An obesity expert has warned of the risks of people going abroad for gastric procedures after a coroner heard evidence of how two women died after undergoing such surgeries in Turkish hospitals.
Dr Colm O’Boyle, consultant bariatric surgeon at the Bons Secours Hospital in Cork, said he and other specialists in the field were deeply concerned at the number of adverse outcomes among people having gastric procedures abroad.
“There are many hazards related to pursing surgical intervention in a foreign country,” he said. “Most medical tourism is based in non-English speaking countries and is encouraged by low tariffs and shortened waiting times for surgery.
“The selection for surgery appears to be on ability to pay rather than medical appropriateness ... the emphasis is on the surgical procedure and often very little advice or care is given regarding the appropriate preoperative selection and work up and the post-operative follow-up.”
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Dr O’Boyle was speaking at Cork City Coroner’s Court where coroner Philip Comyn held inquests into the deaths of Estelita Hamelin (46), from Fermoy, and Pamela Canty (53), from Cork city, who died after having gastric procedures in hospitals in Turkey in 2021 and 2022 respectively.
Mr Comyn said the cases highlighted the risks associated with going abroad for gastric procedures, adding that it seems there is inadequate preoperative consultation and post-operative care, including early discharge, at some hospitals.
“Ultimately it’s a decision for the individuals themselves but people need to be aware of the risks involved when they go abroad for this type of surgery,” the coroner said. “I am concerned that people should know the nature of the risks involved and discuss it here with the relevant medical personnel.”
Dr O’Boyle said it is estimated that some 300 bariatric procedures are performed on Irish people abroad annually and he was aware of several deaths in recent years in surgical procedures.
Finbarr Canty told the court his wife Pamela travelled to Su Hospital in Izmir for a gastric sleeve procedure on October 17th, 2022. When it was noted that she was suffering from a hiatus hernia, the doctors repaired the hernia before carrying out another gastric procedure.
She was discharged from the Turkish hospital late the following day, even though she had a temperature and was sweating a lot. She flew home on October 19th and collapsed on October 22nd. She was rushed to the Mercy University Hospital but died there the next day.
Dr Bolster said a postmortem concluded that Ms Canty, who appeared to be suffering from an infection when she was discharged, died from septic shock due to an improper healing of a gastric bypass with inflammation of the thoracic cavity.
Mr Comyn returned a verdict of death by medical misadventure in the case of Ms Canty.
The coroner heard that Ms Hamelin travelled to Ayvrupamed Hospital in Istanbul for liposuction and a tummy tuck after she was given the name of an agent for the hospital by a beauty therapist. She travelled there on October 18th, 2021.
Ms Hamelin’s daughter, Hazel Gervacio, said she and her mother were collected at the airport and taken to the hospital, where blood samples were taken before they were brought to their hotel. They returned to the hospital with others from the hotel the next morning for the surgery.
She said her mother was given documents by nurses at reception and they were rushing her to sign them so she could go upstairs to the doctor. He put marks on her body to indicate where she was to be operated on and they then told her the operation could proceed.
Ms Gervacio went to the hotel to get some clothes for her mother. She returned to the hospital and was left waiting for hours with no word on her mother. She met a nurse who had good English and was told her mother had suffered massive blood loss and was in intensive care. She eventually met a doctor who said her mother’s condition was critical.
She said she was taken to the office of the doctor who performed the surgery, who suggested that perhaps her mother had some underlying health issue. Ms Gervacio was taken down the ICU and another doctor said her mother had died.
She said was not allowed to see her mother’s body and that she was moved to another hotel so that she would not be able to tell other people awaiting surgery what had happened. She contacted a solicitor who arranged for Ms Gervacio to see her mother in the morgue.
Mr Comyn said he had written to and emailed the Avrupamed Hospital, requesting all medical records in relation to Ms Hamelin, but got no reply. He said enlisting the help of the Department of Foreign Affairs and Turkish embassy also failed to elicit a response.
Assistant State Pathologist Dr Margot Bolster said she conducted an autopsy on Ms Hamelin on October 28th, 2021. She said she concluded that the deceased, who showed no evidence of any significant natural disease, died from haemorrhage and shock during a liposuction procedure.
Mr Comyn returned an open verdict in the case of Ms Hamelin due to the failure of the Turkish hospital to provide medical records in relation to her death after she suffered a bleed in theatre.
Dr O’Boyle, who has conducted some 1,500 gastric bypasses, said there was very little evidence of accountability when things go wrong when people travel for surgeries.
“There is anecdotal evidence that preoperative work up was performed on the day before or the day of surgery, this is too late in the process,” he said, citing a case where a woman had her surgery cancelled due to a blood disorder only for her mother to be offered it instead.
People being discharged early so they can fly home within days to cut their costs run a risk of deep vein thrombosis or pulmonary embolism given the medical advice is they should not fly for a month afterwards, he said. Patients also run a risk of sepsis and bleeding if they are discharged too early and signs of complications are ignored or missed.
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