Is it all about the money?

vinay-mehendale Article by – Vinay Mahendale
India

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I remember from the time it was not called bariatric surgery but Surgery for Morbid obesity. I read about it only in the books in the late eighties.
I thought it should be called Morbid Surgery for Obesity. But I kept the thoughts to myself. In India, we did see some obese people but not morbidly obese, at least not so many. I know of only one surgeon who performed open surgery for obesity that time.Then laparoscopic cholecystectomy happened in 1991.

After some years I found some surgeons indulging in lap bariatric surgery. That time it mainly (or only) consisted of lap gastric banding. Then my thought was if gastric banding was to be done it had to be laparoscopic. And I also thought, “why not interdental wiring?” Then I saw many surgeons venturing into lap bariatric surgery – most of them were not even doing lap choles before that. They started because lap gastric banding was thought to be easy to do and there was money in it. Then real laparoscopic surgeons started treating complications of gastric band. When other procedures evolved, some proficient, expert laparoscopic surgeons started doing these procedures and the trend set in. More and more lap surgeons started joining the bandwagon. One loss was some of the expert laparoscopic surgeons who had excellent surgical skills restricted their practice only to bariatric surgery. Since the obese patients also had complex hernias they started taking interest in AWR. Sure, obese people do need treatment and need the surgeons specialising in these procedures. I know it is not practical to be altruistic but medical world has become too commercial.

Some years back I attended a national lap surgical conference in Delhi with a friend. When we were going over the proceedings, we found that almost 70 percent of the conference and workshops consisted of bariatrics and hernia. And we observed that India must be very prosperous. I am not saying it’s all a scam. After all, I know of a Bariatric surgeon running a gym that would reduce his bariatric practice.

Vinay Mehendale is a general and laparoscopic surgeon practising since 40 years. He has been a teacher in the subject of surgery, and was Professor of Surgery for 19 years.


Vinay Mahendale
India

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