Some statistical improvements include:

• Diabetes: Resolved in 77% and improved in 86%.
• High cholesterol: Improved in 70%.
• High blood pressure: Resolved in 62% and improved in 79%.
• Sleep apnea: Resolved in 86% and improved in 84%.

• 40% reduction in death rate from all causes.

Patients who have had obesity surgery benefit in many other ways:

• Improved quality of life
• Improved psychiatric well being

• Decreased cost of medications

The overwhelming evidence is in favor of obesity surgery when non-surgical methods have failed to achieve weight loss. If you have decided that obesity surgery is right for you and you do not have adequate insurance coverage and you do not have the financial means to have surgery where you live, consider having your surgery done by a qualified surgeon in a safe hospital in Mexico.

The two types of obesity surgery are restrictive and malabsorptive. Some procedures combine both restrictive and malabsorptive properties. Before you go you should decide what type of surgery is best and that it is safe for you to have surgery. You should also arrange for appropriate follow up care which may include medical management and nutritional counseling. Each type of surgery will require that you have some sort of responsible follow up. Many people have successfully traveled to other countries for obesity surgery. There are many clinics and doctors available everywhere that can help you manage life after surgery.

Restrictive surgery limits the amount of food you can put into your stomach at any one time. Examples of restrictive surgeries include the laparoscopic adjustable gastric banding (LAGB), commonly known as the Lap Band TM or the vertical banded gastroplasty (VGB). VGB provides a 66% two year weight loss.

Statistically speaking, you can expect about a 55% weight loss up to 9 years later. Unfortunately the complication and revision rate in VGB is a little high and most purely restrictive surgery is accomplished now with the LAGB.

The LAGB utilizes a synthetic fluid-filled, doughnut-shaped band, which is wrapped around the top portion of the stomach. A small port is attached to the band by a thin piece of synthetic tubing and the port is surgically placed just under the skin on the abdomen. The port is therefore easily accessed so that a healthcare professional can inject or remove sterile saline from time to time to adjust the size of the band. This ability to adjust the restrictive nature of the band has eliminated the need for revision surgery that used to be necessary with the VGB procedure. In addition, the stomach is not cut so there is minimal risk of leaking from the stomach. LAGB is the safest of all bariatric procedures and carries a very low 0-0.05% mortality rate. And, because the lap band is very simple to perform the cost is generally much more affordable. Weight loss with the LAGB is 42% at one year and about 55% at five years. Weight loss tends to be more gradual compared to malabsorptive procedures but at three and five years, the comparative data between the two types of surgery is nearly identical.

Strictly malabsorptive procedures cause food to bypass certain areas of the intestinal tract that absorb nutrients. Calories are not absorbed by the intestines and end up in the toilet and not in your body. Standard strictly malabsorptive procedures include the biliopancreatic diversion (BPD) or the BPD with duodenal switch (DS). Malabsorptive procedures result in more rapid, long lasting weight loss. One study on BPD reported a 72% average weight loss at 18 years. Nutrient malabsorption and a higher complication rare are the major drawbacks of these procedures.

Complications of BPD and DS:

• Diarrhea and foul smelling gas (due to fat malabsorption), with an average of 3-4 loose bowel movements a day
• Malabsorption of fat soluble Vitamins A, D, E, and K
• Vitamin A deficiency, which may cause night blindness
• Vitamin D deficiency, which may cause osteoporosis
• Iron deficiency –a similar incidence with the RYGB (less frequent with DS)
• Protein-calorie malnutrition
• Ulcers (less frequent with DS)

• Dumping syndrome (less frequent with DS)

Some procedures, such as the Roux-en-Y gastric bypass (RYGB) combine both restrictive and malabsorptive components. The RYGB procedure is similar to the BPD and DS operations in that the stomach is divided and the intestines are reattached in a manner that allows food to go around (bypass) the absorptive portion of the small intestine. With the RYGB the attachment is higher up (when compared to BPD) resulting in less dramatic malabsorption. Because the RYGB also involves a restrictive procedure (stomach is divided and a small pouch is formed), rapid, profound weight loss is also achieved. Also, there seems to be more appetite suppression with the RYGB.

Advantages of RYGB

• Better weight loss than after purely restrictive procedures
• Low incidence of protein-calorie malnutrition and diarrhea
• Rapid improvement or resolution of weight-related health problems

• Appetite suppression

All Patients who wish to undergo Obesity Surgery should:

• Be well informed and motivated
• Have a BMI >40; for individuals with a BMI between 35 and 40 with at least one serious concomitant obesity related medical problem such as diabetes, sleep apnea, obesity-related cardiomyopathy (heart damage) or severe joint disease may also be candidates.
• Have acceptable risk for surgery

• Have failed previous non-surgical weight loss interventions

Situations where people who should not have bariatric surgery:

• Untreated major depression or psychosis
• Recent history of binge eating disorders (Anorexia or Bulimia)
• Current drug and alcohol abuse
• Severe cardiac disease that poses a high risk for anesthesia
• Severe coagulopathy (blood clotting disorder)

• Inability to comply with nutritional requirements including life-long vitamin replacement (Some bariatric surgical procedures result in nutritional deficits that require life-long vitamin supplementation).

Potential conditions where Lab Band Surgery should not be done:

• Crohn’s Disease
• Large Hiatal Hernia
• Portal Hypertension (Seen in Cirrhosis of the Liver)
• Connective Tissue Disorders (Scleroderma, Lupus, Rheumatoid Arthritis, etc)
• Prior Ulcers of the stomach

• Chronic steroid use

Summary of Bariatric Procedures

Our physicians and health care coordinators have extensive, hands on experience working with doctors and hospitals throughout Mexico. We began developing our network of Mexico’s finest doctors and hospitals in 2000 by conducting personal interviews and educational background checks on more than 700 Mexican doctors and inspecting over 80 private hospitals. We spent 6 years researching the Mexican healthcare system before we referred our first patient for surgery in February of 2006. As a result, if you decide to let MedToGo coordinate your surgery or medical service in Mexico, you can be assured that you will be working with the country’s finest doctors and institutions.

You will have also hired a team of U.S. physicians and health care and coordinators that will oversee your care and serve as your advocate while you are in Mexico. You will not be alone. Your safety and peace of mind are our primary concern. Furthermore, we can offer you complete healthcare packages with up to 75% off the price of a comparable experience in the U.S.-without a compromise in quality.

• Our physicians meet and hold personal interviews with all Mexican physicians.
• We verify the doctor’s educational experience and credentials, including board certification and licensing.
• We request and check professional references and assess a doctor’s local reputation through various professional and personal resources. Doctors must be in good standing with their community and hospitals. There must be no history of current or repeated legal malpractice.
• We review physician resumés and give preference to physicians who have been consistent with continuing medical education, who are active in their medical societies and who have been entrusted with leadership roles within their institutions.
• We examine evidence of their surgical success rates.

• Prior to including a surgeon or physician into our program, we attend his/her operations to evaluate competence and skill.

You do not pay extra to work with MedToGo. Were you to go directly to the same doctor to schedule the surgery, your cost would be the same as if you were to coordinate it through MedToGo. But if you hire MedToGo we will not only provide you with a selection of Mexico’s finest health care providers and coordinate your procedure, we will also be your advocates while you are abroad and not rest until have returned home.

Your Mexican hospital and doctor compensates MedToGo for marketing services, and MedToGo does not add additional fees to the cost of your package. MedToGo does not accept cash incentives or alterations in compensation from physicians or hospitals. This ensures that our recommendations are unbiased and based solely on our experience and quality assessment.

I consulted Dr. Robert Page, my primary physician, because I knew of his familiarity with surgeons and hospitals in Mexico and I had read his excellent book on Medicine in Mexico. He agreed that this surgery was important to my health and began the process of arranging for the procedure.

Dr. Curtis Page accompanied my husband and me to Hermosillo. He introduced me to the surgeon, a fine man with a great reputation in Mexico. The hospital was wonderful. Much like our American hospitals, the staff was professional and the nurses were every bit skilled as those I had experienced in Arizona.

My surgery went off without a hitch and the next day we drove back to Arizona. Last month I returned to Hermosillo for my one year check up. Dr. Robert Page met us at the hospital and learned the “fill” procedure so that he can perform necessary fills for patients who have this surgery in Mexico.

I was very pleased with this experience, the hospital, staff, and doctors and the care and attention I received from both Dr. Robert Page and his son, Dr. Curtis Page.

Claudelle L’Ecuyer