Call for register of patients who undergo weight-loss procedures abroad to improve post-op care

The study in the latest edition of the Irish Medical Journal claimed that obesity is a growing pandemic in Ireland with an estimated six out of 10 adults deemed overweight or obese.

Calls have been made for a register of patients who travel outside Ireland for gastric bypasses and other weight-loss surgeries because of the risk that serious post-operative complications can arise.

A research paper in the latest edition of the Irish Medical Journal claimed complications experienced by such patients after returning to Ireland have been placing a huge burden on the country’s already under-resourced healthcare system.

The study outlined four cases of patients needing to go to hospital with acute post-operative complications from what it called “global bariatric tourism”. It estimated the average cost for treating each patient was €12,055 excluding outpatient and emergency department costs.

All four patients, who were classified as obese based on their body mass index, required further surgical intervention to reverse their original weight-loss procedure. The lowest cost for treating one of the patients was €3,297, while the highest cost was €18,219.

In one case, an obese 58-year-old man who had an intra-gastric balloon fitted in Thailand sought treatment in hospital after suffering persistent vomiting for five weeks after the surgery. The man, who had lost 22kg since the insertion of the balloon, required an emergency gastroscopy to remove it.

In another case, a severely obese 49-year-old woman experienced abdominal pain and multiple episodes of vomiting eight years after having a gastric band fitted in Dubai.

An examination in hospital found a gastric perforation and she required drainage of an abscess. The perforation subsequently healed but the woman chose to have elective surgery to remove her gastric band.

The study also documented the case of a 53-year-old man who suffered significant indigestion 12 months after he had surgery in Prague to be fitted with an intra-gastric balloon. It noted he had failed to lose weight since it was fitted and he chose to have the gastric balloon removed.

In the final case, an extremely obese 47-year-old woman reported abdominal pain and a fever eight days after undergoing a gastric bypass in Turkey. Tests showed she had a gastric perforation which resulted in an anastomotic leak that was managed by placement of an endoscopic clip under general anaesthesia.

The study claimed a registry of patients who undergo bariatric procedures outside Ireland would ensure appropriate care post-operatively and facilitate dealing with any complications which might arise. It observed that the lack of such a registry could lead to a lack of appropriate follow-up.

“It would be helpful if formal registration for those patients including the time and location where the surgery took place, the performing surgeon and their contact number, dates of expected follow-up, emergency plans, and most importantly data regarding the details of the weight-loss equipment used as this would potentially improve patient outcomes when dealing with complications,” the study noted.

It claimed that obesity is a growing pandemic in Ireland with an estimated six out of 10 adults deemed overweight or obese. The cost of obesity in Irish adults is estimated at €1.3 billion annually of which €400m is attributed directly to healthcare costs.

The study said only 1 in 100,000 people in Ireland undergo bariatric surgery each year due to the overall lack of resources for such procedures. They are currently only available in two public hospitals in Dublin and Galway and are only offered to patients with a body mass index greater than 40 after non-surgical measures to lose weight have proven unsuccessful.

Researchers pointed out that only 154 bariatric procedures were performed in 2020, according to figures published by the HSE, which — combined with a high demand and long waiting times — had led to medical tourism for such surgery.

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They observed that cheaper weight loss procedures in certain parts of the world had also incentivised some Irish patients to travel abroad for bariatric surgery.

Researchers said the temporary procedure of laparoscopic adjustable gastric banding (LAGB) had become uncommon in Ireland due to its level of complications and sub-optimal long-term results but that patients were still going abroad for such surgery.

The study said such medical tourism posed multiple challenges including the lack of access to adequate information about bariatric procedures which resulted in patients understating the risk associated with such surgery.

It claimed the covid-19 pandemic presented additional problems as some patients had procedures designed as temporary weight-loss measures which lasted longer than intended due to restrictions on travel.