The case of a bariatric patient operated on in Turkey, saved by Romanian doctors at the Center of Excellence in Bariatric Surgery
Bariatric and metabolic surgeries are complex interventions, that produce changes in the entire body, therefore they require detailed pre-operative investigations and, mandatory, careful periodic monitoring after the surgery. Successful bariatric surgeries are performed by surgeons with experience in such procedures, who follow international protocols established for more than 30 years. When, however, these essential conditions for the success of surgeries, but especially for the safety of patients, are not met, the risks increase exponentially, thus endangering the lives of patients.
How large are the risks that patients expose themselves to when they choose a stomach reduction surgery, with skipping important stages of the treatment plan and not respecting international protocols, we learn from the following story. It is also the story of a family that regrets the hasty decision to perform the Gastric Sleeve surgery abroad, but they are grateful that they arrived in time at the Center of Excellence in Obesity Surgery at Ponderas Academic Hospital.
At the age of 45, Bogdan decided that the best solution for his weight problems is to have bariatric surgery. He documented, that he saw what the options and prices are in the centers dedicated to bariatric surgery in our country and abroad and chose, based on financial criteria, to do the surgery in Istanbul. He knew that a series of complications could arise after the procedure, including some very serious ones, but he didn’t think that something like this could happen to him. In the middle of January 2022, Bogdan and his wife flew to Istanbul, where he had the stomach reduction surgery, but the problems started to appear even a few days after the surgery.
They sent him home after the surgery, although he wasn’t feeling OK
"The day before we left home, he started to have a fever. We announced that something was wrong, but they said that, from their point of view, everything is normal and we can go home peacefully. The fever continued the following days and the recommendation of the doctors in Turkey was to contact the doctors here to find out what the problem was. When the drain tube placed during the surgery was removed, the infection began to flow from there and, although he was given antibiotics, he was getting worse and worse. Then we decided to return to Turkey, to the clinic where he had been operated on. Thus, 5 days after discharge we returned to the hospital", explained Gabriela, Bogdan’s wife. The patient remembers only a few moments about these days because he was unconscious the whole time.
Bogdan was hospitalized in the clinic in Turkey for 11 days, during which he didn’t find any solution to his problems. His wife says that she was desperate because she could see that his condition was getting worse day by day, although the doctors told her, through a translator, not to worry: "Some superficial investigations were done on him. They told us that it was not a gastric fistula, that it was nothing serious, to keep calm, and that, for our safety and his safety, if there was a small fistula, they’d try to put a tube in the stomach. Thus, he went into surgery again, for the second time. I think that one day he was somewhat more lucid and coherent, otherwise he felt very bad.”
Although Bogdan's condition didn’t improve for a moment while he was hospitalized, the doctors told his wife that, from their point of view, he could go home. Gabriela refused and asked for new investigations, which showed that he had a collection in his abdomen. But, paradoxically, the attending doctors were waiting for an expert to solve this problem.
"The infection was spread throughout the abdomen, and I didn’t dare to go home, because I didn’t know what to do, I could see that the situation was as serious as possible", confessed Gabriela.
When they arrived in Ponderas, Bogdan had a 5% chance of survival
Desperate that the doctors in Turkey were unable to solve her husband's medical problem, Gabriela contacted a friend who urgently directed her to Ponderas Academic Hospital and, following a discussion with a doctor at the Center of Excellence in Bariatric Surgery, Gabriela received all the necessary instructions to arrive as quickly as possible at the Emergency Room in Ponderas.
They left Turkey by car, on signature, Gabriela remembers: "When I got off to take my luggage to the car, someone came to Bogdan with a paper written in Turkish and told him to sign it. Being desperate to leave, he signed it, but he doesn't even know what he signed." She knows that she took a huge risk by leaving the hospital, but at the same time, she is very aware that it was the best decision she made. They left Istanbul by car and they didn’t stop until they arrived at the Emergency Room in Ponderas. "We had to go somewhere to save him, we couldn't leave him there. I tell you honestly, in the situation he was in and the way he was, I couldn't have gone anywhere else", Gabriela told us.
Only when she arrived at Ponderas, Gabriela understood how serious Bogdan's condition was: "He had a 5% chance of survival, he was full of collections in his abdomen, the infection had reached the pleura of his lungs. […] Professor Copaescu was very honest, he explained to me that the situation is very serious, but he told me that they will do everything they can and they know better".
In less than 60 minutes, Bogdan was on the surgery table
The rapidity of the intervention and the experience accumulated over decades in bariatric and metabolic surgery of the multidisciplinary team at Ponderas made the difference between life and death in the case of Bogdan, who was quickly assessed and urgently taken to the surgery room, to be stabilized.
"Our reaction was prompt. In less than 1 hour we realized the seriousness of the general septicemia. A huge amount of intraperitoneal fluid was infected, a tomography was performed and he was put on the surgery table in a very short time. It was a very difficult case to manage, I had to get involved, as the coordinator of the Center of Excellence. [...] The modifications probably took at least 5-6 days, a long period of suffering and exhaustion for the body", explains Prof. Dr. Catalin Copaescu, Surgeon of Excellence in Bariatric and Metabolic Surgery and coordinator of the only Center of Excellence in Bariatric Surgery from Romania.
"The surgery was complex and long, which lasted around 7 hours. It started late at night and included several stages. In the first phase, 2 and a half liters of purulent liquid were extracted from the peritoneal cavity. Multiple procedures were performed to drain the peritoneal cavity, a nutrition route was provided through a jejunostomy, required in situations where the continuity of the digestive tube is interrupted above the duodeno-jejunal angle. At the same time, the gastric stent initially placed in the clinic in Istanbul was removed endoscopically, the gastric fistula was treated and an exploratory thoracoscopy was also performed, to evacuate the fluid accumulated in the left lung" tells Prof. Dr. Catalin Copaescu for describing the surgical maneuvers.
Gabriela is convinced that if they didn't arrive at Ponderas, Bogdan couldn’t have been saved: "I think that if I went with him to another place, I don't think anyone could save him. Now I know that only Professor Copaescu and his team were able to save him".
And, not infrequently, Prof. Dr. Copaescu and his colleagues at the Center of Excellence in Bariatric Surgery in Ponderas are called by doctors from emergency hospitals, who ask for guidance regarding the care of patients who have arrived at the Emergency Department because of complications arising from procedures of bariatric surgery performed in Turkey. "Patients arrive urgently in hospitals, without them having dedicated departments for bariatric patients, there is no bariatric department in any emergency hospital in Romania. They arrive there because the Ambulance takes them to where the Emergency Room and the only medical details they provide are that they did a "miracle surgery". Many patients don’t know the name of the performed procedure, they are incompletely investigated and incompletely informed", says Prof. Dr. Catalin Copaescu.
Bogdan's condition started to improve immediately after the surgery in Ponderas
The surgery was a success, and the first signs that Bogdan would recover came as soon as he woke up from anesthesia. Then he started to be a bit more aware, and when he saw the 3 drain tubes, he practically realized what had happened to him.
"After the professor operated on him, he began to realize everything that had happened to him, what he went through, to regret the fact that he went to Turkey. The mistake is that we followed the herd effect and we didn’t take into account all the implications of the surgery", confessed Gabriela.
The post-operative recovery was slow but favorable. "His luck was that he is a young man, who had resistance and who didn’t have many associated pathologies - he only had high blood pressure, dyslipidemia, if we can say ONLY, a proinflammatory procoagulant syndrome, but the body was a young one and he was able to fight until he was offered the medical help he needed", explained Prof. Dr. Catalin Copaescu.
Bogdan was hospitalized in Ponderas for 15 days, during which the doctors and nurses made sure that he was getting adequate nutrition, and that he was starting to move and walk.
"He tells me fondly about what he lived in Ponderas, about the team and the many doctors who swarmed around him, about the nurses, about the care that was shown to him and that every time he needed something, someone was there next to him, of the joy he felt when his first drain tube was removed, when he took his first steps after the surgery, like a child. I have no words to thank the professor", says Gabriela, adding that what impressed her most at Ponderas was the care for the patient.
At home, recovery was exhausting for all of us
Still being in the hospital, it was explained to Gabriela that Bogdan would need special care at home and that it would not be easy at all, neither for him nor for the rest of the family. She remembers that, at one point, Prof. Copaescu encouraged her to take a break and take care of herself, and her emotional state, because she would have to prepare for what would happen at home.
Once they got home, Gabriela truly understood what Prof. Copaescu was referring to. For two weeks, Bogdan had to be fed artificially, just as he was fed in the hospital, through the jejunostomy.
"First of all, he had to stay in bed, we had to feed him artificially, and one will realize that it wasn’t a very pleasant experience. We were giving him the required treatment through the jejunostomy. It was exhausting for me my little girl, but we didn't lose hope. I kept in touch with the professor all the time and I asked him everything, and he replied to my messages", explained Gabriela while adding that it was also difficult from an emotional point of view, especially since she had to be strong and encourage Bogdan, even when he felt that he was collapsing.
Fortunately, Bogdan's evolution was not only encouraging but amazingly fast. Within a month he recovered, not completely, but he was doing better and better. Even the doctors were surprised by how quickly his condition improved.
"We thought it would be required to feed him artificially for around 4-5 months, but the jejunostomy was removed even faster than the professor predicted.", told Gabriela.
5 months have passed since the emergency surgery at Ponderas, and Bogdan feels very well. For now, he has resumed some of his usual activities, he drives and walks, and he can eat by himself, without any food restrictions. He has not yet resumed his professional activity, but he is happy and grateful to be alive. At the beginning of June, he turned 46 years old and he said that he feels like he has been reborn.
Every week, 2-3 patients arrive at Ponderas with various post-operative complications
Bogdan's story is not an isolated one, unfortunately. Like him, 2-3 patients come to the attention of the multidisciplinary team at Ponderas every week, because of post-operative complications arising from the bariatric surgery procedures they performed in clinics in Turkey.
"Unfortunately, there are patients who could no longer reach specialized centers, there are patients who were left with scars after such surgical interventions, with irreversible consequences because, although they didn’t have an immediate surgical complication that put their life in danger, they had metabolic complications. What does this mean? Having a vitamin, mineral, and protein imbalance, the body is exhausted and certain functions are at risk", explained Prof. Dr. Catalin Copaescu.
Bariatric surgeries must be performed in dedicated centers
Bariatric surgery is a complex type of surgery, which does not only involve performing a simple surgery. Because it produces major changes in the entire body, the surgical intervention must always be accompanied by a series of essential stages - a detailed assessment that provides accurate and complete information about the patient's health before and after the surgery, a multidisciplinary medical team, a careful post-operative monitoring, and indefinite monitoring. The surgery is only part of what a bariatric surgery program means.
"I would like patients to understand that surgeries for metabolic surgery are not isolated, it's not like you extract a tooth or a mole and you no longer have to go to the doctor. These types of surgeries are surgeries that trigger a mechanism that will induce changes in the body and that must be supervised, or this means that one must go to a center that can offer not only the surgical intervention but the entire post-operative monitoring package. Patients don’t leave there slim, patients don’t leave there with problems solved, but in the process of being solved, and this solution must necessarily be performed with medical supervision. And then, I would advise them to focus on centers that offer continuous monitoring", says Prof. Dr. Catalin Copaescu.
In Romania, there are several specialized bariatric centers that can offer persons affected by obesity and other associated complications a safe surgical intervention, followed by adequate monitoring. At Ponderas Academic Hospital there is the only Center of Excellence in Bariatric Surgery in the country, and the program and services offered to patients are internationally certified.
If you feel that your weight problems are affecting the quality of your life, request an appointment with one of our surgeons specializes in bariatric surgery procedures. You don't have to suffer in silence, but only ask for the help you need, from those who can help you!