll hand back to Ahmed.

Mr Hamouda

So of course, what we also need to inform you about is that every operation has its risks and so, when you have an operation, whether it's a general surgical operation, a gynaecological operation, an orthopaedic operation, there's always going to be an element of risk.

I tend to group them into two groups. One is the general risk that comes with having an operation, and the other are risks that are very particular and unique to weight loss surgery.

So the very first group of risks is related to having surgery in general; things like bleeding and having a bit of nausea or vomiting after this procedure, clots in the leg veins going up to the lungs and infection either internal, or on the wounds, and conversion to open surgery from keyhole is about a three percent chance.

Now we, with these general risks, of course we can do things to try and diminish the risks, such as giving you antibiotics during the course of surgery and making sure that we give you blood thinners and TED stockings for a minimum period of a week after the operation.

When it comes to weight loss surgery, you'll find that with the two permanent procedures there's always going to be a stapling device used to cut away or to join bits of bowel and stomach. So that can lead to a risk of leakage from these joints; and the risk is generally in the order of about one to two percent which means that you have a 98 chance of there not being any issues at all following surgery.

What I do at the Benenden is I do a belt and braces approach. I check with blue dye all my joins and I also put an extra line of sutures on top of the staples to make sure that that risk is minimised.

And then, of course, the two big ones are failing to lose weight with a procedure but also in the long-term: weight regain. And I am really, really quite keen to emphasise these two because I find that most everybody that comes to see us is very motivated and they're incentivised; they've done this because they've failed to lose weight over a long period of time they've tried every diet that there is but still they haven't seen the effect.

So, they come and see us because they really want a tool, they want something that's effective so it's almost like, you know, an afterthought that I would say these things when I see people in clinic. But I always mention it because I want to make sure it's in my best interest and your best interest that the outcome of the operation is weight loss.

I feel very lucky and privileged to work in this field because I find that it's a win-win situation. I do it because I want people to become healthier, I want there to be less obviously impact on health provision in the future, on needing treatments for obesity, for diabetes etc and hypertension.

But I know that a lot of people come through because they also have cosmetic needs, so they want to look better, feel better, have more self-confidence, self-esteem and so the beauty of this type of surgery is that it's a win-win situation. Everybody gets what they want out of it and that's why we really want to emphasise the fact that it's a tool and that you have to work with it.

So, thank you very much for that and I’ll hand back to Louise.

Louise

Really interesting, thank you very much. And we've had a few questions coming through, however if everyone else would like to ask questions please do, no matter how silly you think they are - they won't be at all.

So please just use the Q&A panel on the screen and type your question. You can use the anonymous tick box to say you don't want your name to be shared - and I’ll just say your first name, anyway, so please don't worry.

And the first question I have is around the recovery times.

So, you say about two days in hospital, two weeks off work for the most extreme, and then you know - in and out the same day. What are the recovery times long-term after that; when will people feel normal again after each of the surgeries?

Mr Hamouda

So normally after this operation, because it's a keyhole operation, people tend to find that the recovery is much quicker than having any type of open surgery.

So, I would say - and being quite cautious - I would say that within 10 days to two weeks, people start feeling quite normal. Within the first day after surgery, you're out of bed, you're walking to the to the bathroom on your own, there are no tubes inserted anywhere, there's no requirement for you to have fluids through the vein, all the drinking is done orally through the mouth.

And within the next two days that you're with us in the hospital, you're going to be walking up and down the corridor three or four times a day.

Back to normal activity, I would say two weeks’ time, maybe feeling a bit sore etc for those two weeks where the scars are but generally after that I think two weeks really is quite realistic in terms of getting back to work and feeling quite normal again.

The long-term element of it is really interesting because, of course, you have to realise that the operation changes you. So, it's never going to be possible for somebody to have a big meal, sit there and got food or have a big meal. So that's the long-term effect of it is that you will have to change eating behaviours, patterns, ways that we eat.

The fact that perhaps maybe, with a band or a sleeve, if you go out six or seven weeks down the line and you socialise with people and you forget, then you will sometimes inevitably have a vomiting episode. And so that is different to post-operative recovery or recovery from the operation itself but generally I would say, within two weeks people are back to feeling normal.

Louise

Okay, thank you. We have several more questions that have come in so thank you very much everyone. And the next one is:

What sort of time scale is it from the first point of contact?

Mr Hamouda

Maria do you want to take that one?

Maria Duckworth

It's usually you have your two-week cooling off period and then you can make your appointments and it's usually about four to six weeks before you can get through to surgery once you've passed your blood test, pre-assessment, anaesthesia okay and then after that surgery, then a couple of weeks after that, I guess.

From point of contact to surgery is usually four to six weeks, but you know obviously in this present climate things might be a little bit longer is what I would like to highlight here.

Louise

Thank you. I have a question from Sarah.

Is there a BMI level for each to qualify?

Mr Hamouda

Yes, very good question. Thank you for the question. So NICE guidelines in the UK have said that we really should be doing the surgery on people who are BMI 35 and above.

Now that, in recent years, has changed slightly because it applies to sleeve and bypass procedures. But when it comes to band and balloon, because they're minimally invasive, because they are low risk procedures and because the benefit far outweighs the risks in terms of health, the BMI guidance has relaxed a bit.

So, for a band it's BMI 30 and for a balloon it's BMI 27. So you can have a balloon it'll be a 27. Above a band that'll be BMI 30 and above, and a sleeve and a bypass would be BMI 35 and above, with some condition related to obesity.

Louise

Thank you. Another question is from an anonymous person.

They have seen some comments from people who've had complications with the gastric band; what are the success rates from the band?

Mr Hamouda

So a very interesting question again. A gastric band is something that was very popular about 15-20 years ago, and I find that it still remains popular, because it has that flexible and reversible element to it.

However, yes, there is a lot out there in terms of forums about bands particularly because of the fact that there is the flexibility of it, so you may need to adjust it once or twice so, you know, to get the effect out that you require.

The band goes in empty - it's empty - then you come back and see us in six weeks, we do the first fill. And then you see us two or three more times until we get to the sweet spot where we’ve filled it satisfactorily and to make sure that, you know, it's tight enough for people to lose weight - but at the same time it isn't too tight, so there's a bit of an adjustment to it.

There's also - because it's quite high, it sits quite high up on the stomach - there's also quite a bit of reflux that comes with it - regurgitation and vomiting - if people don't do or don't follow the instructions that come with it

So i realised that there is quite a lot on the internet about bands and about people's experiences with bands. I would say, on average, about 70% of the people that have bands with us are very satisfied with the outcome. About 25 percent don't lose the amount of weight that they would expect to lose and about five percent have those other issues with reflux perhaps, maybe regurgitation, that upset them a bit.

Louise

Thank you. I have a question from Angela.

Do i need to inform my GP if I decide to go ahead with surgery?

Mr Hamouda

So, we always advise that it's good to keep your GP in the loop. However, interestingly, weight loss surgery in the UK now you can either get it on the NHS or as a self-pay private patient. And, on the NHS, it can take anywhere between three and four years to get through from referral to an operation.

In the private sector, if you're paying for your own treatment, you really don't have any obligation to inform your GP. However, because the GP is going to do a long-term follow-up, we always advise that you should.

Louise

Thank you. Another anonymous question here.

Will having diverticular disease effect the ability of any of these options?

Mr Hamouda

No, diverticular disease is not a contraindication to having any of this type of surgery. There are certain conditions that, perhaps yes, we would take stock of - and bowel conditions including things like Ulcerative Colitis or Crohn's Disease - but, of course, that's a discussion to be had during the consultation with the surgeon.

And it depends on what medications you're on for the condition etc., and how stable the condition is. But diverticular is not a contraindication.

Louise

Okay thank you. Another question is asking how far away the hospital is. Christine lives on the south coast but, of course, it depends exactly where you live on the south coast Christine.

But the hospital is in a beautiful setting in the Wealden countryside. Generally, most of our patients come from probably from Brighton to Folkestone, right along that amount of the south coast - and sometimes as far as Margate.

The hospital is very well known for being Outstanding; it's the only Outstanding hospital in Kent, so people often travel quite a way to get to our hospital. So if you let us know exactly where you are, we can give you a bit more information.

Another question says:

Would you suggest counselling alongside the procedure?

Mr Hamouda

Yes, so our packages are built with a Psychologist as part of the of the package. So, if you decide to go ahead - and what Maria was alluding to earlier was that you will have a one-stop clinic assessment process, which includes seeing a Psychologist - and that's what counselling is all about.

And then, following surgery, you also get contact with them once or twice during the year that you're with us. So that is built into the package, yes.

Now some people, you know, agree to go ahead with that. Some people don't like it, some people say ‘yes it's good to go ahead’. We always advise it anyway because, at the end of the day, it's about looking into the eating behaviours; about what we can do to improve eating behaviours specifically.

Louise

Thank you. I have an age-related question here:

I will be 70 at the end of March and I’m interested in a balloon. Have I left it too late?

Mr Hamouda

Again, very interesting question. The guidelines I was alluding to earlier - the NICE guidelines - recommend that we attempt these procedures between an age bracket of 18 to 70. And I think it's because of the benefit versus the risk, sort of, of having these procedures.

And so, we do have a cutoff of 70 for these procedures. So i think yes it might be, you know, we might be able to do something just before your 70th birthday but after that it becomes more difficult.

Louise

What is the percentage of unsuccessful procedures, especially for someone that doesn't overeat but still struggles to lose weight?

Mr Hamouda

So, when I was mentioning earlier the band satisfaction rate of about 70%, I would then go on to say for the sleeve and the bypass, the satisfaction rates are probably in the order about 90 to 95 percent - and so that's the effectiveness, in other words, which means you're hitting your weight loss target.

And, of course, at the end of the day, let's re-emphasise the fact that this is a tool. It is your tool; we offer the tool, we do it safely, effectively. We give you the follow-up and the support. At the end of the day, some people take the tool and they lose 100% of the excess weight they're carrying. Some people only lose about 40 to 50 percent because they don't put the effort into it. So, it really is quite individual.

Louise

Okay, I have a really interesting question from Christine. She says she travels a lot usually; she's heard that flying means that the band needs to be altered according. Is this true, please, as she generally does several visits annually, so it'd be quite difficult.

Mr Hamouda

The band is a water-tight, airtight system. If there's obviously any small bubbles or air within that system, and there is a variation in pressure -  and the two sort of circumstances I found that to be the case is flying or diving - then the variation in pressure can cause the band to become either tighter (which is usually the case) or looser.

So yes, a very valid question and perhaps not the best option if there's a lot of frequent long-haul flights.

Louise

Thank you. Richard has asked:

Can you have the balloon procedure if you suffer from acid reflux?

Mr Hamouda

Yes, so restrictive procedures - and they would be the three; the balloon, the band and the sleeve - are restrictive procedures and can increase or exacerbate reflux.

So, if someone suffers with reflux quite badly then we would have to take that into consideration because it will potentially increase the reflux.

With a balloon, we ask you to go on onto acid medication anyway for the whole year that you have the balloon, so you'll be on it whether you're on it now or not. And, of course, yes it can increase reflux, so we have we have to think about other ways of dealing with it.

Louise

Thank you. I have one around the whole package. There's more a question for Maria perhaps. If this anonymous person was progressed to an appointment and start the journey, would everything be included in the package price: the one-year support with Maria, the dietitian, the psychologist?

Maria Duckworth

Yes, everything's included in the package. The package price covers everything and if it was a band, it covers the band adjustments and fills for a year. There's no limitation on how many times they can talk to me.

Mr Hamouda

Can I also, if I may Louise, can I add one thing to that? Completely agree with Maria, but also it's important to remember that if you have any issues with the surgery, for example if you need to stay in hospital for longer than two night stay, if you need a blood transfusion, if we - for any reason need to deal with, you know other elements such as coming back for an endoscopy to have a stretch of a sleeve for example - that's all covered within the package price.

Louise

Okay thank you. We have an interesting question here about the possibility of having children in the future, relating any of these surgeries to anything affected.

Mr Hamouda

So very interesting question. With any of these surgeries, what we're hoping and aiming to do is reduce weight to the point where it's very close to an ideal BMI. And it is arguably going to be better in terms of health for the mother and the baby to be at that, or near, that ideal BMI.

So all the research that we've done over the years with pregnant ladies following bypass sleeve band or even, you know, not the balloon because obviously would be out by the time that a delivery occurs, is that they have full-term babies who are a very healthy weight and there is no issue at all with pregnancy.

Louise

Great, thank you. Just a few more questions here. One is:

Is the consultation still in person or is it available online now? And is the follow-up appointment in person or online?

Mr Hamouda

At the moment, we're still carrying on with face-to-face consultations. It is a very good question and I think, at some point, we might need to consider virtual consultations. But having said that, there is always going to be a need to see the person face-to-face and that will be to carry out the pre-assessment bits, to listen to the heart, the lungs, to do an ECG, to take some bloods, to do swabs etc.

So, we could initially have a virtual consultation but it might be difficult from then on to carry on virtually.

Louise

I would add to that Benenden Hospital takes safety very, very seriously as well. So, as you enter the hospital, your temperature will be checked, and you'll go through a series of questions. There's hand sanitiser around the hospital and you have to wear a mask. So, all the precautions are taken. And then - before any surgery - you would have a COVID test as well. So, you know, there's very low risk.

We’ve still got more questions coming in, but I think we'll just do one more question, one comment and then we can answer any questions offline afterwards. The last question is:

What is the impact on gallstones?

Mr Hamouda

Again, very good question. Gallstones with weight loss surgery are quite common so here we think a 20 to 30 percent chance of people forming gallstones or having flare-ups of gallstones if they already have them in about 20-30 percent of people who have had weight loss surgery.

So, from that you can see that there's about 70% chance that there won't be any issues after weight loss surgery with gallstones and therefore we do not recommend or take out the gall bladder during this operation.

If they become problematic after surgery then, of course, you have to go through a process where you see your GP, you get all the tests done and you progress to having gallstone surgery, which we can either provide at Benenden or obviously that can be done on the NHS.

Louise

Okay, thank you. So just to end the question session, Jenny, which was one of the couple with the case studies earlier; she just wanted to say how delighted she is with her new life.

“Mr Hamouda banded me two years ago; I lost approximately 60% of excess weight within the year, now down to normal weight and maintaining it. My health has improved and I no longer take the handful of pills I was on for blood pressure, cholesterol, pain etc. Thank you, thank you, thank you Mr Hamouda, Maria and everyone else at Benenden.”

So that's really lovely, thank you so much for typing that, Jenny. It's really sweet of you.

So, thank you very much for everyone joining us today. Thank you Mr Ahmed Hamouda and Maria Duckworth for your information, your expert knowledge. It's been really interesting, I hope everyone agrees.

You'll receive a short survey afterwards and I’d be really grateful if you could spare a few minutes to, you know, share your feedback because it helps for future sessions.

Our next webinar is on Thursday 11th of February on varicose veins with Eddie Chaloner and Aaron Sweeney.

So, on behalf of Mr Hamouda, Maria and myself and the team at Benenden Hospital, I’d like to say thank you so much for joining us today. We look forward to you joining us again and have a really good Saturday and really good weekend. So, thank you very much.