Medical Tourism Insurence Questions

[galaxygrrl]

My surgeon removes the GB at the time of the DS. I had already had my gallbladder removed prior to my surgery so it didn't matter anyway. If I had to pay cash to have it removed in Mexico vs. waiting to see if problems occurred and having my insurance cover the cost in the US, I might consider the wait and see approach. I have a huge deductible so really, it hardly would matter either way. It is two surgeries but, a cholecystectomy is nothing compared to getting the DS as far as recovery goes.

See, that and the data I posted makes me think its worth waiting.

 

[Larra]

It's actually a very controversial subject. True, if your doc prescribes Actigal for you for months while you lose weight rapidly, that reduces your risk of gallstones (though there is still some risk).
HOWEVER... and this is key. Sometimes, a gallstone escapes from the gall bladder and finds its way into the common bile duct. For most people, meaning people who have not had DS or gastric bypass, this stone can be removed with a variety of endoscopic tricks by placing the scope past the stomach into the duodenum to where the common bile duct enters the duodenum. But for us, after the DS, the duodenum has been disconnected above where the common bile duct enters the duodenum, so this approach is no longer physically possible. There are other ways to get there, but they are trickier and not as likely to work, meaning that if you aren't lucky enough to have the stone pass on its own, you would need surgery to get it out of the duct. This is not only more involved, it also means cutting an opening in the duct, and leaving a drain in the duct for at least 2 weeks. Not fun!!
I was happy to part company with my gall bladder. Admittedly, I didn't have to pay at extra 2K to get this done, so I understand that there are other considerations for you, but gallstones are not just painful, they can make you very sick are not to be taken lightly.

 

[Spiky Bugger]

Galaxy girl, that study--which has the names of experienced DS surgeons--is likely quite valid...but thirteen years old.

Here is one from last year...in which fully 50% of patients had problems and subsequent surgeries. This focused on the RnY gastric bypass, but I don't think the HOW you lose weight is as crucial as HOW FAST you lose it for our purposes here.

• Abstract

Send to:



Obes Surg. 2015 Nov;25(11):2054-60. doi: 10.1007/s11695-015-1650-6.
Potential Benefits of Prophylactic Cholecystectomy in Patients Undergoing Bariatric Bypass Surgery.
Amstutz S1, Michel JM2, Kopp S3, Egger B4.
Author information

• 1Department of Surgery, HFR Fribourg Cantonal Hospital, 1708, Fribourg, Switzerland. [email protected].
• 2Department of Surgery, HFR Fribourg Cantonal Hospital, 1708, Fribourg, Switzerland. [email protected].
• 3Department of Radiology, HFR Fribourg Cantonal Hospital, 1708, Fribourg, Switzerland. [email protected].
• 4Department of Surgery, HFR Fribourg Cantonal Hospital, 1708, Fribourg, Switzerland. [email protected].

Abstract
BACKGROUND:
In patients with morbid obesity, laparoscopic Roux-en-Y gastric bypass (LRYGB) is the treatment of choice. Patients with gallstones routinely undergo cholecystectomy at the same time as LRYGB. Although the risk of developing gallstones afterwards is high, prophylactic cholecystectomy during LRYGB remains controversial. Therefore, we conducted a retrospective study to evaluate the risk associated with prophylactic cholecystectomy and risk factors for developing gallstones after LRYGB.

METHODS:
Data for patients on whom we consecutively performed LRYGB in 2003-2008 were extracted from the prospective bariatric database. The primary endpoint of the study was detection of newly developed gallstones by ultrasonography, and the secondary endpoint was evaluation of the incidence of post-LRYGB cholecystectomy (questionnaire).

RESULTS:
Of 117 patients who underwent LRYGB, 20 (17 %) had a previous and 26 (22 %) had a concomitant cholecystectomy. Of the 71 LRYGB patients remaining who had not had their gallbladders removed, 22 (34 %) developed gallstones, with 11 (17 %) requiring emergency cholecystectomy before the study began. Seven (10 %) patients were lost to follow-up, and 53 (75 %) underwent abdominal ultrasound during follow-up, which detected stones in another 11 (17 %) patients up to end of the study period.

CONCLUSIONS:
Nearly 50 % of our patients had either experienced gallstones before LRYGB or developed gallstones after LRYGB. In the group with new gallstone development, 50 % required emergency cholecystectomy. These results, together with the reported better quality of life after a combined procedure and the reported economic benefits, support the use of concomitant prophylactic cholecystectomy in patients undergoing LRYGB.

KEYWORDS:
Bariatric surgery; Gallstone disease; Gallstones; Prophylactic cholecystectomy; Roux-en-Y gastric bypass




Kindly correct me, your @Larra -ness.

 

[Larra]

there is nothing to correct. The study found what it found, and you are absolutely right that the development of gallstones is related to rapid weight loss, not to the type of operation, and can also occur with rapid weight loss without bariatric surgery. And an emergency surgery of any type is higher risk than a planned, elective surgery when you are healthy and the gall bladder (in this case) is not inflamed.

 

[Spiky Bugger]

there is nothing to correct. The study found what it found, and you are absolutely right that the development of gallstones is related to rapid weight loss, not to the type of operation, and can also occur with rapid weight loss without bariatric surgery. And an emergency surgery of any type is higher risk than a planned, elective surgery when you are healthy and the gall bladder (in this case) is not inflamed.

I got lucky!!!!

 

[galaxygrrl]

I have very much appreciated this thread. @Spiky Bugger thank you for the updated info. If you read the study closely, it still shows 66% of people don't get Gallstones after the surgery. The data says what it says.

Yep, it's a risk for sure, but i lost a lot of weight quickly when I did a liquid diet and I did not have problems. Now, I was younger and I had less weight to lose. But, this is just a risk-reward analysis. And here is the thing, while it's very bad to need a second surgery, it's not the end of the world. I might win this bet or I might lose it. But on both studies that data is on my side. Could I be conservative and get my GB out. Yes, sure. Is it the safe bet. Yes. But, there are costs there and it's a roll of the dice with the data in my favor.

To be honest, I'm really more worried about being the unlucky 2% where diabetes does not go away. That freaks me out more. Or not getting to a healthy BMI. I'm 5'3. I need to get to 134 pounds to have a BMI of 30. Since i was 18, I've been 134 pounds or under, just once.

I so love how this board is full of such smart and educated people who are passionate about this topic and willing to help. Thank you!

 

[SmilinsShrinking]

I'm having Dr. Esquerra do my DS in August. When I made my plans, my BMI was 59.9 They said that they were pleased that I had a couple of months before my surgery date, because they wanted my BMI closer to 50 (that is 60 pounds down), so he will have a better chance of doing it laparoscopically rather than an open procedure. So I've been dieting like crazy... I still have 34 pounds to go.

I also asked about having the gallbladder taken out at the same time. They said it's not standard.
Since my insurance has ZERO bariatric coverage, including complications from having bariatric surgery, does that mean that I will have to pay out of pocket to have my gallbladder removed if there are issues as I'm losing? ((I have lost over 100 pounds 4 times before both quickly and slowly and never had GB issues before.))

 

[Clematis]

Your insurance company can't pin the need to have your gallbladder removed on bariatric surgery @SmilinsShrinking. Gallbladders have to be removed from any number of causes, including losing weight quickly without surgery. If you need gallbladder surgery in the future, your insurance is sure to cover it.

 

[Spiky Bugger]

I'm having Dr. Esquerra do my DS in August. When I made my plans, my BMI was 59.9 They said that they were pleased that I had a couple of months before my surgery date, because they wanted my BMI closer to 50 (that is 60 pounds down), so he will have a better chance of doing it laparoscopically rather than an open procedure. So I've been dieting like crazy... I still have 34 pounds to go.

I also asked about having the gallbladder taken out at the same time. They said it's not standard.
Since my insurance has ZERO bariatric coverage, including complications from having bariatric surgery, does that mean that I will have to pay out of pocket to have my gallbladder removed if there are issues as I'm losing? ((I have lost over 100 pounds 4 times before both quickly and slowly and never had GB issues before.))

I would argue that IF you have issues, they might be related to weight loss, but not to the surgery that helped with the weight loss.

 

[Spiky Bugger]

I have very much appreciated this thread. @Spiky Bugger thank you for the updated info. If you read the study closely, it still shows 66% of people don't get Gallstones after the surgery. The data says what it says.

Yep, it's a risk for sure, but i lost a lot of weight quickly when I did a liquid diet and I did not have problems. Now, I was younger and I had less weight to lose. But, this is just a risk-reward analysis. And here is the thing, while it's very bad to need a second surgery, it's not the end of the world. I might win this bet or I might lose it. But on both studies that data is on my side. Could I be conservative and get my GB out. Yes, sure. Is it the safe bet. Yes. But, there are costs there and it's a roll of the dice with the data in my favor.

To be honest, I'm really more worried about being the unlucky 2% where diabetes does not go away. That freaks me out more. Or not getting to a healthy BMI. I'm 5'3. I need to get to 134 pounds to have a BMI of 30. Since i was 18, I've been 134 pounds or under, just once.

I so love how this board is full of such smart and educated people who are passionate about this topic and willing to help. Thank you!

Different life experiences? About 37 years ago, I was in the OR at City Of Hope having a boob lump biopsy. "But we can do a frozen section right now and proceed if needed," said the sweet young doctor. "They are 95% accurate," his partner explained.

"And guess which 5% of the population you're talking to right now!" I responded. "Tell the patholgy department to take their time."

Some of the Laws which guide my decision making. (Keep in mind that perpetual optimists constantly run the risk of being disappointed...pessimists...not so much...lol.)

• If anything can go wrong, it will
  Corollary: It can
  Corollary: It should
  MacGillicuddy's Corollary: At the most inopportune time
  Extension: it will be all your fault, and everyone will know it.
  
  
• If there is a possibility of several things going wrong, the one that will cause the most damage will be the one to go wrong
  Extreme version: If there is a possibility of several things going wrong, the one that will cause the most damage will be the FIRST to go wrong
  
• 
  
• If anything just cannot go wrong, it will anyway
• 
  
• If you perceive that there are four possible ways in which something can go wrong, and circumvent these, then a fifth way, unprepared for, will promptly develop
• 
  Corollary: It will be impossible to fix the fifth fault, without breaking the fix on one or more of the others
  

And so on.

 

[Larra]

@galaxygrrl you've heard our opinions and personal stories. Ultimately you're an intelligent adult, it's your body, your health, your money, and your decision. And no matter what you decide about your gall bladder, everyone here will wish you only the best.

One other little thought - if you are ever in the ER with abdominal pain and the docs there are trying to sort out what is wrong with you, not having a gall bladder makes the task easier as that rules out one very common possibility. Just sayin' But again, you are the one who will live with the decision, it's up to you and only you.

 

[galaxygrrl]

@SmilinsShrinking It's amazing to take off 100 pounds once let along 4 times. I've done it twice and it nearly killed me.

@Spiky Bugger Ha! Nice existential post on a Saturday night. I prefer to live my life looking at the glass half full. But, there are risks and rewards to both approached.

@Larra Thank you! And time will tell if I'm making the right decision. And thank you for helping me find this forum. It's been really helpful. I have so many questions I want to post here to learn from people. I'll post them over the next few weeks.

 

[Larra]

Do you have a date yet?

 

[galaxygrrl]

I've locked in Aug 19, but I have not been able to talk to the Dr. yet, so it's all a bit tentative. It's not like there is another place to go in MX. My best friend is coming with me, but my family is NOT supportive of the Mexico idea.

 

[Larra]

Once you are sure of your date, let @southernlady know so she can add you to the surgery calendar. And don't too much about the family. They are just concerned for you, and to people not familiar with medical tourism and your surgeon in particular, it all sounds scary.