Page 100 - Hospital Authority Convention 2017

Masterclasses
HOSPITAL AUTHORITY CONVENTION 2017

M5.1 Metabolic and Bariatric Surgery in Hong Kong 14:30 Room 423 & 424

Paradigm Shift – from Bariatric to Metabolic Surgery
Wong SKH
Department of Surgery, Prince of Wales Hospital, Hong Kong
Obesity and type 2 diabetes mellitus (T2DM) are ongoing healthcare problems in Hong Kong. Both diseases are closely
related and very difficult to be controlled by current medical treatment. In a survey in 2012, 18.8% of the Hong Kong
population has BMI>25kg/m2 and 3.4% has BMI>30kg/m2, which means that more than 150,000 people have severe obesity
that required close attention. Since the first adjustable gastric banding was performed in the Prince of Wales Hospital in
2002, effort was made to raise the awareness for both patients and physician on the use of surgery to manage obesity and its
comorbidities. Over the last decade, more than 1,000 cases of bariatric surgery were performed and according to the SOMIP
database, the morbidity of surgery has significantly improved over the past few years.

On the other hand, T2DM is a more important epidemic health problem than obesity as about 10% of population has
T2DM. However, less than 50% of our diabetic patients can achieve optimal glycaemic control of HbA1c<7%. As surgery is
the most powerful ammunition for obesity treatment with strong evidence that surgeries can induce remission of T2DM in
obese patients, the focus of bariatric surgery has slowly shifted as a treatment option for T2DM. In 2016, a new international
guideline is published which recommends obese diabetic patients to consider metabolic surgery especially when their
glycaemic control is suboptimal. In most recent International Federation for Surgery of Obesity global registry, Hong Kong
has the highest proportion of DM patients who undergo operation and over 60% of our operation is aimed at diabetes
Tuesday, 16 May control. Without optimal control, they are more likely to suffer from diabetic complications, which will increase the burden
resolution. More than 50% of our diabetes patients achieved remission after surgery and the result is encouraging. However,
we noted that young-onset diabetes (onset<40 years) is common in Hong Kong. They have higher BMI with poor glycaemic
of our healthcare system in the future. We believe that by performing an effective and safe surgery, metabolic and bariatric
surgery will be more widely accepted by patients, physicians and health administrators in the future.

M5.2 Metabolic and Bariatric Surgery in Hong Kong 14:30 Room 423 & 424

Building a Multi-disciplinary Team
Chan CKO
Department of Surgery, Queen Elizabeth Hospital, Hong Kong

Metabolic surgery is the treatment for type 2 diabetes and obesity using a surgical method. The classical treatment paradigm
of type 2 diabetes is education, exercise, diet and medications. However in some patients, disease progression is inevitable
despite the best medical treatments used. In such cases, metabolic surgery should be considered as a treatment alternative
as studies have shown that established surgical procedures are associated with larger and more sustained weight loss and
better obesity-related co-morbidity outcomes (including diabetes remission) as compared to non-surgical interventions. A
Multi-disciplinary Metabolic Surgery Service (MMSS) is required in our cluster to deal with the increasing number of patients
with type 2 diabetes and obesity.

MMSS was initiated by the Department of Surgery of Queen Elizabeth Hospital in 2015. Current evidence recognises that
the outcomes of patients receiving metabolic surgery perform better if the service was provided by inter-disciplinary team
of healthcare providers. Therefore experts from various clinical and allied health departments were invited to join MMSS and
eventually a multi-disciplinary team was formed. Clinical staffs from our team consist of upper gastrointestional surgeons,
anaesthetists, otorhinolaryngologist, physicians from the intensive care unit, endocrinologists, respiratory physicians and
nurse specialists, whereas allied health members consist of clinical psychologists, dietitians and physiotherapists. A case
conference with the participation of all MMSS members will be held every six months to study the progress of morbidly obese
patients enrolled in this programme. A combined endocrine meeting will be held for patients requiring metabolic surgery for
diabetic indications. The choice of metabolic procedure will be based on indications, operative risks, anticipated metabolic
benefits and harms on the patient. It is tailored to the patient’s condition and will be carried out by the upper gastrointestinal
surgeons. Objective assessment after metabolic surgery will provide data on patient satisfaction, achievement on excess
weight loss percentage, as well as diabetic control.

The MMSS is a modern example of multi-disciplinary collaboration, providing an international standard of care beyond
conventional medical treatment for a special group of patients with morbid obesity and metabolic diseases.

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