First things first. If it looks to good to be true, it probably is. If you are thinking of getting elective surgery in Mexico,  going for the cheapest price is asking for trouble. A little more though should be invested in this process, after all this is your life and well being we are talking about. Just like in the United States, Mexico offers a wide range of quality and price points, from very reputable centers  all the way to shady take your money and run establishments and everything in between. So if price is the only selection criteria for you, don’t say I didn’t warn you. When selecting a destination you need to look at the center or hospital, the practice and the surgeons. Centers can have the highest recognition by valid organizations established in the U.S. such as the prestigious Centers of Excellence in Bariatric Surgery. Only two centers in Mexico have that distinction, but at least you know you will be getting the same quality as you would in the top centers in the U.S. Check out the facility, go online, talk to others. The practice will have qualified surgeons, by this I mean not only will they have all their official credentials available to you, they usually have distinctions like being a fellow of the American College of Surgeons, member or fellow of the American Society of Bariatric Surgery, recognition as professors in their field, frequent lecturers at international settings  etc. This information is usually available in their own website as well as the organizations they are affiliated to. Lastly a quick google search will typically give you a general idea of their reputation. Every practice, center and doctor is going to have patient complaints once in a while, but this is usually the exception not the norm. If complaints are heard left and right, don’t touch with a ten foot pole.

Be careful when you book through surgery brokers. They offer the cheapest prices. Then they take their cut. Then of course the hospital has to get paid, that is when they start cutting corners to make a profit. By the time you reach the surgeon, he is on a weekly salary and doesn’t really care about your final outcome. He just want to hurry up and get back home.

It is easy to find a reputable center. Look at their websites. Practices that reinvest in their online material are sure to also have good followup and customer service. If they are only eager to take your money but offer poor follow-up you might as well burn your money.

Use your common sense. Going out of the country for surgery is not easy especially when you here misleading comments from your ignorant friends about the quality of healthcare in Mexico. Don’t select only by price, if you do you may end up paying with dear life.

This is not the first live surgery that has been transmitted in the surgical field, in fact this trend started a decade ago, when laparoscopy (keyhole surgery) started to gain popularity. It is simply the interposing of a camera and lens going into the body creating the surgical view on a screen for everybody in the operating room to see. This technology is what facilitated the use of keyhole incisions. Before this era, the view was limited to the eyes of the surgeon standing directly overhead of the surgical field. Now you connect that same camera to the internet and presto, live surgery through modern communications.

This was a historic event for OCC and the staff. Surgery was transmitted live for about an hour from the state of art operating room in OCC’s Centers of Excellence Hospital. Over 2,500 invitations to join this event online were sent. We had surgeons attend from every corner of the world. At one point, questions to Dr. Ortiz and his team were asked real-time from Russia, China, Japan, Canada, USA and other countries. The procedure being performed was a Gastric Plication and the video transmission was of great quality. It was such a success that we have received numerous additional requests to transmit live surgery by Dr. Ortiz to other prestigious venues.

Check out the amazing 3D Graphics and video material:  http://vimeo.com/31466940

In my fifteen years of practice I have personally seen over 10 thousand patients come to Mexico for Weight-loss surgery. In the early ninety’s it was the lack of options for certain weight-loss procedures in the U.S. that drove patients to seek healthcare elsewhere. Gastric Banding was widely available in Mexico and Europe and remained experimental in the U.S. until 2001. We are seeing this again with the new Gastric Plication Surgery still not readily available in the U.S. today.  The additional restrictions imposed by the FDA on Body Mass Index (Lower weight patient did not qualify for surgery) as well as extremely challenging insurance coverage policies denying crucial and life saving procedures have helped increased the flow of patients traveling for their care abroad. The recession and economic crisis affecting most American homes and the inaccessible cost of healthcare in the U.S. are the  compounding factors that have helped increase health tourism to an all time high. Global healthcare refers to the medical resources available to patients around the world. Physicians cannot see healthcare as an independent entity that ends where the borders begin. We have an obligation to treat patients and follow-them up independently of their nationality, race, beliefs as well as where their treatment originally was started or where their final destination will be. I can only tell you how it saddens me to see patients being refused medical treatment because they opted for a more affordable or more qualified option and traveled outside the U.S. for medical attention. Refusal to treat patients on that basis is not only unethical it is inhumane.

The outlook on healthcare in the U.S. is not a good one. A broken system has been deemed unfixable. A system where the foundation is the insurance carrier who is out to make a profit, not spend it on your health. The more you think about it, the more traveling for healthcare seems a logical and sensible answer to a complex problem. It’s a void that nobody else is willing or able to fill.

More and more Canadians are seeking weight-loss surgery and in a government run health system 2 or more years waiting list is not unusual. Another challenge faced by Canadians is that heir procedure of choice may not be available in their region.

Surgery is not seen as a last resort  for weight-loss as it once was, it is now widely accepted as what it really is: a permanent treatment for obesity which is proven to be a life threatening disease. Obesity is an world wide epidemic, and is especially prevalent in North America where Mexico and the USA are in the leading spots with Canada rapidly closing in. At Obesity Control Center we have specialized in patients traveling outside their country for  weight-loss surgery (WLS). In fact over 10,000 patients from the USA and Canada have had some type of WLS at our center. Many have gone on to lose all their excess weight and return for Plastic Surgery mainly to address the excess lose skin resulting from massive weight-loss. I have recently seen a increase in Canadian patients at our center. said Dr Ortiz, Director and Cheif of Bariatric Surgery at OCC a United States certified Center of excellence in Mexico. Canadians may find it nearly impossible to schedule a WLS in their own country and many will  look outside Canada for their healthcare. Some will schedule surgery in the U.S. because of proximity and reputation. Mexico is also a logical choice. It is known for it’s advanced healthcare system and is a popular destination for health tourism. Dr Ortiz explain why Canadian patients are not hesitating to come to Mexico for weight-loss surgery:  I think Canadian patients have less of a preconceived notion about Mexico and it’s healthcare. Any worries are put to rest when they see that we are an International Center of Excellence designated by the U.S.A. which basically means that our standards of Healthcare and expertise are comparable to the best centers in the United States.

Video: Canadian Patient

No surgical procedure is has perfect results or is totally complication free. Usually the more weight-loss a technique produces the higher the risk of serious complications. This is why still many patients will select a Gastric Band, since it is a simple procedure with an acceptable weight-loss and complications tend to be benign. Gastric ByPass on the other hand has better weight-loss but more serious complications when they develop. Gastric Sleeve has a similar weight-loss to a Gastric ByPass at least with a five year follow-up but the complications tend to be severe when present. The  main complication and most severe is the staple line leak. At present world literature puts the rate at 3%. Somewhat lower at 2.6% when the staple line is over sewn. It is also slightly less when buttress material is used. Because of patient demand our  Gastric Sleeve surgery is more frequently performed at our center in the last couple of years. We tackle the challenging patients since many of our patients are conversions from Gastric Band to Sleeve. Because of the technical difficulty of having to remove the band and the scar tissue around it then performing the gastric sleeve, tis is considered revision surgery and happens to have twofold risk of staple line like. At the moment after thousand of weight-loss procedures and hundreds of Gastric Sleeves  we are happy to say that our leak rate is still 0%. This doesn’t mean we will never have a leak since many contributing factors can predispose to one including, malnourishment, tissue quality, ischemia, diabetes etc. but we believe that is the years of experience in the field that has helped us in fine tuning the procedure. We can actively avoid these leaks by  performing a very delicate dissection, treating tissue with respect, the use of the latest stapling devices and oversewing with a special material and technique. We don’t know what the future will bring for us but in the meantime we are pleased to say that procedures are getting safer as they evolve in the hands of experts around the world.

Brazilian Bariatric Group describes new procedure to fix failled gastric sleeves.

Gastric sleeve has become one of the more popular weight- loss surgery procedures. As with all Bariatric procedures, there is a failure rate to be dealt with. We have dedicated over 15 years of our practice to weight-loss surgery. As the years pass, new and more effective procedures have been developed. It is interesting to se how the last decade has evolved. A decade ago the two most popular procedures were the gastric by-pass and the gastric band. Gastric bypass surgery was related to a good weight-loss with a low but serious complication rate. Gastric banding on the other hand had a milder weight-loss but milder complications as well. Gastric sleeve surgery was introduced and after 5 year follow-up it was accepted as a good stand alone procedure with good weight-loss, comparable to that of a gastric band and sometimes to a gastric bypass. The Gastric Sleeve has low complication rate with it’s most frequent and severe being a staple line leak. Recent literature puts the number at around 2.6% to 3%.  Failure rate is low, but progressive as with any surgery, the more time elapsed the more Gastric Sleeves that will expand and fail.

We recently applied a new technique to failed gastric sleeves at Obesity Control Center  said Dr Ortiz, Director of Bariatric Surgery. Gastric Sleeves that have failed usually do so because of stretching of the sleeve itself. Re-stapling of the sleeve has a high risk of leak. So we decided to plicate a sleeve (Fold the outer edge inward) to diminish the capacity of the failed sleeve to regain restriction and further weight-loss. Preliminary results are looking good. A brazilian surgical group headed by Dr Ramos, presented their data on the technique during the IFSO  meeting in Hamburg. They concluded that it is as effective or better than re-stapling without the risk of a staple line leak.

The World Federation for the Surgery of Obesity meeting took place in Hamburg Germany.  Thousands of Weight-loss Surgeons assisted the event many of who are in search of the newest, safest and more effective procedures. Gastric Plication was one of these hot topics at the meeting.

The field of Bariatric Surgery is a constantly changing and expanding into new and different horizons. The buzz this year at the World meeting was the Gastric Plication Surgery. We spoke to congress organizer Dr Rudolph Weiner, Bariatric Surgeon from Frankfurt and Congress President. Our expectations have been al met and exceeded for this event, we have over 2500 surgeons from every corner of the world at the meeting. He went on to explain that one of the key topics for the week long event was in the research of new devices and techniques. I have invited my long time friend and esteemed colleague Dr Ariel Ortiz from Mexico. He has a vast experience with a new procedure called Gastric Plication. Dr Ortiz presented 400 cases of gastric plication with a one year follow-up and a 60% excess weight-loss.

Session 6 of the IFSO meeting took place on the final days of the meeting. I was surprised to see so much interest on the Gastric Plication and our presentation.   The discussion after the presentations directed numerous questions to the panel, many to Dr Ortiz. How to obtain better results, how to avoid complications to how we and where to surgeons train for those interested in the technique, were some of the questions directed to him. After the session there was a long line of surgeons waiting to interview personally with Dr Ortiz and the other experts in the panel. They wanted to ask me specific questions not discussed during the event. There is definitely a growing interest in the procedure world wide.

IFSO is the World meeting for Bariatric Surgery providing us with the latest news, research and innovation in the field of Weight-loss Surgery

Session 6 on Gastric Plication was a total success if you measure it by how many congress goers attended. The room was full, all seats were occupied with many surgeons standing in the back and isles. They came to see the top leaders in their field talk about Gastric Plication and their initial experiences with the procedure. One of the presenters and well known surgeons from Argentina, Dr Carlos Casalnuovo and former Congress President spoke about his experience with Gastric Plication combined with gastric banding. The initial question to the audience: If one procedure is good, will two make it better?  This is our problem question. He then presented his data on his patients undergoing a gastric band placement where once positioned he then turned to perform a plication of the stomach distally to the band.  In his methods he discussed how he would let the gastric plication take effect early on after the procedure and not adjust the gastric band until the patient had lost the early satiety and restriction related to the plication.He presented a follow-up of a year with a handful of cases and discussed the difficulty in standardizing the approach. The Gastric Band with a Plication group had less than desirable weight-loss and concluded in his presentation that more follow-up is needed, a better more standardized reproducible technique is necessary and he finalized the talk by leaving the question still un-answered: Is combining to techniques better for the patient or will it only be adding the risk of a second surgery without the benefit of more weight-loss? 

This year’s most important Weight-loss Surgery meeting was held in the beautiful city of Hamburg, Germany . Many of the most recognized leaders in the Bariatric Surgery field were present during this whole week event.

The scientific program  included the latest research on well known and established weight-loss surgical techniques as well as new and upcoming procedures like the gastric plication, which had the attention of much of the congress attendees. The scientific program had some speakers briefly talk about their experience with this new procedure but all attention was focused on the Gastric Plication Session that Friday at noon.  The Chairman was well known Surgeon from Cleveland Clinics Dr Phil Schauer (USA). A total of eight speakers from every corner of the world participated in this highly anticipated session.  Dr Talebpour (Iran) considered the pioneer of the procedure was a moderator and  speaker, presenting a multi-center experience of over 800 procedures. Dr Schauer  compared the Gastric Plication to the Gastric Sleeve with the available data in the medical literature. Other notable presentations included Dr Ramos’s Group (Brasil) describing the innovative use of plication as a rescue technique when other procedures have failed including Gastric Sleeve and Gastric ByPass. Lastly Dr Ortiz (Mexico) presented the second largest experience with 400 cases of Gastric Plication Procedures. In his presentation he focused on recent technical advances that his group has developed to perform a safer more effective procedure. He described the most frequent complications and how to avoid them. Lastly, he presented a 1 year follow-up on over half of these patients with an average weight-loss of 60%. He concluded by asking those interested in performing this procedure to undergo formal training before attempting this technique.

With over 2500 congress goers, this meeting definitely qualifies as one of the largest IFSO has every seen. More to come.