SP2.1.2 Increasing Burden of Complications of Gastric bands on NHS Bariatric Services

Background

Approximately 40% of patients that undergo laparoscopic adjustable gastric band (LAGB) insertion for obesity experience long-term complications and a lack of weight loss. This has caused a surge in LAGB removal procedures under the NHS. We review patient outcomes for these procedures at our tertiary bariatric centre.

Methods

All LAGB removals performed between October 2012 and August 2021 were reviewed. Data was collected prospectively & analysed retrospectively for demographics, body mass index (BMI), surgical indications and postoperative complications.

Results

During the study period, a total of 178 patients underwent LAGB removal (93.8% female). Most bands were inserted out of province, done privately and patients’ mean BMI pre-operatively was 41.6. Indications for band removal included dysphagia (41.1%), band slippage or tubing damage (25.8%), pain (15.2%), obesity-related health condition (11.2%), infected/ leaking band (3.9%), and band erosion (2.8%). At LAGB removal, patients’ mean BMI was 37.0 – thus there was a mean decrease of 4.6 in BMI between index and removal operations. One LAGB removal case was converted to open. The mean length of stay for LAGB removal patients was 2.9 days. 12 patients had post-operative complications: wound infection (58.3%), peritonitis (25.0%), pneumonia (8.3%) and food ball in stomach (8.3%). 38 out of 178 (21.3%) patients then underwent revision bariatric surgery in the form of laparoscopic Roux-en-Y gastric bypass procedures.

Conclusion

Although most primary gastric banding procedures are performed privately, the number of removals under NHS services is increasing. LAGB removal can be successfully performed to ease debilitating symptoms with excellent symptom resolution and minimal peri-operative complications.

Emotional breakthrough and psychedelics: Validation of the Emotional Breakthrough Inventory

BACKGROUND

Psychedelic therapy is gaining recognition and the nature of the psychedelic experience itself has been found to mediate subsequent long-term psychological changes. Much emphasis has been placed on the occurrence of mystical-type experiences in determining long-term responses to psychedelics yet here we demonstrate the importance of another component, namely: emotional breakthrough.

METHODS

Three hundred and seventy-nine participants completed online surveys before and after a planned psychedelic experience. Items pertaining to emotional breakthrough were completed one day after the psychedelic experience, as were items comprising the already validated Mystical Experience Questionnaire and the Challenging Experience Questionnaire. Emotional breakthrough, Mystical Experience Questionnaire and Challenging Experience Questionnaire scores were used to predict changes in well-being (Warwick-Edinburgh Mental Wellbeing Scale) in a subsample of 75 participants with low well-being baseline scores (⩽45).

RESULTS

Factor analyses revealed six emotional breakthrough items with high internal consistency (Cronbach's alpha=0.932) and supported our prior hypothesis that emotional breakthrough is a distinct component of the psychedelic experience. Emotional breakthrough scores behaved dose-dependently, and were higher if the psychedelic was taken with therapeutic planning and intent. Emotional breakthrough, Mystical Experience Questionnaire and Challenging Experience Questionnaire scores combined, significantly predicted subsequent changes in well-being (r=0.45, p=0.0005, n=75), with each scale contributing significant predictive value. Emotional breakthrough and Mystical Experience Questionnaire scores predicted increases in well-being and Challenging Experience Questionnaire scores predicted less increases.

CONCLUSIONS

Here we validate a six-item 'Emotional Breakthrough Inventory'. Emotional breakthrough is an important and distinct component of the acute psychedelic experience that appears to be a key mediator of subsequent longer-term psychological changes. Implications for psychedelic therapy are discussed.