National Institiue for Health and Clinical Excellence

Annual Review - 2012/2013

Introducing safe and effective surgical procedures to the NHS

Our interventional procedures guidance provides recommendations on surgical techniques, to ensure new treatments or diagnostic tests are introduced into the NHS in a responsible way.

Our guidance aims to protect patient safety, and support healthcare professionals working in the NHS who are in the process of introducing new procedures. Many of the procedures we examine are new, but we also investigate more established procedures if there is any uncertainty about how safe they are or how well they work.

All our guidance is developed through an independent Interventional Procedure Advisory Committee, which consists of NHS professionals, and people who are familiar with the issues affecting patients and carers. Advice is considered from specialist advisers, who are nominated by health professional bodies with members involved in the use of interventional procedures.

In 2012/13, we produced 29 pieces of guidance on procedures such as treating varicose veins with foam injections using ultrasound guidance; new ways of treating prostate cancer using freezing and ultrasound; and procedures that use electrical pulses to kill cancer cells.

A full list of procedures we have produced guidance on this year, together with all previous guidance we have issued, is available on our website.

Keyhole surgery for those who are severely obese

This year, NICE produced guidance on a new keyhole operation to support weight-loss in people who are severely obese.

Obesity is growing problem, with the majority of people in the UK either now overweight or obese. Being obese or overweight also has long-term health implications, as it increases the likelihood of certain conditions such as type 2 diabetes and heart disease.

Weight-loss operations are often considered by doctors and their patients when other options such as diet, exercise and medication have proved ineffective. Gastric banding and gastric bypass are the most common weight-loss procedures.

This new procedure examined by NICE, known clinically as laparoscopic gastric plication, involves folding part of the stomach inwards and stitching it together. This reduces the space that holds food in the stomach by up to two-thirds, which in turn lowers a person’s food intake.

There is currently no published evidence from the UK on laparoscopic gastric plication. However, international studies show that it can be a further treatment for people with obesity. For example, in a study of 100 people who had the procedure, half had lost 60 per cent of their excess weight.

Having examined the published studies available, NICE produced the first evidence-based guidance on the procedure, and encouraged further research on it to determine long-term outcomes.

NICE says that clinicians considering the procedure as a further option for their patients with severe obesity in certain cases should:

  • submit data to the National Bariatric Surgery Register and make special arrangements to monitor what happens to their patients after the procedure
  • take special care to explain the uncertainties and risks to their patients before obtaining their consent, such as how it could affect future operations on the stomach
  • inform their clinical governance leads (usually the hospital's medical director) that they would like to perform the procedure.

Professor Bruce Campbell, Chair of the independent committee that develops NICE's interventional procedures guidance, said: “Although there is evidence that laparoscopic gastric plication is safe in the short term and could help people with severe obesity to lose weight, there are a number of uncertainties from the published research regarding its long term implications.

“In particular, we would like to find out whether there are potential risks associated with plication being reversed, how the procedure could affect future operations on the stomach, and whether it really is an effective weight management option long term.”

He added: “Our guidance encourages further research on the procedure for severe obesity by advising doctors to monitor the long-term outcomes of their patients and to submit data to a national register.

“Comparison with alternative procedures would also be useful, so that patients who do require surgery can be offered the most suitable option.”

Our guidance aims to protect patient safety, and support healthcare professionals who are in the process of introducing new procedures