Bariatric Surgery

With bariatric or obesity surgery obese or morbidly obese patients can reduce their overweight tremendously with many methods like gastric band, vertical gastrectomy, Roux en Y gastric bypass but other methods like gastric balloon or new endoscopic methods like TOGA or VBLOC to help reduce weight are introduced. With all other methods like diets, diet and slim clubs, medications etc. a lot of companies have made a lot of money but nothing else besides medical surgical treatments seems to work. Bariatric surgery started almost 20 years especially when the laparoscopic surgery to remove the galbladder was introduced is went sky high. Worldwide the bariatric surgeons are assembled in the world organization IFSO with more than 400,000 surgeries/year know that at this moment surgery is helping for many thousands of people but it doesn’t effect obesity at all.

Take USA as example

USA is perfect example for bariatric surgery, 1/3 of total population is obese; this 100 million and this number is unfortunately stark raising. In 2007 the number of surgeries was around 200,000. This means 0,2% of total obese population. For 2008 the american surgeons expect to do around 300,000 surgeries. Although the american surgeons are making the highest numbers worldwide it is a drop in a bucket. The majority of the Americans are absolute behind surgery but facing a lot of problems:

- Financially most insurance companies are still not funding for the surgery although the results for the last 15 years of bariatric surgery are so clear and they save within 5 years after surgery all major expenses in medication, hospital treatments, visits to physicians etc.

- When patients are turned down for financial investments of the insurance companies they are indicated to pay private for surgery. The prices surgeons in USA have to ask due to high insurances, strict policies to regulations/protocols and other issues makes those prices the highest worldwide, with second place for the United Kingdom.

For patients there are alternatives in countries like Mexico, Brasil, Argentina and Europe but most patients get lost in the jungle of medical tourism, providers make high profits and if patients go direct to the surgeon it is unclear is this surgeon has good qualification. Besides that most surgeons in USA don’t want to give after care to this patient.

It seems that without solving these problems the end of obesity is far far away. What could be a solution?

Medical outsourcing

With medical outsourcing the US-surgeon offers the cheaper option but stays in control the whole time. The patient will be her/his for the rest of the treatment. The screening for surgery – coordination with outsourcing surgeon and after care is in the hands of the US-surgeon.

Outsourcing to high qualification centres in India

Although India has just a handful high trained bariatric surgeons the future to support USA for this matter is there. For instant in our Centre, Obesity Asia (www.obesityasia.com) by dr. Shashank Shah we have 3 excellent methods to offer medical outsourcing to bariatric patients of USA. First method is our guidance and interaction by our bariatric coordinator Jaap Suyk who is with expertise after more 12 years bariatric surgery support and advisory to patients pre-and post-op care and more than 20 years long career in the medical industry one of our spear point. Second method (but actually first method) is our top-surgeon dr. Shashank Shah who has proctored hundreds of surgeons in last years for bariatric surgery and with his high qualification guarantee for the bariatric patient and her/his surgeon to offer the best surgery against very competitive price for every body. Third method is our video conference during surgery what offers the best information to the US-surgeon that her/his patient gets the best treatment.

Medical tourism or medical outsourcing?

Everybody in the field of bariatric surgery knows that the future to get obesity (and also diabetes) really treated only can work with the help of medical outsourcing. Our Centre looks for all kinds of cooperation methods, we started with the Netherlands recently, for medical outsourcing. This doesn’t mean that we will refuse patients who come by their self but outsourcing has definetely our preferences. We believe that India can be the helping hand on the field of treating obesity. And besides these arguments with us in Pune we have developed a special method in which outsourcing and bariatric surgery itself really helps to create extra funding to the poorest people of Pune. It is a start and we will put all our energy into this method. How Obesity can benefit poverty. We hope it will.

In bariatric surgery we go some steps further with the US-concept of Centre of Excellence bariatric surgery set up by Surgical Review and American Society of Bariatric and Metabolic Surgery. Clear guidelines according to US-laws and regular inspection of surgery and service providing is real guarantee for quality. 

The database of Centre of Excellence bariatric surgery is called BOLD and gives an unique option to share data between hospitals, when they have a tight cooperation together. 

Obesityasia (www.obesityasia.com) is in process to become, hopefully also the first, International Centre of Excellence bariatric surgery in India so we can make strong commitments with US and European hospitals on the field of medical outsourcing to us.

In mijn ogen is er een groot verschil tussen medisch toerisme en medische outsourcing. Toerisme althans voor Nederlanders (UK en USA is heel ander verhaal) zie ik mensen die voor hun dentale of cosmetische ingreep naar een ander land uitwijken. Geen medische noodzaak, hoewel mensen mij dit niet in dank af zullen nemen, en geen grote nazorg nodig. Mensen kunnen het risico nemen hiervoor naar het buitenland uit te wijken.

Medische outsourcing, ik denk overigens NIET dat er 1 ziekenhuis in Nederland is die dit al inzet om de kosten in de gezondheidszorg fors te drukken, is wanneer een patient met beleiding van het Nederlands ziekenhuis en specialist een behandeling of operatie ondergaat in het buitenland waarbij de operatie of behandeling eventueel live via videobeelden kan worden gevolgd in Nederland en waarbij het Nederlands ziekenhuis het voor en natraject gewoon blijft uitvoeren.

Misschien een kwestie van tijd want binnen de huidige kostenstructuur en DBC is medische outsourcing een volstrekt winstgevende zaak. Juist door deels uit te besteden worden kosten beter beheersbaar en kunnen ziekenhuizen veel eerder winst maken dan in de huidige situatie. 

Ik wil als voorbeeld de bariatrische chirurgie meegeven. Met 1,5 miljoen obese patienten en 500.000 diabetes type II patienten heeft Nederland een heel serieus probleem. De kosten drukken steeds meer op de gezondheidzorg maar de Nederlandse ziekenhuizen zijn niet in staat een fors aantal operaties uit te voeren. Na meer dan 15 jaar bariatrische chirurgie komen de Nederlandse ziekenhuizen niet verder dan twee duizend operaties per jaar en wijken er ongeveer 1500 patienten uit naar Belgie. Waarom zo weinig? De kosten van deze operaties zijn hoger dan de opbrengsten. Daarnaast wordt er in Nederland niet in ieder ziekenhuis bariatrische chirurgie uitgevoerd en is de druk op de OK programma’s heel groot.

Er komen meer patienten per jaar bij dan men in Nederland kan opereren. Besteedt men uit naar India levert deze operatie opeens geld op in plaats van geld te kosten.

Waarom India? India heeft medisch een van de hoogste medische opleidingen in de wereld en heeft vele prive ziekenhuizen. De kwaliteit van zorg is heel hoog in deze ziekenhuizen. In Pune zijn enkele kwalitatief hoogstaande prive ziekenhuizen opgezet door stichtingen waardoor de medische outsourcing ook daadwerkelijk bijdraagt aan gezondheidszorg voor de minder bedeelden in de samenleving in Pune.

Medische outsourcing of uitbesteding naar India verdienen de aandacht van de Nederlandse ziekenhuis directies als zij de kosten beheersbaar willen houden. De toekomst zal uitwijzen op dit concept kan werken in Nederland. Wij zijn klaar om Nederlandse patienten vanaf het begin tot na de operatie optimaal te begeleiden.

Veel operaties uitgevoerd in Pune
In 2007 werden er nu al zo’n 1000 operaties uitgevoerd, waarvan de meeste operaties plaatsvinden in Pune, een wereldstad met 5 miljoen inwoners op 160 km van Mumbai. In 2008 wordt minimaal 2.500 tot 3.000 operaties verwacht en voor het komende jaar wordt een explosieve groei verwacht van minimaal 6.000. In Pune is het enige bariatrische centrum van dr. Shashank Shah dat verspreid wordt over 3 ziekenhuizen in Pune, obesityasia, www.obesityasia.com. In Pune werden door dr. Shashank Shah en dr. Jayashree Todkar de laatste 2 jaar veel(meer dan 200) aziatische chirurgen uit India, China, Maleisie, Indonesie, Filipijnen, Pakistan en Bangladesh opgeleid voor deze belangrijke vorm van chirurgie.

Nederlander bij Obesityasia
Vanaf augustus 2008 zal aan zijn centrum de nederlander Jaap Suyk worden verbonden, Jaap Suyk heeft in Nederland en Engeland de laatste 10 jaar veel activiteiten verricht in deze chirurgie en bariatrische patienten begeleid en ondersteund. De ziekenhuizen in Pune van dr. Shashank zijn luxueus en zeer goed uitgerust. Daarnaast is de service in Pune erg goed en vooral ook echt 24/7. Het verblijf in India voor maagband is 3 nachten, gastric sleeve 5 nachten en 7 nachten voor een gastric bypass. De kamers bieden tevens plaats voor de partner die geen apart hotel hoeft te boeken tijdens het ziekenhuisverblijf.

Pune biedt mogelijkheden voor Nederlandse patient
Voor Nederlandse patienten kan Pune ook in de toekomst mogelijkheden gaan bieden via samenwerkende ziekenhuizen. Op dit moment zijn er gesprekken tussen Obesityasia en een aantal Nederlandse chirurgen. Hierdoor zullen patienten, indien zij dit graag willen mee te kunnen werken in deze bijzondere samenwerking. De patient kan haar/zijn operatie sneller laten uitvoeren en de Nederlandse chirurg kijkt mee bij dr. Shashank Shah via een speciale video-internet verbinding.

Kleine groepsreizen Amsterdam naar Pune
Vanuit Nederland worden in de toekomst kleine groepsreizen georganiseerd om dit alles professioneel te stroomlijnen. Ander voordeel voor de patient is: de operatie combineren met een goedkope maar ook luxeuze vakantie in een hotel resort in Lonavala of Khandala.

Armoede bestrijding in Pune
Maar er is nog een ander belangrijk argument voor chirurgie naar India. In de ziekenhuizen van dr. Shah worden ook gratis operaties uitgevoerd bij inwoners van Pune. Zoals bekend leeft 27% van de totale bevolking van India nog steeds op de absolute armoede grens van € 0,60 per dag onvoorstelbaar voor Nederlandse begrippen. Door deze speciale manier van medische outsourcing worden de allerarmste van Pune direct geholpen. De ziekenhuizen van Pune lopen overigens hier wel mee voorop en de Nederlandse patient dient hierbij twee doelen. Ten eerste wordt hij/zij snel geholpen in een groot en vakkundig bariatrisch centrum met behulp van haar/zijn eigen chirurg en draagt deze deze operatie ook werkelijk bij tot de armoede bestrijding in Pune.

Plastische chirurgie Pune
Er zijn in Pune overigens ook prachtige mogelijkheden voor plastische en dentale chirurgie die op dezelfde manier bijdragen aan dit prachtige project. Buikwand correctie of totale dentale make-over voor slechts 10% van de prijs in Nederland.

Downside in USA With the information that 1/3 of the total population of USA is suffering for obesity, at this moment 0,2% of obese patients are having surgery. It is a start if the numbers of obesity are not raising more than surgery can help it would. For these patient groups more than 80% will have good result. After 20 years of bariatric surgery worldwide this is one of the outcomes of surgery. But 0,2% is hardly any effect on obesity in USA, for real results like taking down diabetes, sleeping apnea, heart & vascular diseases caused by obesity the effect should be raised at least to 5% of the total obesity population. This means 5.000.000 surgeries/yearly. Is that realistic figure?

The downsides in USA is that most insurance companies will pay based on information on the Internet but the procedures can be quite long, sometimes 1-2 years, and not every company pays for surgery. Some companies pay only for gastric band surgery because of the costs.

Loans for financing surgery Another negative effect of the situation in USA is that when patients for what kind of reasons need to finance (or are uninsured for this type of surgery or uninsured at all) their own surgery they are forced to pay a high price for surgery in USA. Based on the Internet average price for gastric band surgery is 10,000 – 15,000 USD and after care is most cases separate and can add some thousands of dollars to this investment. Prices for gastric bypass are even much higher to 20,000 – 30,000 USD. A lot of people are creating financial problems for themselves to finance their surgery with loans. It is the reality at this moment.

Medical tourism for surgery? Is medical tourism the future for bariatric surgery to Americans? Medical tourism is for some type of surgery like cosmetic or dental surgery combined with nice and luxury stays at resort on an exotic island or country a nice way to undergo surgery, but is this the case for bariatric surgery too? Bariatric surgery what requires an intensive after care and check-ups to get the good results is not the most ideal scenario for medical tourism. Patients are not sure about the good quality of the surgeon, high or low expertise? These are not something like an international database for bariatric surgeons. And a lot of exotic countries have other hygiene guidelines and infection prevention than USA. For these reasons US surgeons are not very happy to perform after care to patients who underwent surgery abroad.

Outsourcing to India by bariatric surgeons

If medical tourism has his negative arguments, how about medical outsourcing of bariatric surgery to India? Outsourcing to India is in many sectors an interesting option like ICT, Financial business and Telecommunication. Would this be the help we are looking for to a large group of patients in USA, insurance companies and bariatric surgeons in USA? With this type of outsourcing US surgeons and medical insurance companies have full control to their patients in pre-op and post -op care and financially. But cheaper options for everybody, India can offer the same surgeries for less than half the cost in USA. If surgeons in USA would use this extra option to avoid medical tourism to some less experienced countries the patients would be the winners. In India bariatric surgery started since 2000 and with the high medical knowledge and expertise of good group of surgeons it would a very good option for outsourcing bariatric patients also in most private hospitals the video-conference options are THE method for the US surgeons to keep in touch with their patients and to see the surgery themselves. It saves money and higher volume of patients is possible. We see at Obesityasia, www.obesityasia.com, in the last year a strong growing interest of US surgeons and insurance company for this unique concept of outsourcing.

After 50 years of thousands of different diets, change of lifestyle, new and old medications to the market we don’t know how to stop obesity, surgery can help obese patients should be consider by large public more and more. Physicians worldwide must consider bariatric surgery as real medical treatment to help their obese patients. There are thousands of medical papers since 15 years show the good results of bariatric surgery. Despite a small percentage of patients who regain weight again for most of the patients surgery is the final solution and most bariatric surgeons are seen as their friends for life.

In 2007 in Asia, USA and Europe more than 350,000 surgeries were performed and especially in USA we see that a very small effect to obesity. Is bariatric surgery the ideal method? This is related to the patient and medical professionals but in most situations it is a very good help to solve comorbidities.

In several countries in Europe and in USA more and more medical insurance companies refund or finance the surgery what can give patients back their life. Is bariatric surgery an ideal method and is it safe? Since 15 years we know that surgery to obese and morbidly obese patients can be high risk in respect to anesthesia and good information and lecture is probably one way to reduce the medical risks. In India, now fast start in bariatric surgery worldwide these lectures makes a part of the whole procedure. India is now heading to be number 1 in obesity and diabetes with USA and China as quicker followers. For that reason bariatric surgery can be very helpful to reduce obesity in India. In Pune free lectures we as Obesity asia started as standard for bariatric surgery in India. With help of many organizations and medical industry we hope to start at many other locations in India. For the sake of the obese patients in India. www.obesityasia.com

The NHS plays an important role in the obesity treatment in UK, first of all not funding is making the problems worse and worse but funding these type of surgeries creates an enormous financial gap in their budgets. But what is the best strategy to follow for the NHS? Obesity is the largest medical danger in direct relationship with diabetes, hypertension, joint problems and joint replacements, sleeping apnea, cardiac problems and most cases also a lot of extra medication too. Would bariatric surgery not safe a lot of these costs NHS is already refunding? In USA bariatric surgery is paid back by many medical insurance companies who found out that funding is saving more money and more investments than all these other medical costs.

The same strategy was followed in France, Belgium, Holland and Scandinavia.

With respect to the NHS because of their strategy the only solution for obesity surgery is paying private. Because so many people need surgery the private prices in UK are really high. Gastric band surgery from 5,500 till 9,000 GBP, the Roux en Y gastric bypass (being the most popular bariatric procedure worldwide) know prices till more than 18,000 GBP.

Prices in India are totally different with approx. 3,400 GBP for gastric band, 3,800 GBP vertical sleeve and 5,600 GBP for roux en y gastric bypass. And those prices are average for the total care. In some case patients stay in luxury suits with their partner with no extra costs.

Because of these high prices for bariatric surgery it motivates a lot of people to chose for medical tourism to countries to cheaper countries like Belgium or France. Or even for medical tourism to more exotic places in far east. To bariatric patients, at this more than 12 million people not a very positive picture. Would the NHS not be better of funding bariatric surgery till a specific maximum like in Belgium or the Netherlands? Total price including the pre-op and post op care for every patient who falls in the International criteria? Knowing that these thoughts will be far away for UK bariatric patients at this moment, let us hope for better times for the UK. Obesity is and will be a disease what causes many medical problems to everyone unfortunately.

If the NHS would pay for surgery on regular basis, patients are better off and also UK surgeons and NHS-hospitals would also consider a part of their patient population for outsourcing. Maybe this is all future music and not realistic at this moment one thing is very clear: the moment NHS would consider outsourcing their bariatric patients to India, we, as being the largest bariatric surgery centre n India as Obesity asia, www.obesityasia.com will be ready.

If you can effort diabetes treatment like daily medication, insulin injections diabetes can be under control in a lot of situation. You have been very strict and motivated with your health but you can. If you can’t effort diabetes treatment with hospital/physician and you have no money for medication/insulin and diabetes needles on the long turn amputation of arms and legs is the future for you.

Diabetes type II caused by obesity is to be cured by bariatric surgery. Bariatric surgeons around the world know this and more and more surgeons are making their data known to the world.

Although for 8 years bariatric surgery is quite new to India, with a handful of experienced bariatric surgeons in India, the real treatment for diabetes is bariatric and metabolic surgery like Roux en Y gastric bypass, Vertical Gastrectomy or vertical sleeve, and other bariatric methods. In Pune in several hospitals multidisciplinary team of surgeons and physicians offers diabetes surgery. Dr. Shashank Shah and his team of Obesity Asia www.obesityasia.com having the largest expertise in India, being the first bariatric surgeon in India and trainer to hundreds of new surgeons with their focus to bariatric surgery.

Although there is very long way to go in India there is possibility to cure diabetes.

Chosing for medical tourism is in most cases a choice to have surgery for affordable price, good and for most european countries even much better service, combined with luxury resort holiday or travel.

Medical tourism is in most cases used for cosmetic or plastic surgery and dental surgery and for the last years bariatric surgery is become an important type of surgery for this type of tourism. Bariatric surgery or with other words obesity surgery like gastric banding, Roux en Y gastric bypass and Vertical gastrectomy/Sleeve has become in Europe and USA one of the most important types of surgery. Everybody who has more details about the tremendous results from bariatric surgery knows that this type of surgery will become number one surgery worldwide in the next 10 years. Solving hypertension, diabetes, sleeping apnea, joint problems and other medical issues within 1-6 months after surgery in most cases is one of the biggest motivators.

In 2007 in Europe and USA more than 350.000 operations were carried out but with the enormous rate in obesity worldwide (In Europe obesity is calculated between 10-35% of the total population depending of which country and USA is approx. 30-35%). Bariatric surgery in India started 8 years ago and approx. 20 surgeons are focusing to bariatrics. A lot of surgeons in India are starting up but can’t be considered as experienced surgeons of course. Especially for stapling surgery like Roux en Y gastric bypass and Vertical sleeve expertise makes the difference between safe and risk full surgery.

Nevertheless India will play an important role in medical tourism for bariatrics sooner or later. But one of the major questions what medical tourists will ask themself if I’m traveling and spending money anyway who will it benefit. Only the surgeon and hospital or can it benefit more people? India has besides very high diabetes and obesity rate also still one of the highest poverty situations of the world. Would it be fantastic if medical tourism would really increase to high number of patients and it would direct benefit also to the poor. This would be one big opportunity.

With strong believe we started as Obesityasia, www.obesityasia.com with help of foundations for healthcare projects in Pune to make a small difference in one of our hospitals for bariatric surgery. One of the private hospitals in Pune, Poona hospital, established in 1986 by late Shri Dongreji Maharaj foundation, is offering free and also concessional surgery to lower socio-economic strata for many and many years. With this motivation and this agreement to the Indian society and to medical tourists we all make small difference with medical tourism.

The future will tell if others in India will follow and if they can make the same effort to medical tourists. Especially for those lower socio-economic Indians who suffer for diabetes and obesity to get bariatric surgery instead of getting blind, get legs and arms amputated or dying after heart stroke. By this way and good structure guided by the Indian governments we call together an make huge difference.