A coroner has advised anyone considering travelling abroad for surgery to realise that follow-up care may often be necessary after a Kildare resident died from complications from a weight-loss procedure in Turkey.
Dublin city coroner Cróna Gallagher said arranging post-operative care, which could involve doctors, nutritionists and other medical professionals, could be more difficult in cases where bariatric surgery was performed outside Ireland.
Her comments were made at an inquest into the death of a 64-year-old grandmother who died over two years ago after suffering complications from weight-loss surgery she had undergone in Turkey eight months earlier.
A sitting of Dublin District Coroner’s Court on Thursday heard Maria Stanca from Fenton Green, Kilcock, Co Kildare was admitted to Connolly Hospital Blanchardstown (CHB) in Dublin on March 22nd, 2022, with severe abdominal pain.
Ms Stanca, who was originally from Romania, required emergency surgery due to a perforation in her stomach which was linked to complications from the weight-loss procedure she had in Istanbul the previous year.
Although she made a recovery and was discharged from hospital on April 20th, 2022, Ms Stanca was returned to CHB nine days later after suffering a cardiac and respiratory arrest and died later that evening.
A grandson of the deceased, Dufan Cirpaci, gave evidence that his grandmother had travelled to Istanbul in 2021 for the surgery to lose weight which she also hoped would reduce pains she had in her legs.
Mr Cirpaci said there had been no problem with the procedure in Turkey and in the months afterwards until she became unwell when she was back in Ireland in March 2022.
His sister, Suzana, said her grandmother had chosen to have the surgery in Turkey after becoming aware via Facebook of other Romanians who had gone there for similar procedures.
In reply to questions from the coroner, she said the deceased had no medical consultations with anyone in Ireland before travelling to Istanbul.
Ms Cirpaci, who with her father, George, had accompanied Ms Stanca to Turkey, said her grandmother had been assessed by doctors in Turkey and informed after three days that she was suitable for the surgery.
She was allowed to return to Ireland four days after the procedure.
Ms Cirpaci said the operation was performed in a big hospital which was similar in size to the one in Blanchardstown.
She recalled that her grandmother was advised to eat small amounts but could gradually have larger meals.
Asked if her family were pleased with the treatment she received in Turkey, Ms Cirpaci replied: “We were happy it was something good for her.”
She also pointed out that Ms Stanca was very happy about losing weight which had decreased from 120kg prior to the surgery to 85kg after eight months.
Ms Cirpaci said her grandmother had not visited any doctor on her return to Ireland as she had felt there was no need.
A consultant surgeon at CHB, Achille Mastrosimone, gave evidence of having to perform an emergency operation on Ms Stanca after she presented with severe abdominal pain on March 22, 2022.
Mr Mastrosimone described finding the patient’s stomach was “full of bile,” while the procedural work that had been carried out in Turkey was “almost completely undone.”
He told the coroner that he was not totally sure about what exact procedure Ms Stanca had had in Turkey as it appeared “a little bit unusual.”
The consultant said he believed the actual procedure was a combination of two of the most common types of bariatric surgery which had involved both the stomach and small intestine.
Mr Mastrosimone said it was “extremely rare” that complications of weight-loss surgery would arise after several months as they normally occurred within a few days.
Asked by Dr Gallagher why such complications might have arisen with Ms Stanca, he said it was extremely difficult to say.
He also confirmed that he had carried out operations on other patients who had experienced complications after having surgery abroad.
Asked if he felt all such patients needed follow-up care after such surgery, the consultant replied: “100 per cent.”
However, Mr Mastrosimone said he could not say if something “technical” had gone wrong with the surgery performed on the deceased in Turkey.
Dr Jaipreet Singh, who carried out a postmortem on Ms Stanca’s body, concluded she had died as a result of acute bronchial pneumonia with heart disease and a fatty liver as contributory factors.
The pathologist acknowledged that the complication related to the surgery in Turkey would have placed a lot of pressure on the deceased’s body.
The coroner recorded a narrative verdict to reflect the fact that Ms Stanca’s death had occurred against a background of complications from weight-loss surgery which had arisen after she had appeared to have made a good recovery.
Dr Gallagher admitted that it was “something of a mystery” why the complications had occurred after such a long period after the procedure.
Offering her sympathy to relatives of Ms Stanca, the coroner said she believed it was important to highlight the need for follow-up care after any type of complex surgery abroad.
She noted the demand for weight-loss surgery was not being met in Ireland.
However, Dr Gallagher also stressed that she was not saying that such procedures when done abroad “lead to a bad outcome.”
