MEDICS HAVE CALLED for the need for a national registry of patients who have undergone weight-loss surgery overseas after a new study documenting four Irish people who had procedures done.

In the July-August edition of the Irish Medical Journal (IMJ), the medics have made the call after detailing post operative complications of patients here who had bariatric procedures.

Bariatric surgery, which includes gastric bands and gastric balloons, involves making changes to the digestive system to help with weight loss.

The medics state that “having a registry of patients who have bariatric procedures elsewhere will ensure appropriate care post operatively and facilitate dealing with post operative complications if they arise”.

They state that global bariatric procedures “can carry a significant risk of complications if appropriate post operative care is not available”.

The medics state that such a national register should include the time and location where the surgery took place, the performing surgeon and contact details and most importantly details of the weight loss equipment used.

The medics state that such details would also help in estimating the annual cost of bariatric medical tourism to the HSE.

The medics state the management of post operative Bariatric surgery complications “carries a significant burden to the Irish healthcare system thereby requiring regulations to control post operative complications”.

In their new paper, ‘Challenges associated with Global Bariatric Medical Tourism’, the authors state that the estimated cumulative cost to the HSE of treating the post operative complications of the four totalled €48,129 ranging from €3,296 in one case to €18,219 in the most costly case.

The medics state “when complications arise, the cost is borne by the HSE”.

Estimated costs in the study exclude outpatient and emergency department costs.

In one of the cases documented, the medics report that a 58 year old man presented to his local emergency department with persistent and progressive vomiting for five weeks after having an intra gastric balloon inserted during a procedure in Thailand.

The medics report that the man had lost 22kg since the insertion of the balloon – he was a non-smoker and an occasional drinker.

An exam found that the gastric balloon was blocking a gastric outlet and a trial of conservative management with oral fluids over eight days aimed at moving the balloon away from the gastric outlet failed.

As a result, the man underwent emergency surgery under general anaesthetic to have the gastric balloon removed. The man had an uneventful post operative recovery.

In a second case, a 49 year old woman was admitted to a Bariatric Centre here in pain radiating from her left shoulder and multiple episodes of vomiting.

The medics report that the woman had a gastric band inserted in Dubai eight years previous and had developed an abscess. The patient underwent drainage of the abscess.

However, as the woman continued to show symptoms of abdominal pain, she had the gastric band removed here and discharged the next day.

In the third case documented, a 53 year old man was referred to a Bariatric Centre here after having a gastric balloon inserted one year prior in Prague.

However, the man failed to lose any weight and the balloon continued to cause significant indigestion.

The man was due to return to Prague to have the balloon removed but was unable to do so due to Covid-19 travel restrictions. As a result, he had the balloon removed at the Bariatric Centre.

In the fourth case, a 47 year old female patient presented with abdominal pain eight days after undergoing a gastric by-pass in Turkey.

On returning to Ireland five days after surgery, the woman developed a sharp pain and a subsequent examination found that a leak at the woman’s suture line from her gastric by-pass procedure.

The woman remained in hospital for two weeks here and underwent surgery here under general aesthetic surgery to resolve the leak with an endoscopic clip.

The medics state that limited access to bariatric surgery here has led to significant waiting times and cheaper weight loss procedures overseas have incentivised patients to seek bariatric surgery abroad.

The medics state that there are multiple challenges associated with global bariatric tourism including inadequate information resulting in patients under-estimating the risks associated with bariatric surgery.