thinking outside the box

Question
I read your answer about only using USA surgeons for lapband surgery but I found an MD in Mexico who will do the surgery for 1/3 the cost of USA doctors PLUS he has done thousands of these procedures vs. USA doctors who have done hundreds.  Traveling to San Diego is not a huge expense or hardship.  Also the clinic has a large list of referring MDs in the USA for fills and post op.  The surgeon here in Oregon also opted for the more expensive RNY surgery for the majority of the cases- more expense for the pt and more $$ for her. Interestingly, we heard they "always do lapband for self pay clients".  It's a business first and money is the goal.  Sad, huh?

Answer
Dear Adrianne,

You are right that I have encouraged US patients to try to have surgery in US facilities.  While there are some very good facilities overseas, there are also a lot of bad ones, and there can be unexpected issues in aftercare that patients do not always understand until after the fact.  Many lay people do not have the skills to evaluate what is and what is not a good/safe clinic and will elect to do something purely on price.  If you have researched the facility and the procedure, and have located locations (such as Fill Centers USA) where you can get local after care, then this may be a great option for you.  One thing that will be great for the future is that the American Society of Metabolic and Bariatric Surgeons is starting to certify international Centers of Excellence.  This will really help patients who want to go overseas to see what facilities meet high international standards.

I do think, however, that some of your other comments reflect perhaps an isolated experience with a local surgeon.  The Roux-en-Y gastric bypass is still the most prevalent procedure in the US and is (in most studies) still the more effective procedure for weight loss and for correction of diabetes.  The RNY should be more expensive - it is one of the most technically challenging surgical procedures done on humans and can only be done by a highly skilled surgeon (or at least should only be done by a highly skilled surgeon).  It also requires (usually) more operating time and more hospital time, which means more costs. (Bands can often be done out-patient)  The lap-band, by contrast, is a much easier procedure to perform.  You may disagree, but I do think that surgeons and other professionals should be paid more when the procedure or service they offer is much more complex or specialized.  

It is also really common that surgeons who do both procedures do more bands in cash pay patients.  This happens for 2 reasons:

1) Sometimes that patient wants a band and insurance will only cover RNY so the patient pays cash

2) The patient is shown the out-of-pocket price for both procedures and sees that band is overall less expensive and chooses that option

While it is true that there will always be some doctors who are in business just for the money, many more are not.  I am glad that your bad experience with your local doctor did not cause you to stop looking for an option that is appropriate for you.

Please let me know if I can provide further assistance.

In Health,

Dr. Jacques

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