US Residents: Considering Surgery Outside the U.S.?

[PhotoNut]

I recently came across these two articles and felt it important to pass them along. The first is from Allergan, makers of the LAP-BAND® System. The second is from a post from Sandy R. on the Smarter Bandsters Yahoo group. Sandy is one of the facilitators of the group who was banded in Mexico and was, for a number of years, a patient coordinator for a band surgeon in Mexico.


Considering having LAP-BAND® Surgery Outside the U.S.? (http://www.lapband.com/get_informed/costs_payment/surgery_outside/?cid=twitter_1)

There has been a lot of press recently around “medical tourism”, defined as seeking medical care outside of the United States. Perceived benefits include potential cost savings and travel package deals. However, when considering the LAP-BAND® System, it’s important to understand all aspects of the procedure, including the essential post-surgical care and support from your surgeon you’ll need in order to succeed in your weight loss journey.



Important facts that should weigh into your decision about having the LAP-BAND® System surgery outside the U.S.:
The LAP-BAND® System requires ongoing care and a relationship with your surgeon and their staff after having surgery. In fact, in the first year, you should expect to schedule appointments with your surgeon every 4-6 weeks for adjustments, support and medical care to monitor other medical conditions you may have prior to having surgery. This care and follow up is essential for optimum outcomes and should factor into your decision where to have surgery. Many surgeons outside the U.S. cannot offer the level of support and required care in the U.S. following your surgery. Traveling outside of the country frequently for post operative care is not realistic and would be challenging for many Americans.
In Mexico, the latest generation FDA-approved LAP-BAND AP® System is NOT available for use. This advanced performance technology for LAP-BAND® surgery was approved by the FDA in 2006 for use in the U.S. Surgeons in Mexico offer the older LAP-BAND® System models, which are called the 9.75 and 10mm, and the VG models. Nearly ALL LAP-BAND® systems implanted in the U.S. are now the new LAP-BAND AP® band, as surgeons prefer them significantly.
It’s also important to understand your insurance coverage if you have surgery outside of the U.S., as well as legal recourse should you have complications. It is recommended that you fully understand this before making your decision.
The LAP-BAND® System is a lifelong commitment. Consider how important near-term cost savings to you may be compared to how important excellent long-term care will be from a qualified U.S. surgeon close to home.
Get Informed




Considering LAP-BAND® System surgery is a major life decision, so it’s important for you to get informed before you select your surgeon. Here are some other links to helpful information:

The LAP-BAND® System is affordable. Know your options (http://www.lapband.com/get_informed/costs_payment/payment_options/), including filing an appeal to your insurance company, receiving a tax credit and low-cost financing options only available for LAP-BAND® patients.
Talk to your doctor (http://www.lapband.com/get_informed/consult/discussing/) about LAP-BAND® System surgery and writing a letter of necessity to your insurance company.
Learn about what to look for in a surgeon (http://www.lapband.com/get_informed/consult/what_to_look_for/). Only LAP-BAND® System certified surgeons are approved to perform the LAP-BAND AP® System surgery.
Finding a surgeon (http://www.lapband.com/get_informed/consult/find/) in your area is easy. You can search by location or by name.
Once you have found a surgeon, make sure you get answers to any questions (http://www.lapband.com/get_informed/consult/questions_to_ask/) you may have about the LAP-BAND® System.
See why more patients and surgeons choose the LAP-BAND® AP system (http://www.lapband.com/get_informed/obesity_weight_loss/lapband_realizeband/) for adjustable gastric banding surgery.
LAP-BAND AP® System is Affordable

Low-cost financing options
Why travel outside the U.S. for surgery when you can receive financing here in the U.S.? There are a number of flexible, low-cost financing options available to you. CareCredit® (http://www.lapband.com/life_after_surgery/supporting_a_loved_one/partners/carecredit/), the nation’s leading patient financing program, has created low-interest payment plans offered exclusively for LAP-BAND® System patients. CareCredit® offers a variety of payment plans to offer you the flexibility to meet your needs. Talk to your surgeon about the best financing options for you.


Pre- and Post-op Support


LAP-BAND® System surgery is only one part of your journey to successful weight loss. As a patient you will rely on the support of your surgeon, bariatric support staff, family and friends to help you in your new lifestyle. Having your surgery in the U.S. means you can count on:

8 years of U.S. safety and experience with LAP-BAND® System surgery.
Post-surgery support based on the LAP-BAND® TOTAL CARE™ Program (http://www.lapband.com/get_informed/about_lapband/total_care/) which provides clinical and operational best practices to your surgeon and their team intended to facilitate optimal patient outcomes.
Access to exclusive partnerships (http://www.lapband.com/life_after_surgery/supporting_a_loved_one/partners/) and nutrition, lifestyle and support tools with
My LAP-BAND® Journey, including exclusive offers with Lindora® and Curves®.
By choosing LAP-BAND® System surgery you are committing to changing your lifestyle, and you’ll need ongoing medical care and support as you progress through your weight loss journey. Having your surgery in the U.S., by certified LAP-BAND® System surgeons gives you the peace of mind and comfort that you will receive the best possible care as you continue your weight loss journey.

[PhotoNut]

I am quoting Sandy's post with her permission to share any of her informative material on Band2gether. Thanks Sandy!


"The average price in the US now is about $13-17,000 and this includes the full team and, usually, fills for 1-2 yrs. there are several excellent surgeons, including one in S Ca close to Mexico, who band for $12,500 - $13,000 and another in Denver for $10,500.

There surely are good surgeons and hospitals in Mexico - that is not the question. it's the aftercare and lack of the best bands that are the crux of the problem, especially the last 2 yrs since the AP bands have been released. the older models have a worrisome , increasing slip and erosion rate first reported at the 2007 ASBMS meetings. It has more than doubled in the last few years, and the new AP bands were designed to reduce this rate. Why in the world would someone want one of the older bands? (But, sadly, I know of no Mexican doctor who is telling their patients they will not be getting the most advanced band)

As far as researching docs - that is also very hard. There are no public records available in Mexico. There are no FDA guidelines or stats, as there are in the US. Many docs exaggerate their stats. Many others pay people to post how wonderful they are, even when they are not even patients. facilitators are paid only if they convince a patient to have surgery. Some say they are banded when they are not. some have office clerks as facilitators, an claim they are banded and have done great, when they are not banded. lots more, trust me, that i have learned, sadly, In my 6++ yrs as a banded patient of a Mexican doctor - and someone who has worked for a major Mexican surgeon and see what often goes on under the radar.

The surgery itself is only the very first, small, easy step - it is he years of follow-up and aftercare that are what determine our success, and I’m afraid that is really very lacking when we go to Any foreign country - whether it is Mexico, France, Belgium, or other places in Europe. all of these have been doing bands longer than the US. But once a surgeon has done more than 500 bands, even that is a moot point. Banding is really a very simple procedure.

As far as "Finding a local US hospital/weight loss center who will offer a comprehensive fill and follow-up program BEFORE having the surgery" - this is nearly impossible. I know maybe 8-10 band surgeons in the whole US who will see any Mexican band patient. The fill centers will FILL people - but that again is only the smallest part of banding. i know a huge 3 of people who have gotten into major trouble with a fill center, because they generally fill anyone who comes in with the money. Few have fluoros to help assess if we even need a fill, or to assess problems. Plus, they teach 5-bite meals which is very absurd.

In my experience, to do well, e need a local surgeon whom we can see regularly (monthly is ideal0, who has a nutritionist, psychologist, and more to help us. all the studies agree that those taking part in a comprehensive band program are those who do well. SO very many people are having serious trouble and losing their bands at 3-5-7 years, it's truly frightening.

Those who have not used a Mexican doc just can’t understand all this, imo. I also thought Mexico was a good choice at the time, and it probably was because way back then, few US surgeons banded and even fewer had much experience. Now, there are thousands and thousands of highly-experienced US bands surgeons with excellent aftercare programs, and imo it is very, very foolish to purchase only the surgery at a cheaper price and expect to do well. VERY likely, one will end up paying far more overall and get far poorer care - and even doing poorly and losing their bands altogether - and then paying more than the original surgery to have the band removed."

Sandy R, BSN, MN
SmarterBandsters Yahoo Group
Facilitator

[redgrldj]

Susan I am wondering who sponsored that article.. I was going to Mexico for my band. You know I do my homework.. Dr. ortiz is one of the leading lapband surgeons.. I am wondering, if it is directed at getting more people to use U.S. surgeons... here is a little bit of info on Dr. ortiz.

http://www.obesitycontrolcenter.com/images/spacer.gifAriel Ortiz Lagardere MD, FACS
http://www.obesitycontrolcenter.com/images/surgeon_ortiz2.jpg Dr. Ariel Ortiz, Board Certified Mexican medical doctor under license #2526822, is a world renowned expert on Lap-Band surgery. Dr. Ortiz trained almost a decade ago under the designer of the Lap-Band, Dr Mitiku Belechew, and has now trained hundreds of surgeons around the world to perform this procedure safely and effectively. In numerous occasions he has been designated as the professor of Lap-Band workshops hosted by Allergen (Inamed) in the United States, Canada and also the first workshop ever in the Philippines.
Dr. Ariel Ortiz is the past president of the Mexican Association of Bariatric Surgery and is an invited guest speaker to numerous lectures around the world. He is Director of the Obesity Control Center which is one of the busiest Lap-Band surgery centers in North America, and is credited for innovations and the opening of new fields such as rescuing a failed gastric bypass by placing a Lap-Band over it. Dr. Ortiz is also a pioneer on Lap-Banding for obese teenagers and other new exciting fields.
Dr. Ortiz was a pioneer in the development of a USA based nationwide network of professionally trained aftercare providers, Fill Centers USA. In the company of other distinguished US surgeons, Dr Ortiz currently serves on the board of Medical Advisors for this one-of-a-kind organization.

[redgrldj]

Oh and Mammichelle was one of his patients and had no problem finding a fill Dr. in Vegas, that would take her... I know probably 9 people who used Dr. Ortiz and either still go to him or get fills here in CA..

[PhotoNut]

Hey Pattie :)

Please do not take the posting of these articles to mean that we are telling people that all Mexico band surgeons are bad or that going to Mexico to be banded is bad. This is not a slam against anyone who has chosen, or is choosing, to be banded in Mexico.

There are, however, some very important points to be considered prior to choosing surgery outside of the US. Being fully informed is a MUST, thus the reason for sharing this information.

[redgrldj]

oh I know that Susan... I just sometimes wonder who sponsors some the articles out there... Those aren't the only articles I have seen.. I guess people just have to really investigate who they go see... I know alot of people saw that teen age girl named Cassie on Oprah who got the lapband.. Dr. Ortiz is her surgeon and was on the show.. i think I just hate when they bunch everyone together...

[gregken77]

http://www.obesitycontrolcenter.com/images/spacer.gifAriel Ortiz Lagardere MD, FACS



Dr. Ariel Ortiz is a good doctor. My doctor in Monterrey knows him and even told me he was very good at what he does. But the best doctor in North and South America , hands down is Dr. Rumbaut of Monterrey Mexico. Im scheduled to be banded with him on Oct 1st so when I heard that they dont have the AP band in Mexico I was worried. Dr. Rumbaut called me personnaly after I e-mailed him. He told me that Doctors in America have it set up right now where the AP band is not available to doctor in Mexico. How weird! He told me ---But I purchase them from Vensualia and do have them. Also he told me that the AP band is not the lastest technology in Lap bands. The Johnson and Johnson C band I believe it is called is the latest and he has that one available. Interesting enough there is not any data that says the AP band is any better than the older models. (no scientific studies yet just hear say) Dr. Rumbault said he can put which ever band I would like in at the time of my surgery. He also said that the reason he prefers the Inamed 9.75 band IS because it is alittle more stiff on the inside than the AP. The AP band is easier to cheat on he tells me. Anyway just thought I would throw this out there. Mexico is a great choice to get banded in if your self pay. The service blows the socks off hospitals here in America also. Nursing staff is better---ect. You just need to do some reasearch on doctors down there. Oh and reasearch someplace besides the internet please ---such as find there credentials, who trained them , how many surgerys they have performed ect. Dr. Rumbaut has done over 6,700. Try finding a doctor who has done more lap band surgery anywhere. I promise you will not. Oh and look at the doctors stats on his patients. They make this available--they have to. You can find out what % of his patiens have had problems after surgery ect. Dr. Rumbaut has a les than 1% rate----Ortiz has 1% so he is very good also. Ok I am through writing the book! :)

[PhotoNut]

Thanks for sharing that info Greg. When making such a big decision, it's important to get facts from all sides, and to make sure they are indeed facts.

It does concern me to hear the 9.75 band is still being used, as it was discontinued in the states some time ago due to a high rate of slips. What we were told was that this particular band was short in length and was often too small to be placed in patients with larger stomachs. Patients were experiencing too much restriction in the earlier stage of banding, which obviously led to prolapsed stomachs ("slipped bands").

The newer Allergan bands are larger and have different buckles, which eliminate the protrusion of the end of the band. The new buckles are also made of a different material, which is supposed to be softer and less abrasive against the outer stomach wall.

Please understand that the intent of sharing this information is to provide everyone in the decision making process with as much information as possible so they can make a fully educated choice. I would say the largest concern about being banded outside of the US is not the quality of the medical facilities or surgeons, but rather the limited availability of -complete- after care which has proved to be essential to success with the band. However, there have also been some documented cases of fraudulent bands being placed in patients who were banded in Mexico. Again, do not take offense at this.. I am not accusing any doctors in particular nor do I intend to shed a bad light on anyone. I am stressing the importance of knowing exactly what you are getting BEFORE you invest your hard earned money into something that you are going to depend on for a safe and successful weight loss journey.

I personally know two women from Boise who was banded in Monterey by the same surgeon. Both women had very positive experiences prior to and during their banding process in Monterey. One has done a fantastic job with her band and has experienced no issues at all. The other was quite a different story. Four months after she was banded, she began to experience a lot of pain and extreme restriction. The pain was bad enough to send her to the emergency room here in Boise. No one could, or would, unfill her band. (Not only are many emergency room doctors unfamiliar with the simple process of band adjustments, there is also the risk of liability. The risk of law suits runs high for doctors who become involved in patients who have been banded by doctors outside of the US, so most will not assist.) She wound up being air lifted to Salt Lake City and nearly lost her stomach to necrosis before it was all over. She is now without a band, and has incurred exorbitant medical expenses ($50,000+) which she is unable to pay.

I am not saying that her issue was caused by the surgeon. Complications could occur with anyone, banded by any doctor. The key factor for consideration is what kind of medical support will a person have if they happen to be one of those who experience such issues. Flying back to Mexico isn't always an option for people who have scraped and saved to get down there for the initial surgery. There is also the time frame of such a trip to consider. When issues occur, they usually require fairly quick intervention and resolution to prevent more serious problems from occurring. Realistically, returning for proper follow up care is often just not feasible unless you live very near the border and can fly quickly and inexpensively.

Like I have said on many occasions.. be willing to listen to all of the information before making a fully educated decision. No matter where people choose to be banded, and no matter which band they choose, the journey is their own. We are here for support and education. I support everyone's right to make decisions about their own weight loss journey and pass no judgment upon anyone regarding their decisions. Likewise, I feel responsible to educate people about all aspects of being banded.. the good, and the bad.

It is not my intent to offend or upset anyone. It is simply my goal to support and educate those who are here looking for advice and guidance. I can not do that by sharing only the things which everyone agrees upon. :wink2:

[gregken77]

P-Nut---Im actually glad you started this post. I honestly didnt know there were different types of bands and it got me to researching alittle more. Keep doing what your doing please! ha ha By the way I am going with the AP band simply because thats the one more doctors here in the US will be familiar with. I didnt have a problem finding a doctor here to take me on. It must be harder in different parts of the country. I already contacted this doctor here before hand and he gave me a list of info to bring back with me. Maybe those getting banded in Mexico should try pre-op to contact a doctor and see if they can get things set up prior. Hope this helps.

[PhotoNut]

That is EXCELLENT advice my friend! :)
I'm glad to hear that the thread helped!

[jet9999]

I'm even worried about moving to a different state and losing the relationship I've developed with my surgeon and his staff. Believe me I considered Mexico because of the cost differential but decided to go with the local doc because I knew I could get aftercare.

However, the job market in my local area is not the best at this time and I have to consider the real option that I might have to move to a more major metropolitan area in order to make a decent living (and believe me... my idea of decent living is paying my bills, feeding the pets and keeping me healthy so I'm not exactly living large if you know what I mean? lol!)

I do have to really consider what I would do for aftercare if I lost my job here and had to move on short notice since I am a very recent banded person (March09)

[PhotoNut]

Today, while speaking with Dr. Anderson about the upcoming conference, he talked about a surgery he had recently performed in which he had removed a "slipped" band from a patient who had been banded in Mexico. He said that this patient had been banded with the 9.75 band. As I mentioned earlier in this thread, the 9.75 band was removed from the US market after numerous cases of complications had been reported -- primarily erosions and slipped bands -- due to the band's small size. Most of the patient's stomach was prolapsed up through the band (aka slipped band on steroids!) and required additional surgery to remove some of the scar tissue that had formed around the lower portion of the stomach.

I didn't mention this thread to Dr. Anderson because the conversation moved quickly to other topics, but I did make a mental note to share this with you all... and now, I have. :-)

[redgrldj]

I was going to Mexico to have my band done.. But with all that has happened in the last year or so, I am thinking of waiting and going through my hospital.. But am not sure that they are even doing the band anymore.. Right now I would settle for someone kicking my ass weekly to get this freaking weight off..

[PhotoNut]

That's probably a very wise decision, Pattie.

And I'll be happy to kick your ass weekly. Starting on October 8th. :wink2:

[redgrldj]

LOL.. I just want to be under 200.. really close, but can't get there..

[sassy46545]

I was banded in Mexico the same day as my sister. She has lost a significant amount of weight with very few complications. (She got the large band)
I initially lost about 70# but have experienced alot of issues for the past year. At this point I cannot tolerate any amount of a fill. I got the 4 cc band.. (not sure what else it's called). I have regained some weight due to be totally unfilled five times in the last year for months at a time. I'm self pay. I'm currently saving up enough money to go back to my surgeon to have my lapband removed and the surgery revised to a gastric sleeve. I only hope I get the money saved before there is stomach erosion around the band.

Tracy

[PhotoNut]

Wow, Tracy. So sorry to hear about all of the trouble you've been having. I would think you could switch to the larger bands, which would alleviate the problems and allow you to achieve great results as a bandster. The older bands were much smaller and the types of problems you are having are not uncommon in patients who have them. Switching to the larger band seems to resolve the issues quite well.

Since you are considering the sleeve, does that mean you will be proceeding to the full bypass in a couple of years? I ask because the sleeve is only a temporary solution, which is typically used for rapid weight loss in the super super obese (BMI +60). After the first 18-24 months the stomach will have stretched out again and the weight loss will slow or stop. The stretched stomach also means that the weight loss results will not be long term, thus the reason this surgery option is typically used as a precursor to bypass or gastric banding rather than a long term solution.

[gregken77]

Photonut---I hear what your saying but there is no study anywhere that says the 9.75 band is not as good as the lap band AP. Yeah there have been people who have had problems with that band but the same problems occure with the AP band as well as the latest technology J&J C band. The AP band and the J&J band are much wider though so if you are self pay and going to Mexico request either one. You know the medical field is like running for president. Its very political for lack of a better word. Why would the medical community keep the AP band from being sold in Mexico? That is happening right now by the way. Well Im guessing here but my theory is ---they decide hey lets get it out there that this band is better than this one and scare people not to use it. Then you ban mexico from having that certain band and you slow down the traffic of self pay going to mexico. Was a pretty good ideal if that indeed is the truth. I honestly think it is myself. But there are doctors in mexico that order those AP band and even the J&J C band. They order them from other countries. For example the doctor I am using is ordering the AP band from Vensualia--(however you spell that). Anyway if you have that 9.75 band right now I would not freak out and think oh Lord I got a dollar store band inside of me. I dont think it the case. A slipped band usually results from the patient doing something he should not do. Now that you can prove. Call a few doctors and ask them about there patients who have had slipped bands. I think I called every doctor in Texas. ha ha Anyway ---just thought I would throw this out there.

[PhotoNut]

Thanks for your input, Greg. It's always smart to look at things from all points of view.

I will add that when I was banded in Jan 2006, the 9.75 was still on the market but our surgeons refused to use them because of the issues that all surgeons were seeing with them, which prompted the release of Allergan's 10cm/4cc band that I have.

So I do not think the 9.75 band was intentionally replaced by the current day bands for the sake of politics. That is not to say that there are no political issues going on, but I don't believe they would be related to the reasons that surgeons stopped using the 9.75 band in the first place.

I hope that made sense... I'm only on my second cup of coffee. :)

[PhotoNut]

I was just looking back through some archived posted and found one that listed the bands available in the US in September 2006. From what I understand, they were released in this order but don't hold me to that. :wink2:

9.75 cm (4 cc capacity)
10 cm (4cc capacity)
11 cm (9cc capacity)
Vanguard (10cc)

[sassy46545]

Photo Nut,
I don't have all the answers...just the problems. When I get done researching everything I'll be sure to let you know. Repeated surgeries are not my goal, but neither is having a band that doesn't do it's job.

Tracy

[PhotoNut]

Aww Tracy. I feel really bad that you're having such a struggle. I can only imagine what a stress it must be. You really do sound like a good candidate for a larger band. I hope you find the answers soon!

[Want_2_B_Free]

Today, while speaking with Dr. Anderson about the upcoming conference, he talked about a surgery he had recently performed in which he had removed a "slipped" band from a patient who had been banded in Mexico. He said that this patient had been banded with the 9.75 band. As I mentioned earlier in this thread, the 9.75 band was removed from the US market after numerous cases of complications had been reported -- primarily erosions and slipped bands -- due to the band's small size. Most of the patient's stomach was prolapsed up through the band (aka slipped band on steroids!) and required additional surgery to remove some of the scar tissue that had formed around the lower portion of the stomach.

I didn't mention this thread to Dr. Anderson because the conversation moved quickly to other topics, but I did make a mental note to share this with you all... and now, I have. :-)

I will back P'nut on this statement after a conversation with my surgeon this week. He said that even those in the US that had the smaller band have had lots of problems. He said that the new bands are larger and wider. The best part being the wider so its way more difficult for the stomach to slip/erode through the band. Not that it can't happen. I agree Tracey, maybe a newer band will correct your problem. Goodluck. Hope all works out for you.

[sassy46545]

I've contacted my surgeon to find out if he has the larger band available and what the cost is in changing from one band to another.

Waiting to hear back.

Tracy

[PhotoNut]

Good, Tracy. Let us know what you find out. I'll keep my fingers, toes, and eyeballs crossed for ya girl!

[sassy46545]

ok, the surgeon's nurse got back with me and said they can replace my small band with a larger band but they don't recommend it. Her comment was that more people have revision surgery to remove a large band and replace it with the small band. She didn't give me a price...but I know it's $4000-$4400 to remove the band entirely depending on if there is erosion or not. No clue what it is to replace with the larger band although I'm betting it's nearly the same as the original surgery. It's still out of my reach financially since I'm self pay in a single income home. I'm guessing it will be a year minimum before I can afford to do anything about it. I have to accept that and simply make healthier food choices.
Anyone that thinks lapband surgery is the easy answer...is INSANE!

Tracy

[gregken77]

I still have to say that there is no medical proof or study that says the wider ones have less complications than the smaller bands. Im sorry but the hype just is not true. Its all about dollars. The wider bands dont function any better than the smaller ones. They all do about the same job. Anyway-----Oh and since this post was about surgery outside of the US let me give a brief update about Monterrey Mexico. I was a self pay bandster and went to Dr. Rumbaut in Monterrey. If you dont know who Dr. Rumbaut is do alittle research on him. He is the best doctor in North and South America. You will not find anyone better. I had zero complications , very little pain and absolutly no gas pain what so ever. Yeah I have heard that everyone reacts differently but I still think the surgen has alot to do with how quickly you recover and how you feel. I mean the less they move stuff around inside of you the better your going to feel. Well The hospitals in Monterrey are very clean and modern. Looked like I was here in America actually. They have the same technology and I was very pleased with the whole experience. So if you headed to monterrey to be operated on by Dr. Rumbaut ---rest assured you will be in good hands when you get there. Monterrey is beautiful! My hospital room had this big window and when you opened up the curtains you could see nothing but these big beautiful mountains. Made sitting in that bed more interesting with such wonderful scenery! If your a single man I suggest you just move down there ----I never saw an ugly woman. Im serious! ha ha Anyway monterrey mexico is a good place to go for surgery!