Scheduling uninsured surgery in Mexico

[Growing Smaller]

Husband's doctor suggested gastric surgery for several issues including Morbid obesity.

I have gained over 50 lbs since quitting smoking 10 yrs ago and suffer from Severe Reflux, Hiatal Hernia and Spastic Duodenum Bulb. Our insurance gastric surgery (says it won't even cover complications?) So my we're going to Tijuana, MX. He's getting the Sleeve and I'm getting the Bypass. I'm only slightly obese but hopeful to have stomach issue relief.

I'm hoping to get some support (or objections) from those who know. Thanks in advance.

 

[galaxygrrl]

The only place in MX I would go is the http://www.mexicalibariatric.com/ And I did go there. I would consider the DS though. Why do you want a bypass. The DS is much better.

Here is the info on the center. Read the whole page for a full description.

http://bariatricfacts.org/threads/march-2017-target-date.4858/page-3

There are Drs. to stay away from in MX too, research carefully.

 

[Growing Smaller]

Thanks, galaxygrrl. The surgeon was recommended by a close friend that sent his three adult children, his sister and others to him.
He suggests the bypass because I'm a snack eater? Dumping and malabsorption would help, I also have duodenal bulb spasms, which would be bypassed, theoretically helping as well. Plus I need a Hiatal hernia repair and maybe the bypass helps keep the stomach down?

 

[Larra]

Welcome!
It's difficult to know what to tell you. Most people here have had the DS, though anyone is welcome here. But because of this, we know little to nothing about surgeons in Mexico who do operations other than the DS. Also, while it sounds like your husband is MO, it is unclear what you mean by being only slightly obese, so it's possible that gastric bypass may not be appropriate for you - or, maybe it is, but I can't tell from the information at hand.

Dr. Esquerra, the only surgeon people here would recommend for the DS, also does the sleeve (which is part of the DS) and has an excellent reputation, so he's someone your husband should consider. I don't know whether or not Dr. Esquerra, or any of his colleagues, offers gastric bypass, but his office staff could answer that question. I know nothing about any surgeons in Tiajuana, but we've seen some real horror stories out of there over the years, and I wouldn't recommend going there to anyone.

 

[Clematis]

I too would only recommend Dr. Esquerra at Mexicali Bariatric Center.

And I wouldn't get a roux-en-y if you paid me a million dollars. You need your pylorus! You do not want dumping syndrome which can be quite debilitating. There is very little malabsorption with RNY. Data shows by year 5, you'll be on a strict diet the rest of your life just to hold on to whatever weight was lost. And, gee, if diets worked for us...

Contrast that with a proper DS with 2 anastomoses and a common channel based on the Hess Method. You'll have the VSG to initially lose the weight and malabsorption to keep your weight off. (The VSG turns into a diet after several years, too.) Yes some docs might try to steer you away from a VSG (a DS just adds a switch to the VSG) with your severe reflux, but your reflux may be from weight gain. Lose the girth, lose the GERD.

What is your BMI?

 

[Larra]

Based on your last post, I think you need to learn a lot more about gastric bypass. First, there is no guarantee that you will dump, which is NOT a weight loss tool, but instead is a potentially very nasty side effect that some (not all) people with gastric bypass have. There is no way to predict ahead of time who will dump and who won't, and no way to know if you will dump of carbs, or fat, or neither. And gastric bypass won't prevent you from snacking, either. The only thing it does is prevent you from eating a lot all at once. If you continue to eat small amounts frequently, in other words snack, you will not lose well and will start regaining soon after.
The malabsorption of gastric bypass is mostly vitamins and minerals, and not calories. There is a little bit of caloric malabsorption, but not much. The operation works almost entirely by restriction, which is lost over time, and there are honest gastric bypass surgeons who tell their patients that after about 18 months, your success relies entirely on behavioral changes.

As far as reflux/GERD goes, it will probably improve with weight loss, and if you need a hiatal hernia fixed, it could be done along with any bariatric surgery, not just gastric bypass.

Keep doing your research. You have better options. though again, I have no idea what you mean by only slightly obese, and maybe you don't really need any bariatric surgery at all.

 

[Growing Smaller]

Wow, thanks! Maybe I'll forego my surgery until I have more information.
My duodenal spasms are caused by stress. I've been having to take valium whenever it becomes unbearable.
I often eat because I want something to sop up the acids in my stomach or relieve my stomach pain.
I have to get my throat scoped for lesions or pre-cancer due to the reflux. Dr. says the sleeve might make the reflux worse.
But, if I could just figure out how to lose weight and stop the spasms then I could probably just get the hernia repaired?
Glad I found this Forum. I'm 5'7 and 200 lbs.

 

[southernlady]

Okay, at 5'7", and 200 you are only obese at 31.something. As far as covering complications, your insurance company would have prove it was caused by WLS. And a vast number of complications can happen without having WLS at all....like a bowel blockage. My oldest step daughter had one two years ago and has NEVER had WLS.

 

[Larra]

You are right that a tight sleeve can cause or worsen reflux. One of the advantages of the Ds is that it doesn't rely mainly on restriction, so for someone with known reflux, the surgeon can make a looser sleeve in hopes of not worsening the pre-existing reflux.
I would like to say that losing weight will improve your reflux, and often it does, but there are thin people with reflux too, so it's not guaranteed.
whatever you do, don't get a lap band! If ever there was an operation designed to worsen reflux, this is it. And the failure rate is staggering, and it has the highest reoperation rate of any bariatric surgery, partly for complications, partly because it didn't work.

I understand your frustration with your weight, even with a "low" bmi of 31. Since most of us either have, or started out, with much higher bmi's, sometimes we lose our perspective. If you truly believe that you have done everything in your power to lose weight, and your health is suffering because of your weight, talk with a well regarded bariatric surgeon like Dr. Esquerra and see if you would be considered a surgical candidate. I have no idea what he would say. At least at this point in your life, you are well below the usual threshold for bariatric surgery, even with comorbidities. I suppose there has to be a dividing line somewhere, but to some extent it's an arbitrary number, and there may be reasons for exceptions.

 

[galaxygrrl]

Here is a couple things.

Look at this long term data that is attached. The choice is obvious after that.

Also, I talked to Dr. Kelly in Mexico, he has great reviews, and people like him. He gave me the totally wrong advice and there is a FB group that bashed him pretty badly. If I did not dig deep, I would have gone to Dr Kelly. It would have been a mistake and I would have gotten the wrong surgery for me. So be careful.

Dumping is not your friend. If you can get the same impact through a DS and not have dumping that is better. I snack all day with the DS and it's fine.

Keep asking questions. Do your research. This board likes the DS a lot and some people are militant, so take that into account. But understand everyone who loves their DS had it work well for them.

 

[DianaCox]

I would look at a generously cut sleeve with a hiatal hernia repair (if that's what you have) with someone who knows his way around the duodenal bulb issue (I assume you've been scoped and they know it's not an ulcer or something else). I'm sure you are very unhappy weighing 200 lbs at 5'7", especially if you're used to being 150 lbs, but I would never consider any surgery at that level, absent metabolic issues such as diabetes or hyperlipidema unresponsive to medications. I only lost down to a BMI of 33 after my DS for most of the first 12 years - and never considered a revision - I was healthy and unwilling to trade potential complications for vanity reasons.

OTOH, if you have a hiatal hernia causing severe reflux and you are in need of repair of that procedure, you could investigate whether you can find an in-network surgeon who will perform the hiatal hernia repair and anything needed to check out the duodenum at the same time, and then SELF PAY for a sleeve at the same time - most of your surgery cost would be covered and you'd be getting it done in the US.

People do that with plastic surgery all the time - they get the covered procedure (e.g., panniculectomy - removing the apron of belly skin) covered, and self-pay for an abdominoplasty (tummy tuck/muscle tightening that makes the belly tight after the muscles are stretched out from obesity) to make it look better. The majority of the procedure is paid for (OR, anesthesiologist, recovery room, surgeon's fee, meds, hospitalization), and you just pay for the cost of the extra procedure, extra time in the OR, extra time for the anesthesiologist. The rest is already covered.