Call for creation of register logging patients having weight-loss surgery abroad

A group of medics have called for the creation of a national register of patients who have undergone weight-loss surgery abroad.

The call was made in the July-August edition of the Irish Medical Journal (IMJ), which details the post-operative complications of four patients who had travelled overseas to have bariatric procedures including the insertion of gastric bands and balloons.

The medics state that there is “a significant risk of complications if appropriate post-operative care is not available” and that a register would make it easier to keep track of who has had such procedures abroad.

A register should, they argue, include the date and location where the surgery took place, contact details for the surgeon who carried out the procedure, and details of the weight loss equipment used.

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Having this information would, they say, also help to estimate the annual cost to the HSE of bariatric medical tourism, which “carries a significant burden to the Irish healthcare system” due to post-operative complications.

In their paper, entitled ‘Challenges associated with Global Bariatric Medical Tourism’, the authors estimate that the cumulative cost to the HSE of treating the four patients’ post-operative complications totalled €48,129, excluding outpatient and emergency department costs.

In one of the cases documented, a man (58) presented to his local emergency department with persistent and progressive vomiting five weeks after having an intra-gastric balloon inserted during a procedure in Thailand.

It says the man, a non-smoker and occasional drinker, had lost 22kg since the insertion of the balloon. An exam found that the gastric balloon was blocking a gastric outlet and, after other efforts to help him failed, he had emergency surgery under general anaesthetic to have the balloon removed.

In a second case, a woman (49) was admitted to an Irish bariatric centre reporting pain radiating from her left shoulder and multiple episodes of vomiting.

The woman had a gastric band inserted in Dubai eight years previous and had developed an abscess, which was drained. However, the woman continued to show symptoms of abdominal pain and ultimately had the gastric band removed.

The third case related to a man (53) who had complications after having a gastric balloon inserted one year earlier in the Czech Republic. He failed to lose any weight and the balloon caused him significant indigestion, but Covid-19 travel restrictions prevented him from travelling to Prague to have it removed at the time. The procedure was carried out at an Irish bariatric centre.

In the fourth case, a woman (47) presented with abdominal pain eight days after undergoing a gastric bypass in Turkey. She returned to Ireland five days after surgery and developed a sharp pain. An examination detected a leak at the woman’s suture line and she required surgery under general aesthetic to resolve the leak with an endoscopic clip.

The medics state in the paper that limited access to bariatric surgery in the State has led to significant waiting times for patient and the availability of cheaper weight loss procedures overseas has incentivised patients to travel for bariatric surgery.

The medics state a big challenge associated with bariatric tourism relates to the poor provision of information, which can result in patients underestimating the risks associated with such surgeries.