A revolutionary form of stomach surgery is helping thousands of obese Europeans shed weight. Health Editor Barry Nelson discovers why so few such operations are done in the North-East.

KEYHOLE surgeon Hasan Bandi is a frustrated man. He has the rare skills needed to transform the lives of hugely overweight people, but tightly controlled NHS funding means that a relatively new technique known as bariatric surgery - which restricts stomach capacity and fools the brain into eating less - is hardly ever done in the North-East.

Mr Bandi, a laparoscopic (keyhole surgery) specialist at the University Hospital of Hartlepool, carried out what is believed to have been the first such operation in the Teesside area two months ago. He operated on Hartlepool woman in her 30s who was desperate to control her ballooning weight. Weighing 24 stones, the woman underwent a form of surgery which is relatively commonplace in Europe but pretty unusual in the UK.

Carried out using advanced keyhole surgery techniques, it involves making a few small incisions in the abdomen and placing an adjustable, inflatable band around the neck of the stomach. This restricts the amount of food which can be taken into the patient's stomach.

Mr Bandi explains that this reduces the capacity of the stomach from the dimensions of a cabbage down to a large chicken's egg.

Because the sensors which tell the brain that you are full are at the top of the stomach, it means that someone who once would have enjoyed a large blow-out should now feel satisfied after a modest snack. Mr Bandi believes that this procedure, backed up by dietary support, could save the NHS a fortune. It certainly seems to have worked for the first patient, who has already lost three stones.

"Obesity has become a major problem and it is worse in the North than in the South," says Mr Bandi, who has been based at the Hartlepool hospital for a decade. "These overweight patients go to the doctor's surgery with arthritis, hypertension, diabetes and heart failure. Their legs are swollen, they have hernias and they are at increased risk of breast cancer, ovarian cancer, colonic cancer and prostate cancer."

Mr Bandi points out that patients who are carrying excessive weight cost the health service a small fortune in treating weight-related conditions.

"Carrying out bariatric surgery on these patients is a very good investment. It will save the NHS money in the long run because you will not need to treat people for all the conditions I have mentioned," he says.

But because of tight controls on how NHS funds can be spent, it is unlikely that the Hartlepool-based surgeon will be able to help any more patients - unless there is a change of heart.

Health bosses in the region point out that a limited number of bariatric operations are already taking place every year - with the Sunderland Royal Hospital as the designated centre for the Northern region.

However, the bariatric surgery team at Sunderland only have guaranteed funding for a maximum of 12 patients, who must be residents of the Sunderland Primary Care Trust area.

City Hospitals Sunderland NHS Trust officials point out that extra bariatric operations involving North-East patients from outside the Sunderland area have to be individually approved and funded by the host primary care trust as part of a regionwide agreement.

A spokeswoman for the commissioning group said the number of operations could be increased if there was across-the-board consensus from primary care organisations.

Mr Bandi accepts that a small number of procedures are carried out every year in the North-East but argues that he and his colleagues at Hartlepool could also play a part in fighting obesity. "Patients have written to me saying they are desperate to have this form of surgery," he says.

Mr Bandi has been interested in bariatric surgery for a number of years, spending time with specialists in Belgium where surgeons regularly carry out thousands of stomach restricting operations.

"When it comes to this form of surgery, the Europeans are ahead of everybody. For instance, surgeons in Belgium perform around 6,000 bariatric procedures on obese patients every year.

"That is in a population of around ten million. Our population is much, much bigger but we only do about 600 a year and most are in private practice in the London area," he says.

The Hartlepool surgeon is under no illusions about the need for the patient to demonstrate a commitment to losing weight before any surgery is attempted. In Hartlepool, a multi-disciplinary committee has been established to vet prospective patients.

"It includes doctors, dieticians and a clinical psychologist to assess the patient. We have to make sure that the patient is going to help themselves. We have to be convinced that they will comply with the advice on diet and exercise they will be given after the operation."

Mr Bandi feels vindicated by the early results from the first operation in Hartlepool. Apart from shedding a lot of weight very quickly, he says the patient has told him she is "overjoyed" at the prospect of slimming down.

The first procedure cost £1,100 but without additional investment in the trust, there is little likelihood of any further operations of this kind taking place.

Bariatric surgery requires a specially built, specially strengthened reclining operating table with specialist attachments. Mr Bandi estimates that for between £15,000 and £20,000, he could establish a bariatric surgery unit which could help to make an impact on obesity in the Hartlepool area.

A request to establish a bariatric surgery unit has been lodged with the North Tees and Hartlepool Trust but needs approval by the local Primary Care Trust, the body which allocates NHS funding in the town.

Hartlepool PCT director of planning, Lynn Johnson, explains that bariatric surgery is one of a number of specialised services commissioned by the PCT through the Northern Specialist Commissioning Group.

This group includes 19 primary care organisations across the Northern region.

Ms Johnson points out that the nearest bariatric surgery centre for Hartlepool residents is Sunderland and says there are no plans to commission a similar service in the town.

She argues that resources would be better spent on an "obesity prevention agenda" and that bariatric surgery is a last resort for a very small number of patients.

Carole Johnson, health development team leader for Hartlepool Primary Care Trust, says obesity is "very high" on the agenda of Hartlepool but that the emphasis has to be on prevention and on the many, not the few.

"We are organising weight management training schemes and trying to get local volunteers interested in running them. We want these projects, which emphasise healthy eating and physical exercise, to be sustainable in the long run," she says.

In the Hartlepool area, many people have signed up to walking groups or Tai Chi exercise sessions. For residents who have poor access to fresh fruit and vegetables, a scheme is operating which involves distributing heavily discounted healthy farm produce to easily accessible locations such as community centres.

"There are individuals who have reached the point where they might need surgery but we want to catch people who are overweight before they are obese," says Ms Johnson.

"We are also very keen on improving school meals and the company which has the local school meals contract is a member of our obesity group."

So unless there is a change of heart at a regional NHS level, it looks as if Mr Bandi may have to stick to removing gall bladders and fixing hernias.

He points out that, ironically, the company which manufactures the specially strengthened bariatric surgery operating tables - and ships them around the wo rld - is based in Sunderland.