Determining the right questions to ask the Surgeon(s) you are considering can be a difficult process. Many of us before surgery are so hyped up by the thought of getting surgery that we sometimes draw a blank on questions when it comes time to ask them. So for this post, I would like to offer up some of the questions that I feel everyone should ask when considering which surgeon is right for you. Bare in mind that I had surgery in 2012, and I am sure that I will not cover all pertinent questions. This is merely a starting place for those new to wls, and if any of you have addition questions that you feel should be added, please feel free to post them below.
First, if you have not determined a list of surgeons you are considering, there are a few question that you really need to ask yourself to help you generate that working list of potential surgeons that meet your criteria.
1. What are your financial limitations?
In Mexico, prices of bariatric surgery can vary greatly between the various surgeons, so taking a look at your budget for surgery can be a quick way to rule out a number of surgeons.
2. Will you be travelling to have surgery alone, or will you be bringing a companion along for support?
This determination will factor into your financial limitations in many cases. Not all, but some surgeons in Mexico do charge extra fees for patients travelling with a companion. When deciding on a surgeon, you will want to make sure and ask if there is an extra charge for companions, and what those charges cover for the companion. Does it cover their transportation and hotel/recovery house stay only, are their meals included as well. With my own surgeon, there was no charge for companions because they would have shared my transportation and stay at the medical facility and hotel. The only thing I would have paid extra out of pocket for my fiance to come with me, would have been the cost for his meals while we were in MX.
3.Next, you need to consider where you prefer to have surgery at, and why?
Having surgery in Mexico is different than surgery here in the US. In the US, surgeons are normally associated with a dedicated hospital or surgical site, so you don't really have a choice when it comes to where you are going to have surgery. In Mexico, a number of surgeons operate more like independent contractors (Meaning they tend to have operating privileges at a number of locations: Hospitals, Surgical Centers, Clinics, etc.) To me, this is a benefit to those seeking surgery in MX, because it gives the individual options on the location of their surgery. For many people, especially if they have never had surgery before, the tend to feel more comfortable having surgery at a hospital...for whatever reason it makes them feel safer. For people such as myself, I have had a number of surgeries over the years here in the US, so I have had experience with surgery in Hospitals, Surgical Centers, and Small Specialty Surgical Offices, and to be honest I prefer the surgical centers over the hospital setups hands down. Having the option to choose your location is great because the hospital tends to cost more than a surgery located in a surgical center...but in reality, Mexico Hospital vs. Mexico Surgery Center, doesn't always equate to a better or safer surgery setup.
My VSG surgery was conducted at a surgical center (Although my surgeon does have additional operating privileges at Hospital Angeles, INT Hospital and a number of other places as well). I liked the surgical center because it was a smaller setup, dedicated to bariatric surgery, yet still had everything needed to handle the situation, should and unforeseen complication arise. The surgical center had a dedicated ICU, a private ambulance, and my surgeon was a highly trained trauma surgeon, with specialty in bariatric surgery, and was proctor certified...there was no doubt in my mind that I was in the best of hands.
The point is decide what you need to feel comfortable having surgery, and make sure that your doctor's surgical location is equipped with those things.
4. What qualities and credentials are you looking for in your surgeon?
We all want the best when it comes to the guy that is going to be holding the scalpel, but in reality you need to be looking for the surgeon that is the best based on your particular needs and medical history. For example, let's say that you have a lap band, and are looking to revise to the gastric sleeve. That instance alone is going to change the scope of the surgeon you should choose. Choosing a surgeon that has preformed 5,000 sleeve surgeries, really doesn't matter if he has only perform 3 revisions. Instead, you might want to choose a surgeon that has performed 2500 sleeves, but 1000 of those were revisions...make sense?
If you are a person who has never had surgery, been put under general anesthesia, are prone to some type of complication during surgery etc. Then you are going to want to consider those factors when analyzing surgeons you are interested in and make sure the surgeon and his team have the capacity to safely handle your circumstances.
Training, education background, and continuing education are important factors in your decision as well. make sure your surgeon received his/her education from a reputable university, inquire about their specialties and experience, and ask about their efforts in continued education. With any surgery there are constant developments and evolution that are made to perfect the technique and procedure itself, all of which to increase the success of the surgery, and the safety for the surgical patient. Having a surgeon that participates in adapting to those advancements could be a great benefit to your surgical out come. For example, when I had my surgery back in 2012, my surgeon used general anesthesia, a few months after my surgery, I was reading on his forum group that he had changed his methods and started using general anesthesia in conjunction with a new technique, which he has learned at a bariatric conference he had recently attended. His new method allowed less general anesthesia to be used during surgery, which is safer for the patient, and makes the recovery both faster and easier for the patients as well.
Ok, so now that you have some ideas to help you to compile a list of potential surgeons, what questions should you ask those surgeons that will enable you to make your final decision?
1. The what is the surgeons education back ground, training, and continued education?
2. How long have they been performing bariatric surgery?
3. What type of bariatric surgery do they perform, and how many of each procedures?
I noticed that a number of surgeons were quick to list a high number of surgeries either on their websites, or when I talked to their staff over the phone, but many of them never mentioned if that number was compiled of all bariatric surgeries, or simply the number of various surgeries they are performed in their career. Many surgeons perform a number of non-bariatric related surgeries, and will throw those into the count because it make the numbers look better, but that can be very deceiving if a person doesn't think to ask for further details. I personally don't care if my surgeon as performed 2,000 appendectomies through out their surgical career, but it does matter to me if they have only performed 25 sleeve surgeries total, and that knowledge will affect my decision greatly. That notion would be the same if they have done a number of bariatric procedures, but only a handful of those were actually sleeve surgeries, you are going to want a surgeon that has a good amount of experience in whatever bariatric surgery you wish to have.
4. Does the surgeon operate out of additional locations, can you choose the location, and how much extra cost will be added if you choose surgery at another location?
5.What equipment does your surgeon use?
Even though you are seeking surgery in another country you want to make sure that the equipment is quality, and meets FDA approval. Let's face it, most medical equipment is manufactured in other countries to begin with anyway, but it never hurts to check and make sure that your surgeon plans to use high quality tools. With my own surgery, my surgeon used FDA approved Johnson & Johnson cartridges to form the new stomach, along with top quality equipment in the OR. It may sound a little OCD, but I figured if my new stomach required that I be left with staples in my body, I wanted verify the quality of them myself.
6. What closing technique does your surgeon use to form the new stomach?
I never ceases to amaze me just how many people I have met since having my wls, that never thought to inquire about how their stomach would be closed. I actually had a friend in that had surgery in Las Vegas, whose doctor never explained how he closed the sleeve, or that there were other options of how it can be closed.
With the closure different surgeons used different techniques. Some use staple cartridges only, others will use a combination of staple cartridges and then suture over the staple line to provide and extra layer of protection, and a few will used staple cartridges, a suture line, and a special glue to secure the new stomach.
7. How many leak tests are performed by your surgeon?
My surgeon performed 2 separate leak tests, one during the surgery, and an additional one before we were released from the surgical center. Having a surgeon that takes every precaution to insure your safety is an important factor, especially when having surgery in another country.
8. Does the surgeon and staff speak English?
This may not matter to everyone, but I speak next to no Spanish, so it was important to me that I could properly communicate with by my surgeon and his staff. I had a history of sever GI issues that needed to be discusses with my surgeon, that would affect my surgery, and it was VERY important to me that I knew he understood those issues, and could convey to me the methods that would be taken into consideration for my surgery. Now, for surgeons and staff members that are not bilingual, I am sure most places would have someone around the clock that could translate, but anything could happen, and I liked the idea of being able to communicate directly, without having to wait on a translator every time I had a question.
9. Does your surgeon offer copies of your medical documents, and are they in English, and is there and extra cost for them?
Most people might not think they would not really need these documents, but I like to cover all bases...just in case. Now, Mexico surgeons are required by law to file these medical documents in Spanish, so it is a good rule of thumb to also ask if you can receive a copy that has also been translated to English as well. Make sure and get the surgical report, any records and/or nurses notes for your stay at the center, and if available a copy of your surgical DVD. These are all handy to have a copy of should you ever need them in the future once you are back in your country of origin.
10. What size bougie does your surgeon general use, and how will they determine which size is right for you?
11.Will you fly in and have same day surgery, or will you need to fly in a day early and make arrangements for a hotel in San Deigo, or where ever you are flying into.
12. If you are required to arrive the day before your surgery, ask if the hotel cost is included in your surgery price for that stay, or if you would need to pay that out of pocket. If you have to pay for it out of pocket, ask the staff if they could suggest a place to stay, and if they received a special discount price for that place. General speaking if a business sends a number of people to a particular place they receive a lower rate for those accommodations.
13. Ask, if you need to provide an of you medical documents from your doctors in the US, and make sure that you bring them to Mexico.
With some medical conditions a surgeon will require either, records from your US doctor(s), a doctors release for you to have surgery, or tests results that you have had ran in the US. People with things like heart conditions, GI issues, Blood disorders, problems with receiving anesthesia, or with revision patients barium swallow results. I mention this because depending on certain medical conditions: one, your surgeon needs to be well informed of your situation in order to determine the best way to handle your surgery, and two, if you are asked to bring these documents to your surgeon, and forget them at home there you will most likely be required to see a specialist or have those tests ran in Mexico to clear you for surgery which will cost you extra money when you get there, or not be able to receive the surgery.
14. Ask for a list of contact information before, during, and after your stay in Mexico.
It really helps to have the phone numbers of your coordinator, the driver, the surgical facility, and your surgeon, or someone who can get a hold of the surgeon directly. Cell phone service in Mexico tends to be a hit and miss situation, so in addition to getting the staff cell numbers also ask for the direct phone lines or magic jack/Google numbers, that way you are able to reach the staff should you need them.
This list could go on and on, but for the sake of not writing a novel I will this one as is. I hope this helps some of you that are uncertain on where to begin, or questions that you might want to ask. If anyone has more to add to help those that are new to the wls process, please do, and as I think of more, I will add them in as well. Best of luck to everyone, and feel free to ask if you have any questions.
Also, my apologies for the spelling errors and grammatical issues, I wrote this in a hurry, and didn't spell check it before posting...so overlook those issues if ya can