Bariatric surgery in Mexico: training, practice and surgical trends

A systematic review of patient and clinician experiences of bariatric tourism

BACKGROUND

Although bariatric surgery is highly cost effective, accessing this treatment in the UK and other western nations is often challenging. Patients are therefore increasingly engaging in bariatric health tourism despite its associated risks and warnings from health institutions. A systematic review was performed to assess the reasons why patients are travelling abroad for surgery and common practices among bariatric tourism service providers.

METHODS

Medline and PubMed were searched for articles analysing the experiences of patients and service providers. Articles published in English between 2010 and 2023 were considered and seven were included for review after title, abstract and full text analysis.

RESULTS

Four studies assessing patients' experiences and outcomes following bariatric tourism and three examining the perspectives of bariatric service providers were reviewed. Patients across the studies were mostly from western Europe, North America and the Middle East. The most common reasons for pursuing bariatric tourism were a lack of bariatric service provision in patients' home nations, high costs of surgery in the private sector and long waiting times. Examples of practice outside the scope of most internationally recognised guidelines were identified across multiple studies, especially regarding patients' pre-operative optimisation and follow-up. The studies therefore suggest that bariatric tourism may lead to significant health risks and issues that need managing once patients return home.

CONCLUSIONS

Bariatric tourism is a common practice with significant associated risks. The reasons underpinning its appeal however, reflect genuine problems with accessing bariatric services and a lack of pre-operative education and optimisation.

Histological Changes in Skin and Subcutaneous Cellular Tissue in Patients with Massive Weight Loss After Bariatric Surgery

INTRODUCTION

Morbid obesity is a public health problem with high social and economic impact. Due to failure in its treatment with traditional weight loss strategies, surgical interventions are usually required, which give rise to massive weight loss. Until now, the studies made are inconclusive regarding the histological changes in the skin caused by massive weight loss, which may later generate post-surgical complications. Therefore, the objective of this study is to evaluate the cutaneous histological changes before and after bariatric surgery.

MATERIAL AND METHODS

Two skin biopsies were taken from nine different patients who underwent bariatric surgery. The first biopsy was taken before the surgical intervention, and the second biopsy was taken a year after the surgery and massive weight loss. Histological analysis was performed using haematoxylin & eosin staining, Weigert's Resorcin-Fuchsin, and Masson's trichrome stain to analyse the percentage of collagen fibres, percentage of fibrosis, percentage of vascularity, vascular layer involvement and adipocyte population. The differences between the biopsies were evaluated with the Student's T test and Mann-Whitney U test, with a p-value of <0.05.

RESULTS

Biopsies from post-bariatric patients with MWL showed an increase in fibrosis percentage, and a decrease in collagen fibres, elastic fibres of the dermis, adipocyte population, as well as reduced vascular proliferation.

CONCLUSION

MWL after bariatric surgery gives rise to changes in the skin and subcutaneous cellular tissue. Skin shows an increased fibrosis percentage after massive weight loss. Elastic and collagen fibres become disorganized after massive weight loss. Vascular proliferation is decreased after massive weight loss.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison of short- and long-term outcomes of bariatric surgery methods: A retrospective study

The present study is intended to retrospectively compare the short- and long-term outcomes of 3 different treatment methods in patients undergoing bariatric surgery and the variances in weight and nutritional parameters during the preoperative and postoperative periods. In this study, 534 patients who underwent laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-En-Y gastric bypass (LRYGB), and laparoscopic one anastomosis gastric bypass (LOAGB) between 2014 and 2021 were included. The sociodemographic and biodemographic characteristics of these patients, their weight losses and nutritional changes in the preoperative and postoperative periods, operative times, hospital stays, complications, and morbidity and mortality rates were retrospectively compared. There was a statistically significant difference between the surgical methods in the percentages of excess weight loss and total weight loss in the 1st and 3rd months. There were significant differences in the homeostasis model assessment of insulin resistance, folic acid, vitamin D, iron, ferritin, and parathyroid hormone levels (P < .05). All 3 techniques were found to be successful in facilitating weight loss at the end of the first year. LRYGB and LOAGB were found to be superior to LSG in terms of remission from diabetes during the first 6 months, whereas LSG was superior to the other methods in terms of nutritional deficiencies. Despite being more advantageous in terms of operative time, LSG and LOAGB were disadvantageous compared with the LRYGB technique because of the higher rates of leakage and mortality in the LSG technique and the higher rate of bile reflux in the LOAGB technique.