Bariatric surgeons say they are having to carry out emergency procedures on patients who suffered issues after botched treatments in other countries. Waiting lists for other patients here in Ireland are being compounded by the issue.
St Vincent’s University Hospital in Dublin saw a near three-fold increase in the number of people presenting to its emergency department with complications.
Between July 2020 and November 2021, 106 people needed treatment in St Vincent’s for complications, compared to 39 people in the previous 18 months. The mean age of those hospitalised was under 40 and 88pc were women.
Irish people are flocking to Turkey for bariatric procedures in their droves, with medical tourism agencies reporting increases of between 150pc and 220pc in the last year.
Lengthy public health waiting lists and costs of up to €18,000 for weight-loss procedures at private hospitals here are leading people to seek treatment abroad.
Professor Helen Heneghan, a full-time bariatric surgeon with the HSE, warned how young women are being targeted on social media through advertising campaigns promoting ‘refer a friend’ deals for gastric sleeves.
She said bariatric surgery is very safe and can be life-changing for people who are dangerously obese, but she fears people who are not suitable candidates for the procedure, or those who don’t have health insurance, are going abroad as it can be easier to access treatment.
“Some of the patients I had to treat were discharged to a hotel for the rest of their care and healthcare assistants were doing rounds in the hotels, which is completely inappropriate as they were being nursed in a non-clinical environment,” Prof Heneghan said.
“We have a problem with social media changing the narrative, that bariatric surgery is about weight loss, rather than about the huge health benefits and saving lives. It has become almost like a cosmetic intervention.
“Some patients have told me that marketing professionals in these companies have put them under pressure to choose another operation so they get a discount, or are encouraging them to bring a group of friends over so they get a discount.
“I’ve had people who had a nose job along with a sleeve, or they’ve had some skin surgery along with the sleeve – and that’s against all guidelines for safe bariatric surgery”.
Prof Heneghan said one patient told her how her surgery was carried out at 10pm on a Sunday.
“That to me suggests this is all about volume, and about getting through as many cases as possible, which can result in quality being sacrificed.”
The typical death rate from bariatric surgery is one in 1,000, and Prof Heneghan says complications can arise even where the level of care is excellent, but she fears the conveyor system being used in certain health centres abroad is increasing risk.
“I understand why people go abroad with the way things are here. We have people dying on our waiting lists, but that doesn’t get any traction.
“The common themes for going abroad were they couldn’t get surgery in a timely manner here, and the cost of surgery privately in Ireland was too high, or they didn’t have health insurance to cover it. A small number of patients said they went abroad as they didn’t qualify for it here. Their BMI (body mass index) wasn’t heavy enough, as they were almost normal weight, or they wouldn’t have passed the psychology assessment here, and that’s a major red flag as they weren’t suited for it yet they went abroad anyway”.
There are currently 100 people on the waiting list for bariatric surgery in St Vincent’s, with 41 of those waiting more than eight months.
In University Hospital Galway, patients are facing wait times in excess of five years.
Dr Francis Finucane, who leads a regional bariatric service for patients with severe and complicated obesity, said the “utter failure” by the public health system to provide timely access to care for people who need bariatric surgery is leading people abroad.
“Seventy per cent of the patients who are seeking bariatric care have medical cards, so most of them are not in a position to pay for the surgery out of pocket themselves. We have stopped referring people to the waiting list as it’s unethical to refer them to a service that they can’t access.”
Dr Finucane said bariatric surgery is “amazingly effective, life-prolonging and life-enhancing” for patients whose health is at risk due to their weight. He said some centres abroad offer excellent healthcare, but others are less scrupulous than they need to be.
“One has to try and disaggregate the occurrence of the death in a patient with that death arising from the fact they had it in a country such as Turkey. Complications can arise anywhere. It’s worth not tarring surgery abroad with the same brush. It’s often less expensive and that has to be a consideration for people.”
However, while complications also occur after procedures in Irish hospitals, doctors say it is easier to rectify the issue when you have previously performed the original surgery.
Professor Donal O’Shea, clinical lead of the HSE’s national obesity programme, said that while bariatric procedures are safe, there are common complications that arise and it is difficult for doctors here to treat patients who have had surgery abroad.
Patients are presenting with minimal paperwork, often not in English, and surgeons here are becoming increasingly anxious about treating people when they don’t know the background of their medical care abroad.
At least three patients are attending St Vincent’s every week with issues.
“It’s the same in Cork and Galway... it’s becoming a national issue,” he said.
“The most common complication is a leak that happens when they take out a part of the stomach and do some rewiring. That’s potentially life-threatening as you get an infection in your abdomen.
“One of the people in the hospital at the moment had a gastric balloon put in. Balloons are rarely used now. We would have maybe put two in over the last 20 years. It’s a rescue-crisis type of intervention. There is no way this person should have had a balloon put in and be put on a plane two days later.”
Health experts believe the Covid-19 pandemic has increased interest in weight-loss surgery as it made people re-evaluate their health due to being classified as high-risk from the virus.
Dr Colm O’Boyle, a bariatric surgeon at Bon Secours in Cork, has noticed a significant increase in the number of patients seeking surgery in the last year.
“I’m much busier than I was a few years ago,” he said.
Last year, he carried out more than 70 procedures, with the gastric bypass being the most common.
Dr Boyle said an increased number of insurers are covering bariatric procedures in Ireland, which he hopes may deter people from going abroad.
“We’re serving our population very poorly in the public health system, which is part of the reason why they’re going abroad. I think it’s going to get worse before it gets better,” he said. “More people are going to come to harm. This has been rumbling for a while. There’s a higher number of people turning up with complications and that’s going to get more common, in my view.”
The Department of Health advised anyone considering a procedure from a provider outside of Ireland to check with the regulatory authority for medical practitioners in the country to which they intend to travel to confirm they are registered in that country.