Having weight loss surgery in Mexico can be both a wonderful and, at the same time, a frightening experience. Most of the fears are unfounded and based on fear of the unknown and stories we have been told all our lives by others. While there is nothing that will remove all of these fears, the more informed you are and the more you talk to others, the less fearful you will be. Because of long standing rivalries and misinformation, both economic and cultural, the information becomes a little clouded with emotion and a little harder to sort out. Because of the nature of the surgery and the fact that many of us have to pay for it out of our own pockets there is keen competition for your dollar, something we are not so used to regarding other types of surgery. Ultimately you have to sort it out for yourself and you have to rely on your own investigations. Most of the following has been adapted from an excellent post written by one of our forum member. Remember that while we consider this to be an excellent article it also represents the opinion of the author and includes revisions made by us so, again, it is incumbent upon you, the reader, to do your own research and draw your own conclusions.

Surgery in Mexico is handled a bit different from the US. In the US you will receive a bill from each physician. The surgeon, anesthesiologist, internal medicine doctor, assistant surgeon, radiologist, etc. That is not how it works in Mexico. In Mexico you pay the surgeon for a "package" banding procedure. He pays all the other doctors.
In the US (for example) the anesthesiologists contract with the hospital and their agreements are with the hospital, not the surgeon. The surgeon does not always get to hand pick the doctor putting you to sleep. People tend to assume the most important doctor in the operating room is the surgeon. Not so. It's the anesthesiologist that keeps you ALIVE during surgery. HE is focusing on your breathing, your circulation, your heart, everything. The surgeon is focused on one thing, the surgery. In this case I tend to agree with the way Mexico does things. Do you want the surgeon you trust to pick the anesthesiologist or the hospital's administrative contract folks, the folks paid to get the best deals? The surgeon is responsible for your surgery overall, he WANTS you to have the best person putting you to sleep. His reputation depends on it. His reputation means his entire career. Without a good reputation they have nothing.

So in Mexico the surgeon hires the anesthesiologist, not the hospital contract office people. This is an example of why it is a "package" cost in Mexico vs. individual bills in the US from all the various medical providers.

Which surgeon?
Doctors throughout the world have discovered that banding is easy and it has the potential to be extremely profitable. Many physicians are getting in the business, so there are a lot of inexperienced surgeons around.  While a lower number of surgeries performed by a given doctor may mean less experience in certain regards, it does not always mean a lower level of skill and/or success. Teaching hospitals and surgeons who have not done 500 bands or sleeves yet are not necessarily inferior BUT it is up to you to do your homework and to assess your own level of confidence in a particular surgeons record.
Because of the level of competition involved with these surgeries there is, unfortunately, an increased level of dishonesty. There are a lot of claims made that are not substantiated regarding number of procedures done and complications resulting from those procedures. This is a little harder to verify but due diligence is necessary here and aggressive research is worth the trouble. There are quite a few boards and forums online and there are a lot of people who have had each of these procedures who are very willing to share their experiences, and opinions J,  with anyone who will listen.

Experience
How long has your doctor been doing they exact type of surgery you are interested in? That is a question you want to ask. Someone can do 4000 lap procedures but that does not mean he has done 4000 bands. There is a learning curve to each procedure and with each procedure the doctors becomes more skilled and faster at the technique. Again, experience is a factor but it is not the only factor.

Skill
Skill, I think we should discuss skill a bit. Banding is the easiest surgical bariatric procedure to do. Yes, there is a learning curve but after the learning curve it is without a doubt the easiest procedure to do. That is why so many new doctors whan a piece of the action.

Can your potential doctor do the hard stuff too? Can they do gastric bypass? Gastric sleeves? Duodenal switch (DS)? Can they do revisions such as bypass to banding? Many bypass procedures fail and the patient regains their weight. Banding them is not easy at all. Revisions are difficult. Would you rather have a surgeon that only does the easiest surgical bariatric procedure? Banding? Or do you want a doctor that is capable of doing the difficult and tricky procedures as well as banding? MOST doctors do not do all the tricky procedures, they just don't have the training, skill, or experience so they stick with the more simple procedure, banding.  Again, do your homework and assess how you feel about what you have learned.

Patient Coordinators
If you post that you are looking for a weight loss surgeon the patient coordinators are going to come out posting non stop. These are people that are paid to get you to go to their employer. Some of them have had the surgeries and some have not. They will tell you anything you want to hear to talk you into going to their doctor as they usually get anywhere from $300 to $500 for referring you. I am not downing patient coordinators in general. The people I do not like are the people that lie about it. They do not tell you they are making a commission off of your surgery and that is the prime reason they are pushing you to go to one doctor and one only.

If you suspect someone is a patient coordinator do a search of their posts. If the majority of them are pushing a specific doctor vs. giving general advice and thoughts on a topic, it is probably a coordinator. We even caught one coordinator coming up with various screen names so that people would think her doctor has more patients than he does. When people disagree with her she comes up with a new identity, pretends she is another patient, and posts. People think this doctor has more patients and bottom line, he does not.

Believe NOTHING on line. Believe NOTHING that anyone tells you. Verify everything for yourself. I do not care who tells you something, verify the information for yourself. Verify the doctor's credentials, location, years of experience, number of actual bands or other procedure, everything. You may even want to go so far as to verify with the manufacturer that a given Dr. has actually purchased as many bands, for instance, as he claims to have placed. The more research you do the better you are likely to feel about your decision.

Booking Agencies
This is another area of consideration. Do you want to deal with a booking agency? Some do, some don't. It comes down to personal preference. Booking agencies are paid to advertise for several doctors, they contact the potential patients, they schedule surgery, and they let the doctor know who is coming, for what procedure, and when. They deal with all the issues before and after surgery. Do you want to deal with a booking agency or do you want to deal with the doctor's office directly? Again, there is no right or wrong answer, it is personal preference.  

Where in Mexico?
Now you need to think about if you want surgery near the border or deeper into Mexico. This is something that is purely preference. Some people want to make a mini vacation out of their surgical trip and others do not. Some want to go to Monterrey for a few days ahead of surgery and have a little fun. Others (like me) want to be close to the border. If something happened I wanted to be close to the US. Again, it is a matter of personal preference.

Hospital or clinic?
This is another issue of personal preference. Some people do not mind, others do. Some clinics are absolutely fine and perfectly safe and clean. I preferred a hospital vs. a clinic and the reason is potential complications. Let's be realistic, we are fat. Fat people carry more risk for complications such as heart problems, throwing blood clots, etc. If you have a serious complication in a clinic you will need to be transported to a hospital. In the US if you have a problem in a surgical center they dial 911 and you are at a hospital within minutes. That is not the case in Mexico. Yes, they do have emergency services but it is not quite what we are used to. They will get to you when they can. Many times that is not as immediate. For that reason I personally prefer a hospital. The risk for banding complications is quite low but it does happen. If it does happen I want to already be in a hospital.

Price
What about price? Many make the mistake of shopping by price and quite frankly there are times in life that you really do get what you pay for. Cheaper is not always better. Keep in mind that with Inamed and Johnson & Johnson bands the cost to the doctor is $2000 per band. That's what the doctors in Mexico pay for the band. If the doctor is really cheap he may be cutting corners somewhere or... he is only targeting  people shopping for price vs. surgeon skill. There is also little need to go to the most expensive doctor. Expensive does not necessarily mean skilled, it means expensive.

Patient Testimonials
Patient testimonials are critical to read.  There are a number of boards and forums online that contain patient testimonials. Again, you have to be careful how much you trust of what you read and most of these people are available for one on one verification that they are indeed patients as claimed. Some sites make it very difficult to research Mexican doctors, they make it quite simple to research US doctors. They are about as anti-Mexico as they come. Unfortunately there are prejudices ingrained into this type of discussion. One factor is the economic reality of Mexican doctors taking business from American doctors because they can do it for less. It can also be argued that Mexican doctors have been doing the procedure longer and have more experience. In fact amny Mexican doctors have been called on to train US doctors in the past. Another factor comes from the fact that American doctors are people too and have had many of the same prejudices and mis information ingrained in their upbringing since childhood. I have seen American doctors stoop to using tactics as sleazy as advertising “You wouldn’t drink the water, why would you allow them to perform surgery on you?” This type of bickering and prejudice does not make your decision any easier.  For Mexican doctors you need to research by specific name whereas US doctors you can research by geographical location. There should be plenty of patient testimonials. If there are not, that might be a problem. See what the trends are. There will always be patients that no matter what is done they will never be happy so if there are 0.001% of testimonials that are not great, look at the overall picture. If people are happy they will say so if they are taking the time to write a testimonial. Just make sure to read the opinions of a LOT of patients and not just a few.

Pre-Op Testing
This is critical to have a safe surgery. You should get AT LEAST a complete blood count, chemistry panel, urine test, EKG, and chest x-ray. Do not settle for anything less. If the doctor does less testing than this he may be  pinching pennies in all the wrong places. This is your health, you are paying for these tests, make sure you get them. I know of one doctor that claims he does an EKG during surgery. That is NOT an EKG! That is a heart monitor and it does not have the same information as a full EKG. Besides, one of the issues they are looking for during surgery on the heart monitor is if there are any heart changes due to the anesthesia. If you didn't have an EKG before surgery how will they know if there are changes due to anesthesia? If you do not get these tests that you are paying for, the money is just going in your doctor's pocket instead of your health care. You are the consumer here, insist on the appropriate testing. Do you want your money for banding going towards your health care or your doctor's new swimming pool? Bariatric surgeons are not typically hurting for money. They are being paid to do ALL the tests, get them done.

Post-Op Testing
This should be a barium swallow that is done after surgery. One doctor’s office claims they cannot do a barium swallow after surgery because the barium is too thick. This is simply untrue. Barium comes in a powder form and it can be made as thin or as thick as needed. It can be watery or it can be very thick. You want a barium swallow after surgery for various reasons. Example: What if you get home and have some sort of complication? You are going to have to have it done anyway and at home you’ll be paying full price and your insurance is not likely to cover it. Considering you already paid for it in your surgery package you should have had it. You should be given the films to take home with you after this test when done in Mexico along with all your labs, EKG, etc. You also want this test to make sure you are safe to travel back to the US. A barium swallow makes sure that band placement is correct, fluid is traveling through your stoma, and there are no unexpected medical problems. It also does a great deal for you as a patient. When you can actually see the band and see the band working with your own two eyes, this makes a world of difference. It puts things in perspective for you as a patient.

What if you go for your first fill and your fill doc does not use fluoro? It is nice for him to see the films so that he can see where your port is and believe me, that makes it easier for you while he is looking for your port.

Supervision
Regardless if you have surgery in a hospital or clinic you should have a certain amount of medical supervision. If you are in a hospital you will have that. If you are in a clinic you will have it. What about after you are discharged? It is quite common for patients to be sent to a hotel for an extra day of recovery while in Mexico. Some physicians do this, others keep you in the hospital the entire time you are in Mexico after surgery. What kind of supervision is there for you in a hotel? Is someone coming to visit you and check on you? Are they at least calling you? All doctors will tell you they are available but this is where you need to talk to other patients that went to that doctor. Ask them specifically, how much interaction did they have with the doctor or his staff while in the hotel.

Pre-Op   Diets
It is common for doctors to put patients on a pre-op diet before surgery. Many still say it is to shrink the liver, but that isn't quite true. The reality is that if someone is on a low-carb, low-fat, adequate-protein diet of some sort they will lose weight and their liver will have less of a "slimy" feeling to it. It won't slip around as much during surgery. Every 10lbs you lose before surgery  makes it easier for your surgeon to do the procedure. The easier the procedure is for your surgeon, the safer it will be for you.

During surgery there are several incisions made and one of them is basically to hold the liver out of the way so the doctor can get to your stomach and secure the band around it. If it is slippery and difficult to manage, it makes it more dangerous for you, so the pre op diet is indeed quite important. Studies show that the liver does not actually start to shrink in size until you have been on such a diet for about six weeks or longer. Again, it is still quite important to follow the diet for your safety. Some doctors do not require the diet because it does not actually "shrink" the liver. Others do. It comes down to surgeon preference. Some doctors only require it for a specific BMI or higher. You need to ask about the pre-op diet and you need to know specifics.

Post-Op Diets
Most people believe the post-op diet means that when the stomach swelling is gone they are good to go and they can eat anything they wish. That is NOT the purpose for the post-op diet! Just because you CAN eat solid foods does not mean you SHOULD eat them. The srves many purposes, both physical and mental. But that is a post for another day. Find out what your doctor's post-op diet is, make sure you understand it well, and if you do not then ask questions.

Surgeon's Staff
How easy is it for you to reach your potential doctor's staff? Keep in mind, when you are a potential newbie they will be on their best behavior. They will return phone calls and emails much faster than they will after you are scheduled and have surgery. So if you have a difficult time reaching the staff before surgery, what will happen if you have a problem after surgery and need to reach them? What about the middle of the night? Who answers their phones then? Remember that if you have problems in the middle of the night after surgery you will need to have someone you can contact in a pinch.

Statistics
You should ask your potential doctor's office about his stats for infection, slips, and erosion. Infection stats should be less than 1%. Keep in mind, not all infection is the fault of the doctor. There was a person I recently read that posted she went swimming in a public pool 4 days after surgery. Her post op instructions specifically said not to do that. Children PEE in public swimming pools; do you want your newly healing incisions soaking in pool water with urine? If you do that and you get an infection is that the fault of your doctor? Even though it isn't his fault it will still go against his infection stats, so keep that in mind.    

I am of the opinion that most slips (not all) but most are the fault of the patient. Not eating the right foods, not chewing well enough and PBing, etc. Global slip stats according to Inamed are around 3%.

The latest thinking is that erosion is from a band that is too tight. That can be a band that was too small for the patient at the time of surgery or the patient got a fill that was too tight and they did nothing about it. Global erosion stats according to Inamed are 1.3 %

There is one doctor who has a 4% erosion stat. When it came out on the boards that this is a concerning number they changed the way they word things. Instead of saying >1% infection, >2% slips, and >4% erosion he now combines ALL stats and says that his stats are less than 3%. He's just averaging them out to avoid the truth of the 4% erosion figure. An overall complication of about 3% doesn't sound NEARLY as bad as 4% erosion. So be very careful to ask for each individual statistic.
There is another trick to watch for. Ask your potential surgeon how many bands he has placed. Then ask if his stats for infection, erosion, and slips are the figures for 100% of his bands placed or if they are for a smaller number. If a doctor has a given statistic of 4% for slips, erosion, or infection but he will only provide you with the statistics from a given group or given study, those are not true figures.
For example, if a doctor claims to have done 1000 bands but claims an erosion statistic of >1% for the last 300 of those bands, why isn't he telling you his true erosion statistics for all 1000 bands? They get tricky and you have to see what they are doing. They are being honest in the sense that they are telling you their statistics but only the good statistics. They are hiding the bad (and more accurate) numbers from you. This is another reason you need to research and this applies to US doctors as well as Mexican or any other country. If they are a good doctor with a proven track record there is little reason to be deceptive, play games, and hide facts as their reputation and background should speak for itself. But do stop and think about it, if they are attempting to hide figures from you they are doing this knowing full well their deception.  Is this the surgeon you want to trust your health care and your life?
If you contact them again and the give you three pages of nonsense that still does not answer your specific questions, they are attempting to talk around your questions. No good physician will attempt this.  If it is like pulling teeth to get the actual numbers, walk away. Find someone a little more honest.

Which band will you receive?
There are currently two brands of bands FDA approved in the US. Inamed and J&J. J&J was only recently approved for use in the United States, and many US doctors may not have experience with them. Remember this when you are arranging aftercare. It will be hard to obtain a fill for bands other than these two brands, as a US doctor can have problems with the licensing board if he works with a non-FDA approved device. Take this into consideration. If you get an Inamed brand band you should be given the empty box, an instruction book, and an ID card showing the size and type of band you have. If you get a J&J band you should receive the empty box, two booklets, and an ID card.  You may need these items to prove to a US doctor that you have an FDA approved device so they can do your fills. Not all doctors require you to show them the box and information but some do.

Transportation
How will you get from the airport to the hospital or clinic? What about the hotel? Does the doctor provide this? Most do. You should have no additional transportation expenses and this should be taken care of for you by the MD office. You should be able to take $50 with you for incidentals, tips (airport, etc.) and dinner before surgery. Everything else should be included in your surgery package.

Finding a Fill Doctor
Make sure you can find a doctor within driving distance of you before heading to Mexico for surgery. Some live close enough to the border to drive there, for others it is an inexpensive flight for fills. Regardless, you need to work out a fill person BEFORE having surgery in Mexico. You should also be aware that due to prejudices and liability issues many American doctors will not do fills on patients that were banded in Mexico. This situation seems to be improving and as the procedure becomes more common in the US there are more fill options becoming available.