Tag: <span>Surgery</span>

The Irish Times ran an article this week entitled Flawed weight-loss operations abroad creating ‘huge problem’

The article states that there is currently a waiting list of over 400 people in Ireland needing bariatric surgery, and that some of those people are accessing faster treatment by paying for surgery abroad, in places like Turkey and eastern Europe.

However it seems that some patients are experiencing complications when they get back to Ireland, and according to my surgeon Prof Helen Heneghan, who works at St Vincent’s Hospital Dublin, they are presenting to Irish hospitals and need urgent surgery to correct problems.

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.

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.

The answer, of course, is to increase the funding and capacity for bariatric treatment in the public hospitals here in Ireland, where the current average waiting time for surgery is 6 years!

If people could be treated for their obesity more quickly, they wouldn’t have to resort to paying thousands or euros to use a private clinic abroad.

News Surgery

A laparoscopic adjustable gastric band (or lap band) is an inflatable device that is placed around the top of the stomach.

The band presses into the stomach to form a small pouch, and helps restrict the amount of food that can be consumed. The band pressure is adjusted by injecting fluid into the band – often via a port that is fitted just beneath the skin.

Adjustable Gastric Band
By Xopusmagnumx at English Wikipedia, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=10492156

Pros

  • The Gastric Band is considered to be the safest and least invasive of all the weight loss surgeries
  • Patients typically have a shorter stay in hospital, a quicker recovery time, and have smaller scars and less pain afterwards
  • There is no permanent changes to the human body, and it is totally reversible
  • The band can be adjusted (tightened or loosened) at any time after surgery without further surgery
  • There are fewer problems with vitamin deficiencies in comparison to other bariatric procedures

Cons

  • Gastric bands have a slower weight loss than other gastric surgeries, and worse overall weight loss outcomes
  • Sometimes the band can end up scarring of the stomach, or even erode into it
  • Sometimes it can slip out of place or leak and become ineffective
  • Many surgeons do not recommend them any more because of complications and them being less effective than bypasses and sleeves
  • According to a study about complications, 50% of gastric band patients require a further operation, including 25% who experience major late complications – and 73% of patients saying they wouldn’t chose a gastric band again

My surgeon doesn’t fit gastric bands any more, although there are others in Ireland that are still performing the procedure. Some people also choose to get the surgery abroad because it’s cheaper.

Personally, I never considered it as an option, because I’ve heard too many horror stories – about people who have had complications, or people that put all the weight back on again, and eventually opted to have the band removed and get a gastric bypass or sleeve instead.

Surgery

One of the things I’ve learned from reading the Facebook groups is that there’s a lot of Irish people going abroad to get bariatric surgery.

The waiting list for getting weight loss surgery on the public health system is often years, and for those that don’t have private health insurance and are willing to self-pay, then the cheaper surgical prices abroad can seem tempting.

If you have private health insurance in Ireland, and you meet the requirements such as having a BMI over 40, then you will most likely be covered for surgery. However if you don’t have insurance, or you don’t meet the requirements, then the standard cost of around €15,000 in the Irish private hospitals for a gastric bypass can prompt people to look for cheaper options.

Some of the prices quoted for gastric sleeves and bypasses are in the range:

  • Turkey – €2,975 to €3,400
  • Lithuania – €5,500
  • Latvia – €5,370
  • Czech Republic – €4,500
  • Belgium – €4,300
  • Poland – €6,000

All of those prices are significantly cheaper than Ireland – even when you add the cost of flights on top!

Dr Bodnar in Letterkenny

Another option closer to home is a Dr Bodnar who operates out of Letterkenny General Hospital. He is reported to perform gastric sleeves for around €6,000 and gastric bypasses for €7,500.

That might be an option for people who worry about travelling abroad.

Surgery

As I reflect on the past year, it’s with mixed feelings.

For many people it’s been a horrible desperate year. The COVID-19 virus has impacted everyone, through sickness, loss of a livelihood, or impacts on physical or mental health. Many have lost loved ones and haven’t even been able to attend their funeral. Many saw their work for the whole year disappear overnight. Others have stuggled with anxiety, stress, and depression about the uncertain future.

I suppose I’ve been luckier than most. I’ve not been sick with COVID-19, and thankfully all my family are safe and well. I’ve managed to keep working and earning throughout the year, albeit from home. And although I have suffered from anxiety and sleep problems, it has been managed successfully with medication and the support of my GP.

I also feed incredibly lucky to have had my bariatric surgery this year.

The surgery was originally planned for March, but was posponed when the HSE took over the running of the private hospitals during the first wave of infections. Luckily the COVID infection rates dropped, and private hospitals were able to resume performing their elective procedures.

My gastric bypass finally took place in late August, and since then I’ve been getting used to life with my smaller stomach.

In a way it’s actually been easier to deal with everything that came after surgery during the COVID lockdown. Because I’ve been working from home and there’s been no social occasions out in restaurants, I’ve eaten almost all my meals this year at home. I’ve been able to control my portions, eat healthily foods, and track all the macro-ingredients to ensure I’ve been getting enough protein and nutrients in my diet.

I haven’t had to scan through menus desperately looking for a healthy option. I haven’t had to field questions about why I’m eating so slowly or why I haven’t finished all the food on the plate. I’ve been able to get used to the new way of eating at home, in a safe and supportive environment.

I’m also lucky and extremely grateful that extended family and friends have been so positive in their support of my weight loss surgery over the last year.

I’ve ended the year a lot lighter and healthier than how I began it, and that’s the major positive outcome for me of the year 2020!

And of course I plan to continue losing weight and focusing on my health throughout the coming year in 2021.

My Story Surgery

There’s a common perception amongst some people that having weight loss surgery is somehow the easy option or a cheat. However it’s definitely not the easy way out. It involves a lot of hard work and a lifetime commitment.

Misunderstanding

Part of the problem is that people often misunderstand what weight loss surgery is. They sometime think of it as a type of cosmetic surgery, a bit like liposuction, where an obese person will go in for an operation – have huge amounts of fat taken out – and wake up a few hours later 50kg lighter!

That’s definitely not the case.

The surgery itself doesn’t reduce a patient’s weight at all. It reduces the size of a person’s stomach, often to about the size of a golf ball, and also reduces the absorption of nutrients from food. So it’s not the surgery that reduces someone’s weight, but a very restricted diet they must follow after surgery.

So it’s not a quick fix. It’s a lengthy and difficult process that can take a year or more for someone to lose their excess weight.

Stigma

There’s also a lot of social stigma attached to weight loss surgery. Some people have the opinion that if a overweight person just stopped eating so much and exercised a bit more they wouldn’t need to have surgery. They see overweight people as lacking sufficient character or willpower to lose weight on their own.

They don’t comprehend the struggles that overweight people have gone through, over many years, with managing their weight and with yo-yo dieting. They don’t see the psychological and emotional issues around overeating, and they don’t have to live with the shame attached with being an overweight person.

This fear of negative reactions or being judged forces a lot of bariatric patients to keep their surgery secret. And this secrecy only adds to the stigma, because people don’t hear about others having weight loss surgery.

Then there’s also all the lurid headlines we see in the press where they will ‘out’ a celebrity as having bariatric surgery, and pick apart all kinds of private details about their weight management struggles and personal life.

Invasive

The surgery itself is not particularly dangerous – no more dangerous than having a gallbladder operation. It’s mostly done laparoscopically by making 5 small incisions at the top of the belly. However, it’s still invasive surgery, done under a general anaesthetic, requiring a couple of nights in hospital, and is very painful to recover from.

The wounds take a number of weeks to heal and are painful. Patients are also put on a very restrictive diet to stop potential damage to their new stomachs – normally liquids only for a few days, and after that blended/pureed food (think: baby food).

People also need a number of weeks off work to recover.

Hard work

The surgery itself is only the start of a hard journey. The smaller stomach is a tool that can be used to help lose weight. It will make people feel full a lot quicker, and will reduce the amount of nutrients that are absorbed from food. However the restricted diet is the hard work.

People that have had bariatric surgery typically can only eat a starter-sized portion of food at each meal. However they must also try to consume as much protein as possible, and avoid carbs and sugar as much as possible as they will make them sick. And because of the reduced absorption they will need to take multivitamins and other supplements for the rest of their lives.

And just think of all the social occasions that are linked to food: meals out with friends or colleagues, weddings, family gatherings, birthday parties, Christmas, and other celebrations. Someone who has had weight loss surgery will not be able to eat the same amount of food like everyone else. They will only manage a small portion. There are no ‘cheat days’ where they can pig out on a huge pizza and ice cream.

There’s also the social awkwardness of trying to order a starter while everyone else has main courses. Or having to deal with the questions from waiting staff when more than half the food goes uneaten on the plate. Or from well-meaning relatives that get insulted when you turn down their food.

Complications

As with any surgery, there’s always the risk that something might go wrong. It’s possible that the new stomach might leak, or there will be internal bleeding. Other complications may present themselves months or even years after, and necessitate additional revision or corrective surgery.

It’s also possible that over time the new stomach pouch might stretch, which reduces it’s effectiveness at helping to manage weight.

There’s also the unaddressed psychological and emotional issues that led to someone overeating in the past. Without food to act as a comfort these issues will need to be addressed, which might be difficult.

So, all in all, when you consider all of this, weight loss surgery is definitely not the easy option. It’s a lot of hard work, and a lifetime commitment.

Surgery Weight

My gastric bypass took place on Thursday afternoon, and it all appears to have gone very well.

My surgeon is very pleased with how it went. She was previously concerned that there might be some scarring of the top of my stomach from radiotherapy to my lungs a few years ago. She said that if the stomach was damaged then she would have to give me a sleeve rather than a bypass, but it turned out not to be too bad, and I had the bypass as planned.

On the day itself I was wheeled directly into the operating theatre and stepped over to the table myself. The anaesthetist then put me under, and I don´t remember anything else until I woke up in the HDU (High Dependency Unit) in the early evening. My surgeon puts all her bariatric patients in the HDU for the first night, so that they get constant monitoring from staff.

The HDU wasn´t much fun itself. It was noisy with people coming and going, and with machines beeping constantly. I had a blood pressure cuff on that automatically activated every 30 minutes, and I had an IV line in for fluids. And with all that going on overnight, I didn´t get any sleep.

I was thankful the next day to be disconnected from all the machines, allowed to go to the toilet for the first time, and also to be taken to the ward – and to the blissful peace of a private room! Oh, the joys of private hospitals!

My instinct was to sleep, but I had been put on a regime of hydration. Every hour I had to drink 30ml of some stuff called Cubitan (a high protein high energy drink which I grew to loath, due to its sweet sickly taste), and on the half hour I had to drink 60ml of water. This might not sound too difficult, but it was quite hard getting all that liquid down when you can only take small sips. The activity took up pretty much my whole day from 9am to 10pm.

However I was delighted to be able to be out of bed and free to move around. Indeed the surgeon was keep for me to move as much as possible.

The pain was pretty bad, particularly on my left hand side. I had to ask for pain relief a few times. I found that giving the nurses a score out of 10 to describe how bad the pain was helped with getting the right medication.

When I was sat still or laid on my back the pain wasn’t too bad. It was when I tried to move or lie on my side that the pain was really bad. And I don’t really like sleeping on my back, so that was a bit of a problem.

Luckily I was dosed up with good pain relief that night, and finally managed to get a good night’s sleep.

The next day (surgery + 2 days) I was moved from the water / cubitan onto a full liquid diet. So that was runny porridge and milk for breakfast, and some pureed chicken and vegetables (essentially baby food) for lunch. Plus, of course, drinking as much water as possible.

And because I was tollerating all of that quite well, I was allowed to go home that afternoon – about 48 hours after surgery.

Surgery