Flawed weight-loss operations abroad creating ‘huge problem’

Irish surgeons are reporting a massive increase in patients requiring treatment for complications from botched weight-loss operations abroad.

It is only a matter of time before a patient dies from complications of weight-loss surgery in unregulated foreign clinics, the only full-time bariatric surgeon in the Health Service Executive has warned.

"It's a huge problem. Patients are presenting everywhere in the system with devastating yet avoidable complications of their surgery," said Prof Helen Heneghan, from St Vincent's University Hospital in Dublin.

With over 400 people on the waiting list for bariatric surgery in Ireland, desperate patients are resorting to the private sector, often abroad, for faster treatment.

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But surgeons say some clinics, particularly in Turkey and eastern Europe, are unscrupulously treating all comers, whether they are suitable for treatment or not.

“Patients are not prepared properly. There’s no selection process. You or I could ring up a clinic and get a date for an operation next week, whether we’re suitable or not,” Prof Heneghan says.

She estimates eight to 10 patients a week are presenting at Irish hospitals with complications of bariatric surgery carried out abroad, with numbers doubling over the past 18 months.

‘Life-changing’ problems

It cost St Vincent’s, the main centre for bariatric surgery in the Republic, €1 million to treat 90 patients arriving with complications over the past four years, the hospital recently calculated.

At Tallaght University Hospital, Prof Paul Ridgway estimates he is now carrying out about "one to two" bariatric repairs a week, compared to one a month before the pandemic. "We're seeing people coming straight off the plane with potentially life-changing complications."

Among the issues identified by Irish surgeons with some foreign clinics are the provision of post-op in hotels rather than a hospital; a strict discharge on the appointed date rather than according to the patient’s condition; and a lack of follow-up services.

Often, says Prof Heneghan, patients are told to go to the emergency department if they have problems: “Clinicians who do this are failing patients on multiple levels.”

With prices as low as one-quarter of private-sector operations in Ireland, some clinics may be “cutting corners” possibly by reusing equipment, Prof Heneghan believes.

Pain and nausea

The complications observed range from pain and nausea, and a lack of information about how to eat after their operation, to more serious mechanical problems.

Many suffer leaks where their stomach doesn’t seal, or stitches haven’t healed, after the operation. Bowel blockages and clots have also required treatment.

Prof Heneghan says there is a big market for gastric balloons, one of the cheapest procedures. These are supposed to be removed within 12 months but she says she has seen a lot of patients with balloons “ready to burst”.

She describes the willingness of some clinics to carry out operations on pregnant women as “negligent”.

Some clinics offer “add-in deals” for nose jobs, discounts for multiple procedures and for family referrals, she says, adding: “some are no better than a Ponzi scheme”.

The solution to the problem is to provide sufficient surgery in the Irish public system, where the current average waiting time is about six years, according to Prof Heneghan.

“It’s unacceptable. We have patients dying on the waiting list. If transplant patients had to wait this long, it would make front-page news and resources would be provided. But because it’s obesity, nothing is done about it. We just tell people to lose weight, but that doesn’t work for these patients.”