Patients facing big bills to fix obesity surgery

By Martin Johnston

Photo / The Aucklander
Photo / The Aucklander

Obesity surgery was life-changing for Alison - until the surgical band around her stomach slipped, twice.

Now Alison - which is not her real name - is waiting for her second corrective operation following the original surgery in April 2008.

The 53-year-old office worker weighed 146kg, lost 32kg after the first operation, but has subsequently put 20kg back on.

Her husband, speaking after the Government announced it would increase its spending on obesity surgery by $2 million a year, treating up to 75 more patients annually, said better controls were needed on the quality of the gastric bands.

But surgeons already warn of the risk of the bands slipping and other problems that might require revision surgery. Public hospitals tend to prefer the gastric bypass operation - and the sleeve gastrectomy, which removes 85 per cent of the stomach and can cost about $15,000. A bypass can cost about $20,000 and a gastric band operation about $15,000.

Waitemata District Health Board clinical director of surgery Michael Booth, who also runs a private practice, said about 5 per cent of gastric band patients needed revision surgery for problems such as slippage or erosion of the band.

But Counties Manukau DHB surgeon Richard Babor said one overseas study had found a re-operation rate of 30 per cent when all complications were included. He had stopped offering the operation because it required too much follow-up and had too much "nuisance value" for patients. His DHB's preferred obesity operation is the sleeve gastrectomy.

Alison said she felt great after her first operation when she lost a large amount of weight.

"I felt liberated. I wore tops without sleeves for the first time. I could buy clothes, I could mix with people. I could get up and talk in front of people.

"Our 4-year-old granddaughter lives with us. I had more weight to lose, but I felt good enough to go swimming with her at a public pool. Now, I feel crap about myself again."

About 19 months after the first operation - which makes people feel full after eating a small amount of food - she sensed problems.

She had been able to drink only two mouthfuls of water at a time, and her meals were limited to soup and pureed vegetables.

Suddenly she could drink a normal amount of water again, and a sandwich, then sushi - starchy foods that previously wouldn't go down. Soon she was back to eating normal meals.

She and the health insurer Southern Cross went halves for the $15,000 cost of the first operation. After a wait of several months, Alison had the first revision surgery provided by her local public hospital. And now, after another wait since the second slip, it has scheduled her second revision for tomorrow.

HOW IT WORKS

Laparoscopic gastric band surgery:

* Done by keyhole surgery.
* An adjustable, hollow band is placed around the stomach.
* The silicone band is filled with saline solution to restrict stomach.
* This creates a small stomach pouch.
* Band tightened or loosened by adding or removing saline via an injection through the skin and into a tube.
* Patients typically lose 50 to 60 per cent of excess weight within two years.

- NZ Herald

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