Credit score: Worldwide Journal of Surgical procedure (2024). DOI: 10.1097/JS9.0000000000002171
Weight problems surgical procedure (often known as bariatric and metabolic surgical procedure) is without doubt one of the commonest causes folks have interaction in so-called “medical tourism”—the place they journey to a different nation for a process often supplied a a lot lower cost than of their house nation.
Nonetheless, such procedures can generally be botched and result in infections, momentary or everlasting accidents and/or scarring, and within the worst circumstances, could be deadly. In Europe, there may be at present no revealed knowledge evaluating the best way to enhance the protection of weight problems surgical procedure medical tourism.
In search of such a weight problems surgical procedure medical tourism is especially frequent for folks residing within the U.Ok. and Eire on account of lengthy ready lists for weight problems surgical procedure, which generally attain a number of years within the state well being techniques of those international locations. Throughout the U.Ok. there are possible hundreds of circumstances yearly, however it is rather tough to get correct estimates as such a medical tourism is unregulated, and well being care professionals within the U.Ok. will generally not obtain the discharge letters / operative notes from wherever the surgical procedure has taken place.
A collaboration between key organizations within the area—The European Affiliation for the Research of Weight problems (EASO), the Worldwide Federation for Surgical procedure of Weight problems and Metabolic Problems European Chapter (IFSO-EC) and the European Collation for Folks Dwelling with Weight problems (ECPO)—has gathered opinions from members of all three organizations to conform to a set of requirements to use to medical tourism within the context of weight problems surgical procedure.
Their consensus paper is revealed within the Worldwide Journal of Surgical procedure, and its authors embody Dr. Laurence Dobbie, Nationwide Institute for Well being and Care Analysis (NIHR) Educational Scientific Fellow in Basic Apply, Faculty of Life Course & Inhabitants Sciences, Kings Faculty London, UK; Professor Volkan Yumuk, President of the EASO and based mostly at Istanbul College-Cerrahpaşa, Cerrahpaşa Medical School, Istanbul, Turkey; and bariatric surgeons Professor Ralph Peterli, St. Clara Hospital and College Hospital, Basel, Switzerland and Professor Barbara McGowan, co-chair of EASO’s Weight problems Administration Activity Drive; and Susie Birney, Operations Director at ECPO, Dublin, Eire.
IFSO-EC, EASO and ECPO initiated a process drive to delineate protected practices in weight problems surgical procedure. Two professional European panels have been convened, one comprised of well being care professionals (recognized from EASO and IFSO-EC) and the opposite of affected person representatives (recognized from ECPO). A complete of 119 well being care professionals and 88 affected person representatives participated from 26 international locations.
The well being care skilled panel included 66 bariatric surgeons, 28 endocrinologists, 18 dietitians, three nurses, two psychologists, one normal practitioner and one gastroenterologist. A complete of 135 questions on weight problems surgical procedure practices and suggestions have been put to the specialists, and consensus was outlined as 70% settlement.
The suggestions have been divided into six areas, and included:
Regulation
Bariatric and metabolic surgical procedure in Europe ought to solely be carried out at facilities of weight problems administration that are accredited by both EASO (The European Affiliation for the Research of Weight problems) or the nation’s consultant nationwide Bariatric and Metabolic surgical procedure (BMS) society or Surgical society.
Solely surgical procedures/strategies that are accredited by both IFSO (Worldwide Federation for the Surgical procedure of Weight problems and Metabolic Problems) or a Nationwide Bariatric and Metabolic Surgical procedure society, which usually evaluates surgical procedures, ought to be carried out within the context of surgical tourism.
Bariatric and metabolic surgical procedures within the phases of analysis improvement shouldn’t be carried out within the context of medical tourism.
Provision of care
Within the context of surgical tourism, bariatric follow-up ought to be supplied for twoyears by the unit performing the surgical procedure.
Previous to bariatric surgical procedure, sufferers ought to be supplied with clear details about the dangers and advantages of the surgical procedure, together with the elevated threat of getting this surgical procedure away from house, earlier than touring overseas.
Sufferers ought to have written and verbal consent taken previous to bariatric and metabolic surgical procedure
Eligibility
Within the context of medical tourism, sufferers with BMI 2 shouldn’t endure bariatric and metabolic surgical procedure.
A duplicate of the affected person’s medical information, from the affected person’s house nation, ought to be assessed for the medical historical past, previous to continuing with bariatric surgical procedure overseas.
Operative care questions
Within the context of medical tourism, sufferers ought to keep at the least 5 days post-operatively within the geographical location of the bariatric and metabolic surgical procedure earlier than touring house.
Within the context of medical tourism, the working bariatric surgeon ought to liaise with the affected person’s treating physician/normal practitioner of their house nation to facilitate follow-up.
Sufferers ought to be suggested on the adjustments within the absorption of some drugs (i.e., anti-epileptics, anticoagulants, psychotropic drugs) following bariatric and metabolic surgical procedure.
Within the context of medical tourism, when sufferers have vital problems following bariatric and metabolic surgical procedure, they need to solely be cleared to journey house by their treating bariatric surgical group as soon as these have been addressed.
Promoting and on-line info
When discounted charges or particular provides for bariatric and metabolic surgical procedure are supplied by bariatric facilities, this raises concern in regards to the high quality of the care supplied.
Bariatric facilities ought to present publicly accessible info relating to the monetary value and required cost strategies for bariatric surgical procedure at their website.
Bariatric facilities ought to present publicly accessible info relating to the kind of accreditation their surgeons have (i.e., worldwide or nationwide accreditation and what establishment has awarded it).
Affected person consultant panel outcomes
Sufferers have to be knowledgeable whether or not the bariatric surgical procedure being supplied is internationally acknowledged.
Sufferers have to be supplied with all related medical documentation from their bariatric surgical procedure to permit them to have protected follow-up of their house nation.
Sufferers have to be supplied with a translator if they can’t converse the identical language as their bariatric surgeon.
Amongst their conclusions, the authors say, “We advocate a number of facets in offering bariatric surgical care overseas, aligning with worldwide requirements. Surgical models ought to present at the least two years of follow-up, consistent with revealed literature.
“The multi-disciplinary group (MDT) is central to bariatric care; we advocate MDT evaluation for all sufferers present process weight problems surgical procedure overseas. We advocate an higher gastrointestinal endoscopic analysis earlier than weight problems surgical procedure, as a latest examine reveals sufferers present process weight problems surgical procedure have varied endoscopic pathologies, probably impacting process alternative.
“For lifestyle, we recommend pre-operative alcohol screening and counseling on limiting alcohol intake pre- and post-operatively due to the increased risk of alcohol use problems following obesity surgery.”
Dr. Dobbie says, “Throughout Europe, folks residing with weight problems typically wait a number of years, or lack entry fully, to weight problems surgical procedure of their house international locations, prompting many to hunt remedy overseas. Sadly, a few of these suppliers fail to fulfill primary requirements of care, leading to critical accidents and, tragically, even dying.
“These new guidelines—developed in collaboration with health care professionals and patients from across Europe—set out clear standards for obesity surgery in the medical tourism sector, with the aim of improving patient safety and preventing further harm.”
EASO President Professor Yumuk says, “”There have been too many circumstances of poorly carried out, and in some circumstances, unsafe weight problems surgical procedure carried out overseas beneath what we might name medical tourism. In producing these tips, the weight problems group has come collectively to verify weight problems surgical procedure in Europe is protected and meets acceptable requirements, wherever it takes place.”
Dr. Peterli says, “For my part, the interdisciplinary and interprofessional work concerned within the improvement of this consensus paper was essential to be able to defend sufferers if they don’t obtain immediate and competent assist in their very own nation for the remedy of extreme weight problems.
“At the same time, it was also very instructive for me to learn about the most important aspects of the problem together with patient organizations and those affected. However, we will have to continue to work together to eliminate or at least minimize the negative effects of surgical tourism, while acknowledging there is also serious surgical tourism that is positive for those affected.”
Professor McGowan provides, “This is an important consensus which highlights the standards people should expect when considering bariatric surgery abroad. It aims to increase awareness of safety considerations and the importance of post-operative after care. I am pleased to be part of this important work which we hope will reduce complications and improve outcomes for patients.”
Susie Birney, Operations Director at ECPO, Dublin, Eire, says, “Affected person security is our precedence and sadly a lot of our council members could have quite a few accounts of their members from throughout Europe who’ve had unlucky incidents whereas in search of surgical procedure overseas.
“What is even more disturbing is the knowledge that there are many more stories untold because people feel stigmatized and judged for their actions. This is a time when patients need support and guidance and it is important to see this consensus highlight the minimum standards patients should demand, and deserve, when it comes to treatment.”
Extra info:
Laurence J Dobbie et al, European suggestions from well being care professionals and folks residing with weight problems on protected observe for bariatric and metabolic surgical procedure medical tourism: a modified delphi consensus assertion from EASO, IFSO-EC and ECPO, Worldwide Journal of Surgical procedure (2024). DOI: 10.1097/JS9.0000000000002171
Supplied by
European Affiliation for the Research of Weight problems
Quotation:
Weight problems surgical procedure tourism—solely accepted facilities ought to be finishing up acknowledged procedures, say researchers (2025, February 19)
retrieved 20 February 2025
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