Surgeon warns cheap procedures overseas risk 'potential disaster'

Surgeon Colm O'Boyle speaks outside Cork City Coroner's Court on Thursday. Picture: Denis Boyle

A leading surgeon has warned of the dangers of travelling abroad for “cheap surgery”, especially for cosmetic or gastric-sleeve and band procedures, after the details of three tragic deaths were heard at a coroner’s court.

Colm O’Boyle, a consultant surgeon at the Bon Secours Hospital in Cork, and one of the most experienced bariatric surgeons in Ireland and Britain, said doing surgery, particularly bariatric surgery, in isolation, with little pre-op care and discussion, is “courting with potential disaster”.

There is a general concern both amongst general surgeons and bariatric surgeons in Ireland that the complication rates from surgery abroad are considerably higher than they should be.

"We don't have data. If we had data I think that would go along way towards making people realise how dangerous it is," he said.

He said some of the procedures overseas are cheaper than here but the problem with cheap surgery is “lots of corners are being cut”.

“There appears to be little in the way of clinical governance, evidence of surgical or bariatric team accreditation, or evidence of outcomes in these institutions. Furthermore, there appears to be very little accountability when things go wrong."

He made his comments after Cork City Coroner's Court heard inquests on Thursday into the deaths of three women who had all travelled overseas for surgery — one for gastric band surgery, one for liposuction, and one for stomach cancer surgery.

In a detailed report for Cork City Coroner Philip Comyn, Mr O’Boyle said there is ample anecdotal evidence from Irish patients who have travelled overseas for certain surgical treatments of substandard care and of “questionable operative techniques”.

“There are many hazards related to pursuing surgical intervention in a foreign country,” he said.

“Most medical tourism is based in non-English-speaking countries and is encouraged by attractive low tariffs and shortened waiting times for surgery."

He said the selection process for surgery appears to be based on ability to pay rather than medical appropriateness, with the focus on the surgical procedure and often very little advice, pre-operative selection, and work-up and/or post-op follow-up.

He outlined a range of anecdotal evidence about questionable operative techniques, including:

• Patients being discharged too early;
• Money being exchanged early in the process, putting the patient under pressure to proceed despite reservations;
• Previous patients being offered financial remuneration to promote the institution;
• Patients being persuaded to have another major procedure in addition to bariatric surgery under the same anaesthetic;
• Operations being explained poorly, with consent forms in a foreign language;
• Pre-operative work-up performed on the day before or the day of surgery and only basic blood tests being performed.

Mr O'Boyle cited a shocking case of one patient who met the surgeon for the first time on the day of surgery, was asked about a rare blood disorder on arrival at hospital, resulting in the surgery being cancelled, before the patient's mother was asked if she wanted surgery instead.

In another case, he said a patient with liver failure underwent bariatric surgery and died of liver failure shortly following their return to Ireland, while another had a different procedure to the one they thought they were having.

Complications occur in the best of hands following major surgery. If they occur following major surgery abroad there is an increased risk of patient harm.

He cited sepsis and bleeding, and increased risk of deep venous thrombosis when someone flies soon after major surgery as among the main risks.

He said in cases where complications arise upon a patient’s arrival home in Ireland, the appropriate expertise to deal with them may not be easily accessible.

“There are currently only three surgeons working outside Dublin and five within the Dublin area who can deal properly with bariatric surgical complications and a similar number who can deal with complications of esophagectomy,” he said.