FAQ for Weight Loss Surgery
WHAT ARE PRICES LIKE IN BRAZIL FOR BARIATRIC SURGERY PROCEDURES?
Pricing for the surgeries in Brazil are so competitive due to the economy of the country. However, the all important products (like staples, etc) used during the surgery come from the USA and that is the largest expense of these surgeries. Keep in mind that the Surgery Prices will generally include the costs of the surgeon’s fee and team and hospitalization costs necessary for the performing of your surgical procedure/s along with a specific number of nights in the hospital post op. It will also include your Nutrional and Psychological Evaluations upon arrival. It does NOT include extra fees that would occur if you had complications, had to stay longer than the stipulated normal post op stay, or had to return to the hospital for an emergency or complication procedure, blood transfusions, etc. Again, this will be detailed and estimated for you in your Treatment Plan, depending on the surgical procedure you will undergo.
HOW LONG WILL I NEED TO STAY IN BRAZIL?
The length of your stay will depend on several things. Average minimum stay is about ten (10) days (or LESS with a minimally invasive procedure such as VBG/ LapBand), assuming you arrive a minimum of two days prior to your scheduled surgery date. For those of you that are having most of their pre-op testing done in Brazil, you may need another day even. Remember you will need to meet with the nutritionist and have your psychological evaluation done as well as meet with the surgeon and the anesthesiologist! In case you experience ANY complications and the surgeon determines that you need to stay longer for follow-up, PLEASE be prepared for this possibility schedule-wise, emotionally and financially. Check with whomever books your air tickets to find out the penalties or fees for extending your stay if medically necessary! Your health and well-being is VERY important to ALL of us! Follow post-op instructions and you should be well enough to return home with no risks or incidences of complications!
I DON’T HAVE INSURANCE COVERAGE, CAN I DO MY PRE-OP TESTING IN BRAZIL?
Certainly. It will be the surgeon’s final decision to advise you on any testing that he wants to see BEFORE you come to Brazil just to assure you are a viable WLS candidate before you spend money on the airplane ticket. We can provide you a price list for the necessary testing if you opt not to get your tests done in the USA (those without insurance, for example). We have negotiated excellent fees with our laboratory partners and can pass these savings on to you.
I AM CONSIDERING COMING WITHOUT A SUPPORT PERSON,
HOW WILL THIS AFFECT MY STAY AND WHAT DO I NEED TO
CONSIDER BEFORE MAKING THIS DECISION?
Only you can answer this question. Of course, we started this service to make it POSSIBLE and perfectly COMFORTABLE to come alone. Take the time to assess yourself HONESTLY regarding your comfort level in being by yourself somewhat. Although, other than “moral support” and “company” while you literally, “lay around and recover,” a support person generally cannot “help you.” MNB created our unique support structure in Brazil so that you did not HAVE to bring a support person. The money people would pay to buy the extra plane ticket, food (especially as you watch them eat what you cannot in the immediate post op period!), hotel, etc is MUCH better spent by investing it in themselves and their post op support and recovery as they heal fully and completely and are TOTALLY catered to by our trained staff of nurses and physiotherapists, etc. Remember too that there are always other patients just like you staying in the same hotel, affording you a real support group of people going through exactly what you are or have ALREADY gone through it and new friends are always made!
Think about how you have felt in the past post-surgery… Sometimes being alone can affect your morale, your mood, your motivation, your own healing … sometimes it’s about WHO you bring and how THEY react under stress, seeing you in some pain or discomfort, etc… With as many patients as we have seen come through now, ATTITUDE and MENTAL PREPAREDNESS makes a big difference in your recovery!
We have a Medical Basics Package Plan and a weekly fee for the 24/7 Medical Concierge Support services that will include daily nursing visits to help you bathe occasionally and change your bandages assuring you sterile bandage changes as well as your accompanied medical transportation even!! We have thought of everything, trust me.
If your husband or someone wants to be there to support you, I would recommend they come during your last week before you are ready to return to the USA when you will be feeling better and can actually enjoy their company AND they can truly help you with your luggage and things during your long plane ride home! This has worked the best for our patients.
CAN I DO ANY PLASTIC SURGERY OR OTHER PROCEDURES LIKE DENTAL WORK OR LASIK AT THE SAME TIME?
This will depend on the type of procedure you want in addition to the WLS. Generally, minor facial plastic surgery, dental, some laser procedures, etc are easily coordinated with your Bariatric surgery recovery. Generally, combining another procedure DURING the bariatric surgery is NOT possible. Please contact us at info@mednetbrazil.com
WHERE CAN I FIND MORE INFORMATION ON THE BDP/DS (BilioPancreatic Diversion with Duodenal Switch) AND OTHER WEIGHT LOSS (BARIATRIC) SURGERIES?
www.ObesityHelp.com
SOME COMMENTS ON THE LAPAROSCOPIC TECHNIQUE
The surgeon performs ALL bariatric surgeries using the laparoscopic technique. There is some debate about the “open” technique giving the surgeon more “visibility” but this is not necessarily accurate to a good extent. The cameras that are inserted into the five small incisions during a lap procedure allow the lap surgeon excellent up-close visibility and of course, the ability to “zoom in” on an area that he is working on that an open procedure simply does not provide. It is often a matter of the level of comfort that an “Open-trained” surgeon has to acquire with learning the newer Lap technique...kind of like learning to drive on the left side of the road after learning on the right! In terms of actual invasiveness of the procedure, recovery and post op aesthetics when it comes time for your plastics reconstruction, the lap procedure will save you maybe a day, but the real “recovery pain” is NOT from the external incisions (open or lap) but rather the “inside work!” However, in certain specific cases, the surgeon may recommend the WLS be performed “open.” Again, you would be informed prior to the surgery or you can of course, choose.
WHICH WLS PROCEDURES DO MNB’s SURGEONS PERFORM?
Please note that OUR surgeons perform all the various Bariatric surgeries by Laparoscopy or Open, including but not limited to: RNY, BPD/DS, mini Gastric Bypass, Capella, Fobi Pouch, Intra-gastric balloon, Lap Band (VBG) Vertical Gastrectomy or Sleeve Gastrectomy, and others. Revision surgeries are also available. Please inquire regarding procedures not listed on the price list at info@MedNetBrazil.com. Thank you.
WHAT ARE THE MOST COMMON REVISION SURGERIES?
These are the most requested Revision Surgeries:
- VBG (Vertical Banded Gastroplasty) to BPD/DS
The VBG procedure is most easily and with minimal risk, converted to a BPD/DS (Bilio Pancreatic Diversion w/ Duodenal Switch) especially if the ring is silicone or silastic.
- LAP BAND TO VG (Vertical Gastrectomy)
The VG, or “Sleeve Gastrectomy” is a wonderful and permanent alternative to the LapBand procedure. If this restrictive procedure alone has been successful for you but you find you need to remove the band for some reason or it has failed, consider the VG.
- RNY (Roux en Y) to BPD/DS
Conversion to a BPD/DS from an RNY procedure is more difficult and with some risks. What needs to be examined first is WHY the patient is re-gaining weight. A revision of the RNY procedure must be evaluated thoroughly by the surgeon. Please see the list of pre-op tests required for REVISIONAL surgeries here on the site. Sometimes he cannot re-use the stomach that was left inside during the initial procedure since it depends on how the stomach was sectioned in the original surgery. So technically, a revision from an RNY to a DS is on a case-by-case basis. Sometimes the RNY can be modified to create a smaller stomach/pouch (in the case that the pouch has stretched) and can be accomplished with surgically making the pouch smaller or using a gastric ring to diminish the capacity of the pouch and helping to restimulate weight loss. Another method is to create more of a malabsorptive procedure and make a smaller common channel. The RNY generally has a generous common channel so that there is usually little or no malabsorption to help maintain weight loss once accomplished which is why regain is so common. There will be additional pre-operative tests and other pre-op requirements in the assessment of your case that would be needed and the ability to convert your procedure would be decided on a case-by-case basis by the surgeon and may result in a LESSER cost to you.
- Modification of Existing WLS Procedure
The modification of an existing WLS procedure would again require a determination as to why the weight loss has stopped or why weight is being regained. The existing stomach and bowels would need to be evaluated. Again, the most common ways to modify this would be to diminish the capacity of the stomach once again, and/or decrease the common channel creating more malabsorption (distal). Of course, there will be additional pre-operative tests and other pre-op requirements in the assessment of your case that would be needed and the ability to modify your procedure would be decided on a case-by-case basis by the surgeon. Also, another alternative is called “Sclerotherapy” which is a procedure that creates scar tissue at the pouch to minimize its capacity. Please inquire at info@mednetbrazil.com
WHAT IS THE DOCTOR’S COMPLICATION RATE?
His complication rate for the DS for example (a complicated technique!) is 3-4% and mortality rate is less than 1%. Most complications occur when people do not advise their Doctor properly on their health history or medications, IF they occur at all. Most common complications are those most common to any surgery; thrombosis and pulmonary problems. Safety is always our first concern. Chance of post op complications depend on the clinical status of the patient pre-op, hospital infection rates and the experience and thoroughness of the surgical team. He has performed well over 2000 bariatric procedures, and thousands of various gastric procedures.
Most complications occur when people do not advise their Doctor properly on their health history or medications, IF they occur at all. Safety is always our first concern. It is important that we have your pre-op tests in hand and that you fill out the Health history form completely and accurately since this can impact potential complications! SMOKERS PLEASE BE HONEST!!! It won’t exclude you from surgery but the doctor needs to know! =) Let me also reiterate that it is essential that you follow the post op instructions given to you, whether written or ORAL!!
HOW DO YOU CHECK FOR LEAKS?
In our surgeon’s procedure, the stomach is hand-stitched AND stapled and the staple line at the duodenum is reinforced. A blue dye is introduced into the stomach AND the complete duodenal ileum joint to test for leaks before closing the procedure.
WHAT DO I NEED PRE-OP?
Once you fill out the Health History form and the surgeon returns your Surgical Evaluation and Budget Estimate, any necessary pre-op tests will be specified in your Surgical Evaluation. Of course, if you have already been evaluated and tested in the USA for WLS, please forward these results along with the Health History form and that will save time and money! The surgeon will also need copies of your test results whether they are done in the USA or in Brazil. We prefer that you send them as attachments with the requested file formats. Those that are done in the USA, you WILL need to bring them in HARD COPY FORM with you to Brazil!
HOW LONG DO I STAY IN THE HOSPITAL?
The surgery price includes the surgeon’s fees, anesthesiologist and hospital fees including medications and up to a three night stay for an uncomplicated stay (depending on the weight loss procedure that you have). Generally, the less time in the hospital, the reduced risk of exposure to infection, so generally you will find yourself able to be discharged no later than the second day. In the case of complications and the need to stay longer, you will be responsible for the hospital fees. They haveagreed to accomodate our patients for a nominal fee per diem, assuming you do not need ICU admittance.
There is a sofabed in the room for those that are coming with a support person. Meals are provided for the support person at a small additional cost and can be paid in cash upon leaving the hospital.
HOW DOES MEDNETBRAZIL FACILITATE THIS JOURNEY FOR ME?
If you have done your research, you know that it’s not just surgery fees, airfare, and lodging that you need to budget for... let’s face it, this is major surgery! What about medications, blood tests, post op therapies and treatments, how do I get to my appointments and who will take care of me while I’m there?? Well, MedNetBrazil has the MOST first hand knowledge of what EVERY patient needs (medically, emotionally, socially, etc) in coming to Brazil for their surgery. From our personal experiences (both myself and your main caregiver in Brazil have had WLS ourselves!) and our successful five year history of having assisted hundreds of our peers on some part of this journey together, our surgeons and MNB have developed a plan to not only be able to take care of you and your needs both pre and post op, but give you TOTAL support AND we can also give you as accurate a financial sum as possible (for an uncomplicated stay) by providing first-hand information to you. Know before hand what you REALLY NEED, with minimal surprises, to make this journey a SUCCESS!
As we have gained experience and knowledge through helping so many others, as well as having been there ourselves, it is our commitment to provide you with the most Medically Comprehensive (safe!), Professional and Organized service POSSIBLE.
Our Surgeons speak ENGLISH, we have bilingual nurses to assist you daily and while you are in the hospital. We have “Partner Hotels” that cater to our clients (the medical tourist) and offer us great rates for your extended stays. We have contracts with Medical laboratories to get you the best price for your pre-op tests if needed. We have an aftercare Package to help you budget, and we also have a COMPLETE infrastructure of care for you in ENGLISH, 24/7 Hotline, from the moment you step foot in Brazil until you return home that includes your medically necessary transportation while you are in Brazil, and doctors here, stateside to follow up with you in case it should be necessary! I was a patient myself in Brazil and I can promise you that we know exactly what you need while you are here, both as a patient, and as a PEER!
Your Medical Transportation and in-country support services are a weekly fee and will also be detailed with your Surgical Evaluation and Budget Estimation
WHY DO I SEE SUCH PRICE DIFFERENCES FOR THE SURGERY?
Many things help determine a surgeon's price (including the surgeon himself), most importantly, the facility where the surgery is being performed and the materials and equipment used for the surgery. Hospitals are funded and maintained in various ways, some publicly by the government, some privately, some are owned by insurance companies, etc. Of course, the amenities and resources available to the surgeon and his patient through the use of a particular hospital will vary, as will the hospital's fee schedule. Generally a public hospital is less expensive than a private hospital and their amenities (and fee schedule) reflect this. Do they have bariatric beds suited for M.O. patients, what are their accreditations/affiliations, what is their infection rate, where is the hospital located in the city, how many ICU beds do they have, how old is the hospital, how has it been maintained or upgraded? And this list goes on.
Another factor is the actual surgical technique, time spent and thoroughness of the procedure done by the surgeon. How many leak tests are performed? Where? Is there hand-stitching involved or only stapling? Were adhesions properly addressed? How quickly can he perform the procedure? Etc…
WHY DON’T I SEE A PARTICULAR SURGEON ON YOUR WEBSITE?
MedNetBrazil is first and foremost a PATIENT ADVOCATE service! To undergo a surgery such as this is a major life decision and you only have one chance to get it right. It will change your life in so many ways, as it has mine. When certain issues come to light that directly affect patient care, certain IFSO (Int'l Federation for the Surgery of Obesity) standards are not being consistently met, surgical statistics and training statements made by the surgeon cannot be confirmed, repeating post op complications, proper follow-up attention not being given to a patient with major post op complications, of which she ultimately passed away from... these and other issues have ultimately led me to not be able to, in good conscience, recommend or work with a particular surgeon. I did not replace him with another in his city either because at the time, there simply were no qualified DS surgeons that spoke English and fit MNB's standards. Other WLS surgeons were eager to take his place, but I made a decision to look elsewhere, hence Sao Paulo and Santos. I just don’t feel that a compromise is necessary.
MNB’s Mission and promise to our peers from the beginning has been in making sure that certain standards be met and upheld and we are now proud to be working in conjunction with SRC to help make sure these standards are met for International Bariatric Surgery locations to create “Centers of Excellence.” More proof that compromise is not an option.
WHAT ABOUT THE LODGING AND THE SAFETY OF THE CITY ITSELF?
Yes, MNB has contracts with centrally located, 3 to 5 star HOTELS (not ranches or retreats) that offer us corporate discounted rates starting at US$80/night. You will generally stay in a one bedroom apartment suite with kitchenette, free breakfast buffet and in-room DSL internet access. Safe, absolutely!! That is one of MedNetBrazil’s major concerns as well! We are concentrating our growth in the safest and best cities in Brazil! Our current hub, Santos, SP has been rated one of Brazil’s Top 20 Safest Cities and also one with the Best quality of life in Brazil as well as being known as the “Plastic Surgery Capital of Brazil.”
Ranking of Safest Cities: http://www.ssp.rj.gov.br/epoca/p04.asp
Ranking of Most Violent Cities: http://www.ssp.rj.gov.br/epoca/p03.asp
Please do your research. This magazine is Brazil’s “Time Magazine” equivalent. Although we have surgeons in the “Big Cities” of Sao Paulo and Rio de Janeiro, you may notice higher price quotes just due to the economy of these big cities. Our mission is to offer you these options however and want you to be ultimately confident in your decision and thrilled with your final results! There are excellent surgeons to be found throughout Brazil and we are expanding our in-country Concierge Services to be able to bring these surgeons to you.
Since my exit from Vitoria, ES Brazil, there are several other services operating there claiming to have a lot of experience and your best interests at heart. Unfortunately, the state of Espirito Santo (ES) has 4 cities on the Most Violent list (please see above link). Two cities are the actual cities of the surgeons/hospitals and the other two cities are literally suburbs of these operating cities. I have lived myself in both places with my two small children and have appreciated the differences! The American Embassy has also been investigating certain incidences regarding American patients there. This is ultimately about safety, skill, integrity, reputation and providing MY WLS peers with the BEST.
I DON’T WANT TO CARRY A LARGE AMOUNT OF CASH AND I HEAR THERE IS A LIMIT TO THE AMOUNT OF CASH ONE IS LEGALLY ALLOWED TO BRING INTO BRAZIL.
HOW DO I PAY FOR THE SURGERY?
Well we do recommend you have at least R$500 (Brazilian Reais) on you as you arrive (you can exchange at the airport once you arrive) just for starter funds. The current limits on carrying CASH or its equivalent into Brazil are US$4000. Because we are an American company with a domestic bank account, we can offer our patients the most safest and fastest way to get these funds to the surgeon. Your surgical funds will be deposited into our US bank account and wire transferred for you for a nominal percentage fee. You will get a receipt for the funds from the surgeon. Access to ATM machines for daily expenses is easy but there is a daily withdrawal limit. Due to the very poor exchange rate of Traveler’s Checks, we do not encourage anyone to bring or plan on using them and they are not accepted by the surgeon.
CAN I PAY BY CREDIT CARD??
Absolutely. You can use our MedNetBrazil Pay Pal account and for a small percentage fee as well, you can pay your surgery fees or Medical Basics Package Fees by credit card and take advantage of your miles or other reward cards.
CAN I FINANCE MY SURGERY AND OTHER EXPENSES?
If you want to look at financing some of your surgery, check out the links on our website for companies that will loan you funds for your surgery and other costs involved in this trip. They have helped many of our patients and service ALL credit scores. Because MNB is an American company, even though our surgeons are abroad, they will finance our patients.
SO WHO PAYS MEDNETBRAZIL?
Although it is the surgeons who “pay” MNB as we act as his foreign “Front Office Staff,” he does NOT own MNB or have any exclusivity with us, nor does he expect it. It is he who must uphold these standards as well and MNB has NOT been afraid to turn down representing a surgeon, replacing him or simply not offering one if he does not meet our standards of care, follow-up or ethics.
MNB is the advocate for our PEERS, YOU, the foreign patient. We are NOT the advocate for the doctor. We are “giving back” and facilitating this journey for YOU, NOT the surgeon. It is YOU that needs attending to and certain standards of care and assurance when going abroad for your procedure, NOT the surgeon. You are the foreigner in the foreign land undergoing a life-changing procedure and trusting someone to inform, incubate and intimate you with ALL the details. I hope you find myself and MNB uniquely qualified to “Concierge” you on this journey as an American that speaks fluent Portuguese, having immersed myself in the culture and business/medical world of Brazil for 5 years, with my local contacts and savvy from actually living in Brazil, as well as my own experience as a WLS patient AND foreign patient just like you. I am SURE that I am one of the few (if not the only) that has not only been a patient myself, but has actually accompanied hundreds of patients through every step of this journey; from the pre-op arrival help and organization to forehead-stroking in the hospital post-op surgery, to support and follow up in the post op period once you are home and getting used to your new life after WLS!
Hopefully these FAQ’s have answered most of your concerns. I know there are many and varying considerations for everyone. If you have more questions, please feel free to contact me at our toll free line 877-520-8597. 8am-6pm California time. We are on the phone A LOT, so please leave a voice mail message if it rolls over!
