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Short flights often allowed from about 1 week, longer flights from about 2 weeks."},"follow_up_visits":[{"purpose":"wound_check","requirement":"routine","after":{"min":7,"max":21,"unit":"days","qualifier":"First postoperative surgical review, from the day of surgery"}},{"purpose":"assessment","requirement":"routine","after":{"min":30,"max":90,"unit":"days","qualifier":"Dietary, nutritional and laboratory review, from the day of surgery"}},{"purpose":"result_review","requirement":"routine","after":{"min":180,"max":365,"unit":"days","qualifier":"Weight-loss and nutritional review, from the day of surgery; continued periodic lifelong follow-up"}}],"indications":["Severe obesity (BMI 40 or higher)","BMI 35-39.9 with type 2 diabetes, hypertension or sleep apnea","BMI 30-34.9 with metabolic disease in selected patients","Obesity with severe gastroesophageal reflux or Barrett's esophagus","Inadequate results from non-surgical weight-loss measures"],"main_risks":["Anastomotic leak","Bleeding","Infection","Venous thromboembolism","Anastomotic stricture or marginal ulcer","Internal hernia and small bowel obstruction","Dumping syndrome","Nutritional deficiencies (iron, B12, calcium, vitamin D, folate)","Gallstones","Weight regain","Anesthesia-related risks","Rarely, need for reoperation or death"],"pain":"Moderate postoperative abdominal and shoulder-tip discomfort for the first several days, usually controlled with oral analgesics; laparoscopic approach causes less pain than open.","preparation":["Multidisciplinary evaluation (surgeon, dietitian, psychologist, medical review)","Preoperative blood tests, ECG and other cardiopulmonary assessment as indicated","Upper endoscopy or other upper GI evaluation when indicated","Preoperative low-calorie or liver-shrinking diet for 1-4 weeks","Smoking and nicotine cessation","Sleep apnea evaluation and optimization of diabetes and blood pressure","Fasting before surgery per anesthesia instructions","Education on postoperative diet stages and lifelong supplementation"],"recovery_timeline":[{"phase":"Hospital stay (days 0-3)","description":"Monitoring, early walking, clear liquids, pain and nausea control, clot prevention.","restrictions":["No driving while on opioid analgesics","Sip fluids only as directed"]},{"phase":"Weeks 1-2","description":"Liquid then puréed diet at home; incisional soreness and fatigue gradually improve.","restrictions":["Avoid heavy lifting"]},{"phase":"Weeks 3-6","description":"Progress to soft foods; return to desk work and light activity.","restrictions":["Avoid heavy lifting and strenuous exercise until cleared"]},{"phase":"Weeks 6-12","description":"Transition to regular textures in small portions; resume full activity; rapid weight loss with supplementation and lab monitoring.","restrictions":["Avoid NSAIDs and smoking as advised"]},{"phase":"Months 3-18","description":"Continued weight loss until plateau; ongoing nutritional follow-up.","restrictions":[]}],"rehabilitation_days":{"min":14,"max":21,"unit":"days","qualifier":"Light activities from 1-2 weeks; desk work by 2-3 weeks. Heavy lifting restricted 4-6 weeks or more."},"result_longevity":"Durable anatomical change; substantial weight loss is generally maintained long term in many patients, though some regain weight depending on diet, behavior and follow-up adherence.","revision_rate_pct":{"min":5,"max":15,"unit":"percent","qualifier":"Repeat or revision surgery within about 5-10 years for internal hernia, stricture, marginal ulcer, weight regain or malnutrition."},"scars":"Laparoscopic approach leaves several small abdominal scars (about 0.5-1.5 cm) that usually fade over months; open surgery leaves a longer midline scar.","sessions_or_stages":{"sessions":{"min":1,"max":1,"unit":"visits","qualifier":"Single operation; staged approach is uncommon"},"stages":[{"code":"surgery","label":"Laparoscopic Roux-en-Y gastric bypass operation","after":{"min":0,"max":0,"unit":"days","qualifier":"Performed on day of admission/first session"}}],"qualifier":"Single-stage primary procedure; follow-up checks are not counted as treatment sessions"},"success":{"metric":"Excess weight loss (EWL)","value":65,"unit":"% of excess body weight","horizon":"12-18 months, largely maintained long term","evidence_status":"proven","population":"Adults with severe obesity after primary laparoscopic RYGB; typical EWL 60-70%."},"techniques":[{"name":"Laparoscopic RYGB","suits_whom":"Most adult candidates; standard approach","recovery":"Hospital stay about 1-3 nights; return to desk work in about 2-3 weeks"},{"name":"Robotic-assisted RYGB","suits_whom":"Selected patients, often higher BMI or complex anatomy, depending on surgeon availability","recovery":"Similar to laparoscopic"},{"name":"Open RYGB","suits_whom":"Rare cases such as extensive adhesions or when laparoscopy is not feasible","recovery":"Longer stay and recovery, more wound pain"}],"treatment_conditions":["inpatient"],"treatment_duration_hours":{"min":1.5,"max":3,"unit":"hours","qualifier":"Operating time for uncomplicated primary laparoscopic RYGB"},"initial_assessment_documents":["Previous obesity treatment records","Recent blood tests including HbA1c","Upper endoscopy report","Previous abdominal surgery reports","Cardiology or ECG report (if available)","List of diabetes and blood thinner medications"],"travel_trips":{"min":1,"max":1,"one_trip_possible":true,"qualifier":"Single-stage laparoscopic surgery; stay abroad about 7-14 days until first check and flight clearance. Later reviews remote."},"clinic_checks":{"status":"ok","items":[{"id":"C1","text":"Check that the bariatric program is multi-disciplinary and will support dietary and exercise habits long term","scope":"treatment_type","source":{"url":"https://asmbs.org/patients/medical-tourism/","host":"asmbs.org","quote":"Long-term success in bariatric surgery depends on lifelong compliance with dietary habits, nutritional guidelines and exercise as part of a multi-disciplinary bariatric program.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C2","text":"Check that all medical records and documentation are provided and returned to you for your local area","scope":"treatment_abroad","source":{"url":"https://asmbs.org/patients/medical-tourism/","host":"asmbs.org","quote":"Surgical providers should ensure that all medical records and documentation are provided and returned with the patient to their local area.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C3","text":"Check that preoperative education is provided, as it is an essential component for successful outcomes","scope":"treatment_abroad","source":{"url":"https://asmbs.org/patients/medical-tourism/","host":"asmbs.org","quote":"Preoperative education, continuity of care and long-term follow-up are proven essential components for successful outcomes in bariatric surgery and these are not necessarily provided in the setting of medical travel.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C4","text":"Check that the facility has an intensive care unit, imaging and interventional radiology to manage major post-operative complications","scope":"treatment_abroad","source":{"url":"https://asmbs.org/patients/medical-tourism/","host":"asmbs.org","quote":"Some of the facilities participating in medical tourism may not have the capability, such as a modern Intensive Care Unit, imaging capabilities and interventional radiology, etc., to optimally care for major post-operative complications.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C5","text":"Check that individual outcomes for the desired procedure are available during informed consent when possible","scope":"procedure","source":{"url":"https://asmbs.org/patients/medical-tourism/","host":"asmbs.org","quote":"Individual surgeon outcomes for the desired procedure should be made available as part of the informed consent process whenever possible.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C6","text":"Check that postoperative follow-up with a qualified local bariatric surgery program is established","scope":"procedure","source":{"url":"https://asmbs.org/patients/medical-tourism/","host":"asmbs.org","quote":"Prior to undergoing surgery, the patient should establish a plan for postoperative follow-up with a qualified local bariatric surgery program to monitor for nutritional deficiencies and long-term complications, and to provide ongoing medical, psychological and dietary supervision.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C7","text":"Check that the facility is accredited and preferably a bariatric center of excellence","scope":"treatment_abroad","source":{"url":"https://asmbs.org/patients/medical-tourism/","host":"asmbs.org","quote":"Patients should undergo procedures at an accredited JCI institution or preferably a bariatric center of excellence.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"red_flags":{"status":"ok","items":[{"id":"F1","text":"An offer of unproven therapy outside true clinical trials is a warning sign","scope":"treatment_abroad","source":{"url":"https://asmbs.org/patients/medical-tourism/","host":"asmbs.org","quote":"Certain countries may offer unproven therapies to patients outside true clinical trials, and it can be difficult to differentiate between acceptable medical innovation and unacceptable patient exploitation.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"F2","text":"An advert or information that guarantees complete success should raise concerns","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Any advert or information that guarantees complete success should raise concerns.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"F3","text":"Forceful persuasion or cheap, time-limited offers pushing you into a quick decision","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Don’t be pressured into quick decisions either through forceful persuasion or cheap, time limited offers.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"warning_signs":{"status":"missing","reason":"no_official_source","checked_at":"2026-11-13","next_check_at":"2027-02-11"},"take_home":{"status":"ok","items":[{"id":"T1","text":"The home doctor needs it, because what was done during surgery may be unclear","document":"operative report","source":{"url":"https://asmbs.org/patients/medical-tourism/","host":"asmbs.org","quote":"Often an operative report is not available, there may be uncertainty of what was done, and there are concerns whether assuming the care of the patient will make them liable for any complications the patient may have in the future.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"T2","text":"The home doctor needs postoperative imaging for ongoing bariatric-surgery care","document":"postoperative imaging","source":{"url":"https://asmbs.org/patients/medical-tourism/","host":"asmbs.org","quote":"This includes the type of band placed and any adjustments performed in the case of laparoscopic adjustable gastric banding, as well as any postoperative imaging performed.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"T3","text":"Home doctor needs the clinic's follow-up recommendations in a written discharge summary","document":"discharge summary","source":{"url":"https://sbuhb.nhs.wales/about-us/individual-patient-commissioning/ipc-folder/advice-on-accessing-treatment-abroad","host":"sbuhb.nhs.wales","quote":"When you have treatment abroad, you must ask the treatment provider for their follow-up recommendations documented within a written discharge summary in English.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"T4","text":"Ask for copies of all prescriptions before you leave","document":"prescription copies","source":{"url":"https://travelhealthpro.org.uk/news/699/travelling-abroad-for-treatment","host":"travelhealthpro.org.uk","quote":"Remember to ask for copies of all your treatment records, including prescriptions, scans and x-rays before you leave.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"alternatives":{"status":"missing","reason":"no_official_source","checked_at":"2026-11-13","next_check_at":"2027-02-11"},"technique_details":{"status":"ok","items":[{"id":"laparoscopic-rygb","name":"Laparoscopic RYGB","how_it_works":{"text":"The surgeon makes small cuts and uses a tiny camera","source":{"url":"https://my.clevelandclinic.org/health/treatments/17157-gastric-bypass-surgery","host":"my.clevelandclinic.org","quote":"They’ll place a tiny video camera (laparoscope) through the small cut.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},"recovery_daily":{"status":"missing","reason":"no_official_source"}},{"id":"robotic-assisted-rygb","name":"Robotic-assisted RYGB","how_it_works":{"text":"Surgeons control instruments from a nearby control station","source":{"url":"https://www.whittington.nhs.uk/mini-apps/leaflet/?id=589","host":"whittington.nhs.uk","quote":"The Surgeon controls the instruments from a control station nearby.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},"recovery_daily":{"status":"missing","reason":"no_official_source"}},{"id":"open-rygb","name":"Open 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