Owner, patient co-ordinator and eating psychology coach
It was the day that I got on the airplane back from France that changed my life. I had been talking to the lady next to me in the queue and we sat together on the plane. As we were seated, she kept trying to push the arm rest all the way down on the seat; I was too ashamed and embarassed to tell her that it was my thigh that was stopping it going down, the pain was terrible but I said nothing. Shortly afterwards the air hostess came round to check we had our seatbelts fastened and I was trying to hide under my coat the fact that I just couldn’t fasten mine. She whipped the coat away and shouted down the plane “Lady here, needs a seatbelt extension”. I wanted to crawl into a hole and die, I was so embarassed. The following morning I woke up and all of my left thigh was covered in bruises and I knew I just could not go on any longer this way. I just didn’t have a life. I have grandchildren that I couldn’t play with, I had arthritis in my knees and hips and I was in constant pain, and I could do hardly any exercise because everything hurt. Coupled with that and almost more importantly to me, I was mentally in a terrible place, I had lost all confidence and had little self esteem and I felt fat, unattractive and ill.
“Why was it I was successful at everything else I did in my life, but I just could not get a grip with my weight??”
I decided there and then, that I would go to my GP and ask for weight loss surgery, I had tried every diet going, I could have started a library with the amount of diet books, self help manuals and exercise videos Ihad, I had joined a gym, joined various weight loss support groups, tried meal replacements, tablets, supplements, you name it, I had tried it. Each time I would lose a bit of the excess weight, but I just couldn’t keep it up for long enough, and the weight would pile back on plus more. Each year I was getting heavier and heavier., and I knew that I was at the stage where I was putting my life at risk Why was it I was succesful at everything else I did in my life, but I just could not get a grip with my weight??
I went to the GP and she took my weight, height etc and referred me for weight loss surgery. However, I was told that I would more than likely have to wait 3 years as the waiting list was that long. Now, only another person with severe weight problems would understand exactly how difficult it was to walk in there and admit I could not do it alone. That I needed to go to, what I believed to be the extreme lengths of surgery to stop me from killing myself by overeating. So once I had made that decision I needed to do it quickly, I was already at the end, I just couldn’t go any further!
I went home and started to research surgery with a view to getting it done privately in the UK. I did lots and lots of research about the types of procedures, the surgeons, the clinics and hospitals and the costs. Ultimately, for me the costs were just to prohibitive for me to have it done in the UK. I was looking at about £12k for a gastric sleeve and I could not raise that sort of money.
Marie Diesel Dyer
I wasn’t really a fat kid…I had a little ‘puppy fat’ aged 11 onwards, but rapidly developed big boobs in my last year of primary school..oh the humiliation of having to wear a bra before starting High School…in 1971 everyone still wore vests.
Exercise decreases as you move on up at school, leave school and go to college, find a job…dieting is the norm, whether you are overweight or not, and the fear of being fat is all pervasive, so a little yo-yo dieting becomes the pattern.
In fact I had just lost weight and was pleasingly slim when I met the father of my eldest child..probably because I was pleasingly slim. Relationship, baby, lost pregnancy weight with a little struggle, lost partner with bigger struggle, couldn’t exercise as much between work and home life, single parenthood. Life and weight crept on.
The children got older, I got slower, and the peri-menopause approached, with increasingly heavy periods, tiredness, inability and disinclination to exercise at all, lack of iron, and my new anti-depressants gave me my appetite back….sitting and eating became almost life’s only pleasure. So, now I was fat, forty-something, and fit for nothing. I had to get the weight off. Spurred on by comments from someone I loved, I stopped eating, started walking, shifted half a stone, started going to the gym, walking further and faster and the weight started to move. Right up until I had to start working with my husband, and had no time to walk, go to the gym, attend aquafit classes and generally look after myself…then the weight started its insidious creep back upwards. By this time I was almost suicidal. I felt and looked awful, and was starting to experience restriction in my daily life, and wasn’t able to do the lifting and carrying at work. I asked my GP for help, and was offered an appointment it the (overweight) dietitian. But I felt there was little they could tell me that I didn’t already know.
“By this time I was almost suicidal. I felt and looked awful, and was starting to experience restriction in my daily life.”
I asked about the Gastric Band…the only form of weight loss surgery I had even heard of, despite having an interest in medical matters. No chance on the NHS…I wasn’t fat enough! Could I have a Tummy Tuck? Nope, I was too fat. Could I have a breast reduction (from 38H)? No, I was too fat. Stuck between a rock and a hard place as far as the NHS was concerned.
I started investigating the private sector…around £10-£12,000 in the UK for a Gastric Band. More than my annual income. Not a chance.
I’d seen an article in a magazine whilst waiting at the GP surgery about weight loss surgery abroad, and decided to investigate in online. The company was called Secret Surgery, and had been started by 2 women who went abroad for their surgery and had started to offer a service to other people who couldn’t afford surgery in the UK. At this point I still hadn’t flown for over 20 years, and had no idea how I would be able to manage it, but the prices looked keen compared to those in the UK. Fully energised now, I hammered away at the search engine, discovering that there were more and different surgeries that could be performed…not just the Band, but the Vertical Gastric Sleeve, the Gastric Plication (wrap), and several different flavours of bypass (RNY, SADI-S, mini-bypass etc).
Lots of forums, companies, differing reviews, different countries…almost overwhelming, but several things struck me. Most were private clinics in Europe and Elsewhere. I quickly discounted Elsewhere….I wanted somewhere in the EU, where the EHIC card would cover any unrelated illnesses that might occur while I was abroad. Flights in Europe were cheap as well. It seemed that most clinics would allow you to stay for 1 or 2 nights, and then you would go to a hotel for the rest of your stay abroad. I almost gave up as this point. I couldn’t envisage being alone, unwell, and with no nursing care or family nearby. I carried on looking at surgeons and places to say, and came across Dr Hruby and New Leaf. It looked good…the website indicated that the prices were good, there was a 7 night stay in a real, proper hospital with all emergency facilities, and when I enquired further, I would be able to bring my husband who could stay in my actual room in the hospital, and hold my hand. Done, sorted, and booked my sleeve op for about 6 weeks from the moment I spoke to New Leaf.
I chose the sleeve because I am a big wuss…if they’d stapled, cut and cauterised my stomach, and thrown away the useless bit, there was no way I could be a wimp and tell them to put it back, was there? (I know exactly what I’m like the day after an operation). All I felt at this point was euphoria…I was finally going to be able to fix my weight problem. Now I was alternating between terror and elation, but I managed to keep it to elation most of the time, and started planning, packing and organising, whilst going through several days of ‘last supper syndrome’; eating all the things I thought I’d never be able to eat again after my op.
I’m not alone in this apparently, but most people don’t have to give everything up, just modify things a little. When we arrived at the hospital I was given my room which was a brilliant, large room with..TV and Satellite box, excellent ensuite, somewhere to plug in the kettle and fan, and 2 electrically adjustable hospital beds. Settled in went to bed and waited, sleeplessly for the morning; nil by mouth from midnight due to the impending gastroscopy, Nurses in very early pointing a digital thermometer at my head, I have no memories of anything else until Dr Hruby came and introduced himself to us. He was calm, friendly, and spoke to us as intelligent human beings who would understand everything he was telling us; unlike some consultants I have met previously, and answered all our questions. After he had gone, my husbband and I agreed that all our lingering nervousness and worry had been allayed, and we felt completely confident and happy…well, that was easy for Paul as he wasn’t the one having the op. For all the details of my stay at the hospital please read my ‘week in the life’ post but suffice to say I was looked after extremely well and could not fault the care of the nurses, doctors and support staff.
Now I’m nearly 2 years out, and I remain 5 stone lighter. I didn’t have as much to lose as some, and I’m quite short so it made a big difference to my BMI. I have a good memory for medical data, and spent some time answering questions from people who were thinking of weight loss surgery. So, now I am a patient co-ordinator an admin on the facebook group for New Leaf. . I drink some alcohol, and occasionally eat unwisely. I’m human, but I’ve remained at the same weight for over a year now. Not skinny, but pleasantly plump as some would say. And Dr Hruby, who comes to our annual reunion just like a normal person, remains, to me, a hero.
I had a Gastric plication (wrap) with New Leaf, Dr Hruby in July 2013. I was 17 stone pre op. My Bmi was 44. At my heaviest I was at least 18st 3. Bmi 48. I am only 5ft 1. I reached healthy BMI 25 (9 ½ stone) within 9 months. I am now 8st 8 and have maintained that for nearly a year. It was the best decision I ever made and I am more grateful to Dr Hruby, New leaf and its amazingly supportive FB forum members than I could ever say.
Here is my story. I have always had weight issues. I got the stage where I knew I couldn’t diet anymore. I couldn’t keep weight off and I was getting heavier and heavier. I felt like a failure. It was affecting my health, my confidence and I was getting desperate and beginning to dislike myself. I think I tried every diet known to humanity over the years. SW, WW, Rosemary Connelly, Atkins, Dukan, low fat, low carb, meal replacement and even diet pills to name just a few. I was always really good at dieting but an expert at gaining the weight back again and then some.
‘I got the stage where I knew I couldn’t diet anymore. I couldn’t keep weight off and I was getting heavier and heavier. I felt like a failure..’
I believe I ate out of boredom, addicted to high fat, high carb, savoury foods and I loved to eat and drink. I never knew what real hunger was as I ate enormous amounts and never felt full. My wrap has given me that full button. I now know when I have eaten enough and don’t want anymore. I still love food but these days it doesn’t rule my life. I am much more selective about what I chose to eat and really enjoy and savour food these days.
Weight Loss Surgery was my final option. My absolute, desperate, last resort and not an easy decision to make. I researched weight loss surgery for a year. Initially I was looking mainly at the band. However, the more I read the more it became apparent that there are a lot of complications with the band and it scared me. I couldn’t afford a Sleeve in the UK privately and the NHS told me I wasn’t quite fat enough. I discovered Dr Hruby by accident on another forum and learnt about the wrap. It seemed like the perfect option for me, no aftercare like the band and less extreme and more affordable than the sleeve. I hadn’t even considered an operation abroad before. I was put in touch with New Leaf, joined the Facebook forum and asked a million questions. Everyone on the forum had been or was going through the experience of Weight Loss surgery. I was given as much time as I needed, all my worries and fears answered, reassurance given. I made the decision to book with New Leaf 2 months after joining the forum.
I went to my GP with all the information about Dr Hruby. He researched Dr Hruby and was very impressed with his qualifications, experience and knowledge in the WLS field. My GP gave me full support.
Travelling abroad to a strange country for an operation was terrifying. I took my best friend to support me. I was also put in touch with my (WLS buddy) through the FB forum who was having the operation the same time as me. He is now a lifelong friend.
I needn’t have been worried. The care and dedication of Dr Hruby and his nursing staff are outstanding. We were picked up from the airport and taken to the hospital on the Sunday. The hospital isnt a private clinic, it is a proper hospital, like a Czech NHS. We met the nurses, shown our room which was basic but very clean, with fridge, TV and ensuite. It has the bonus of free wi fi! On the Monday we had numerous tests, which ran like clockwork, with no time to get worried or stressed. We had a long chat with Dr Hruby in the afternoon who gave a lot of reassurance and advice. He is one of the kindest, nicest, dedicated doctors I have ever met.
The best thing I think about the surgery and Dr Hruby is that you stay in the hospital for at least 4 days after the operation with full nursing care. No private clinics or hotels. I was very aware after all my extensive research that complications are rare but usually happen within first couple of days of surgery.
I recovered very quickly and would recommend the hospital and treatment to anyone. They are a brilliant team.
Dr Hruby gave good clear instructions on his rules for WLS to follow after the operation. Making it very clear that it was a tool, not a miracle and the importance of following his weight loss plan.
This is where the New Leaf FB forum was invaluable and essential. I went on it every day for advice, ideas, information, emotional support and reassurance. It is constantly filled with success stories, before during and after pictures, non-scale victories which are inspirational. There is always someone there who answers straight away with expert advice, empathy and help. This helped me enormously with emotional eating, head hunger and to be really strict with myself after the op and followed the rules to the letter. Especially the first 6 months. I could follow people who were ahead of me on my journey those alongside and those following me.
I think that those first 6 months are the hardest, but it’s about learning brand new habits for a lifetime. It wasn’t easy, but actually not hard either. It was about relearning to eat properly, some careful planning around meal times and learning how your brain relates to your tummy. It took a while for my head to get used to things. I now know what real hunger and head hunger is. I know what satisfied is. When I eat, it takes about 15 minutes for my head to catch up. Hence why I used to overeat. Now I stop at 100g – 120g. I always eat protein first, avoid high carbs like rice and pasta and I can now eat a biscuit without wanting to eat the whole packet.
I finally believe that my brain has learnt to eat normally without being stressed about food.
I told everyone I had the op. All my family, friends, and workmates. I couldn’t have done it without their support. They were behind me 100%.
I remained an active member of the forum. They were my lifeline. I used it every day. As I became more confident and successful I found myself advising and helping others. The forum is full of inspiring, enthusiastic determined people who want everyone to be successful. When I finally reached my “happy” weight, I was supported by the forum in maintaining my weight as I have never achieved that before. Previously I was always either losing weight or gaining weight. Maintaining is a brand new journey which I never believed I would reach and difficult at first to get your head around. It is a totally alien thought process to stand on a set of scales and be happy to have stayed the same after a whole lifetime of wanting the scales to show a weight loss. The FB forum helped me deal with that.
I was honoured to be asked to be an admin for New Leaf forum. I take this role seriously as I feel it is the forum that took as much of a part in my success as the surgery with their endless support. I want everyone to be as successful as me and be there for others who are at the start or on their journey to “normal” weight, health and happiness. I concentrate on diet advice, low carb, high protein living and nutritional advise. But am there for any question or support that is asked. I will use this forum forever as it keeps me on track. Always.
I love New Leaf and I love Dr Hruby. They have turned my life completely around and I am happier than I have ever been. I will never be able to thank them enough.
I have always been overweight, as a child I was put on many diets, tried every pill and fad and managed to get heavier with each attempt to lose weight. At my heaviest I was just under 21 stone.
In 2013 I was left money and knew that surgery was my last option. I spent months researching the various procedures available and it was during this time that I was directed to New Leaf and Dr Hruby.
The decision making process was made very clear as I was given a wealth of information about the various wls options along with Dr Hrubys CV. I was able to research him at my own leisure and was extremely impressed with both his expertise and his success rates for the various surgeries.
After several months of chatting to New Leaf and bombarding them with questions I decided that the gastric plication would be my preferred choice and in August 2013 I travelled to Turnov for surgery. My stay at the hospital was faultless, immaculately clean, very attentive and caring nurses and I finally got to meet the wonderful Dr Hruby. He made it very clear that weight loss surgery is only a tool and that it would be down to me to make the correct nutritional choices and to exercise.
I embraced my new start and as soon as I was allowed to I embarked on a fitness regime that has helped my weight loss and given me a new focus in life. I’m now over 8 stone lighter and maintaining a healthy bmi. With my new found love of exercise I decided to combine my previous qualifications in anatomy and physiology along with my current degree that I am studying for (life sciences) and am in the process of obtaining my personal training qualification. The fitness company that I currently train with have been so impressed with my dedication and my body transformation that they have offered me a position with them to train as an instructor.
I was delighted to be offered the role of admin (mainly focusing on exercise) with New Leaf and the ability to encourage others who are just about to embark on their own journey. As I tell everyone “if I can do it then you can!” It’s important to remember that after wls you won’t wake up skinny with all your food demons a distant memory, its a tool and requires dedication. The rules may be boring but are very necessary and by following them you will be setting yourself along the right course for a healthy life.
I have had a major issue with my weight for all of my life. I spent months researching the options available in the UK and overseas. I finally chose New Leaf and Dr Hruby and I am so glad I did.
I had my WLS surgery May 19th 2014 under the expert care of Dr Hruby and his team. As a result of this and the efforts I have made to follow his advice on nutrition and activity and the amazing support and insight I have received from Coaching with Amanda Duggan I am now 10 stone lighter (Jan 2016). I am lighter too emotionally as prior to wls I felt like I was living my life with the sound turned off. I was angry all the time – mostly with myself for allowing myself to get to a BMI of 56. Being hugely overweight negatively impacted my life in ways that I am only now beginning to fully understand. I was very guarded in relationships both professionally and in my personal life. As I result I missed out on opportunities and experiences.
“I finally chose New Leaf and Dr Hruby and I am so glad I did. “
Taking the step to embark on coaching where I would need to open up and be more open than I would be normally was a major leap of faith for me. I can see know that this was partly due to my “last chance” mindset but mostly it was down to the initial chat I had with Amanda Duggan. I am by nature quite wary when meeting new people and am very slow to trust and take people into my confidence. I can see in hindsight that even during our initial chat I recognised that Amanda was a safe pair of hands (and ears)
After a lifetime of battling with my weight I realised that my issues were not as simple as eating less. The physical aspect had been dealt with by Dr Hruby what I needed to do was address the emotional aspects of my approach to food to achieve a long term sustainable solution.
I signed up for a course of coaching with Amanda at New Leaf was one of the better decision that I have ever made. During my time working with Amanda I have started to understand the triggers that I have for unhelpful behaviour around food.
I have learnt strategies and methods that ensure that I make positive choices and help me cope with situations that would have previously resulted in consuming a packet of biscuits rather than dealing with what the actual issue was. I have learnt to recognise head hunger – ie Am I bored, upset or angry sad and as a result I make better choices. I still have a choice but usually I make one that helps rather than harms me.
This knowledge and self awareness has been a major factor in enabling me to achieve and maintain my weight loss and has helped me in ways that I couldn’t have imagined a year ago. I stick to the eating guidelines, I don’t crave foods any more and I have completely given up alcohol and chocolate!! Not because I felt I had to as such, but I just don’t feel the need to any more and find more appropriate ways of dealing with my emotions. I have been climbing, done a sky dive, and have signed up for the 3 peak mountaint challenge. I go to the gym at least 3 times a week and really enjoy doing that now. My whole life has changed for the better.
I cannot recommend Dr Hruby’s surgery and Amanda’s coaching enough. Anyone considering WLS should understand the importance of dealing with the “headstuff”. Knowledge is power and I am now empowered to deal with whatever life throws at me without reaching for food as a buffer .I am a realist – life still happens however it is a lot more enjoyable with having excess weight to deal with too. This is a direct result of the benefits of Amanda’s coaching and support and for that I will be for ever grateful.
I was delighted to be asked to be an admin and a member of the support team for New Leaf. I hope that with the skills I have learned from my time with Amanda and following the weightloss guidelines, of clean eating and exercise the majority of the time that I will be able to help others along in their journey.
My story starts like many peoples – I come from a “Fat” family. We all like our food and as a child I associated good things with food such as birthdays, Christmas, Sunday lunches, in fact most of my memories involve food in some way or another. I was quite slim as a young child but once puberty hit my weigh started to creep up. That’s when the yo-yo dieting began! I would do some fad diet only to give up after losing a few stones then put it all back on again and then some.
When I was 21 I joined a slimming club. I was horrified to learn that I weighed nearly 19 stone at the time. I lost 7 stone over the next two years, however I started a relationship and stopped following the plan and all the weight was back on in less than a year. That started another pattern of joining various slimming groups only to give up after a few months and put the weight back on and more.
“I was determined to succeed with losing the weight. Its been 10 months now since my surgery and my life has changed dramatically for the better. “
Starting university in 2006 and then doing a busy office/ community job meant that my eating habits were terrible – I would not eat all day at work, come home late and then sit in front of the TV all night eating anything and everything – in fact I remember several times actually making a sandwich to eat whilst I was cooking my huge evening meal!. I knew my weight was starting to affect me in all aspects of life – I had no energy, my relationship was suffering and I was struggling to do everyday tasks.
I started to care for my niece who was 13 at the time and I realized that I was repeating the cycle of teaching her bad habits and what would end up being a lifetime of weight issues.
One day I realized I couldn’t lift myself out of the bath without going on all fours. I also took my niece to a local shopping centre and couldn’t walk from one end to the other – I drove round to a closer car park! I knew that was the time to do something about it. I was 34 years old and weighed a whopping 25 stone!
I started to do some research about gastric sleeve surgery and found out it would be more affordable to go abroad. I came across Dr Hruby’s name on a group about weight loss surgery abroad – it included his email address so I emailed him and he responded straight away and directed me to New Leaf and Amanda. I read all the information Amanda sent me and did my own research about Dr Hruby and the hospital in Turnov and was really impressed by what I found. I decided to only tell a few people about my surgery – my close family and a few friends.
I booked my sleeve for the 1st March 2015 and started my preop diet on 1st February 2015. I was worried that I wouldn’t be able to stick to it but I was determined to give myself the best chance of a successful surgery so actually found it quite easy to follow once I got the hand of it. On arriving in Turnov I was very impressed with the whole process, from being collected at the airport to having a lovely en suite room with beautiful views outside. I met my surgery buddies – who I soon became close friends with due to the unique experience we were sharing. My operation went without a hitch and my friends and family back home were shocked at how well I was, even a day after surgery. By the end of the week I was walking into Turnov town centre.
On returning home I got weighed and was horrified to learn that my home scales were 1st 6lb lighter – meaning my start weight had actually been a whopping 26st 6lb!, whilst this was devastating at the time it also reminded me why I had the surgery in the first place and I was determined to succeed with losing the weight. Its been 10 months now since my surgery and my life has changed dramatically for the better.
I have lost nearly 11 stone so far (Including preop) and gone from a size 28-30 to a comfortable 18 (sometimes a 16!). At the time of my operation I didn’t use Facebook so didn’t really know about the very active support group for New Leaf or that there were such thing as secret groups where your friends on your main page couldn’t see what you discussed in the group. On returning home from Turnov I decided to join Facebook to participate in the group and I’m so glad I did. I’ve made so many friends and love being able to learn from other people who have had surgery and to share my own experiences – I was thrilled to be asked to join the admin team for 2016 and am really looking forward to sharing my knowledge and skills and supporting others starting this journey.
My life is so different today to what it was pre surgery. I am now interested in food in a completely different way and what I put into my body is now more about getting the right nutrients and protein rather than huge quantities and all the wrong foods – I’ve even started an online nutrition course to learn more about food and what we put into our bodies to help other patients.
I’m not going to say its always easy – the surgery is a tool, but you also have to dramatically change the way you see food and consume it and it can bring other issues to the forefront such as things going on in your life that you didn’t even realise until you go through this process. However, I don’t regret it for a second, in fact I wish I had done it years ago! I now feel that I can fully participate in life – I’ve recently been roller-skating, to theme parks and I just generally have more energy and can walk anywhere without getting out of breath and having to stop every few minutes. I’ve even joined a gym and did a challenging aerobics class that some people only manage half of on their first attempt!
Dr Hruby CV
Dr Martin Hruby is a highly regarded Bariatric Surgeon in both the Czech Republic and Internationally. He graduated from the Charles University Prague in 1987 and has since gone on to become a Senior Consultant in general surgery and the Chief of Staff at Panachova Hospital in Turnov specialising in endoscopic and laparascopic surgery.
He has been a bariatric surgeon since 2003, and has since become the Chief of the Bariatric group and now trains other surgeons in Bariatric procedures. He has an excellent reputation as a top class Bariatric surgeon with a very low sleeve gastrectomy leak rate of 0.6% from approximately 800 procedures.
Graduated from Charles University Prague, Faculty of General Medicine, 1987
1990 – Postgraduate Diploma I
1995 – Attestation II. degree
Senior consultant in general surgery since 1995, Sub-specializations; minimally invasive and endoscopic treatment, gastroscopy, colonoscopy, laparoscopy
Chief of staff since 1998
Bariatric Surgeon since 2003
Member of: IFSO – International Federation for the Surgery of Obesity
EAES – European Association for Endoscopic Surgery
Czech Medical Chamber
Bariatric Surgical Society
Minimally Invasive Surgery Surgical Society
Society for robotic surgery
Chief of bariatric group and trainer of other surgeons in group
Studied at: University of Tubingen, Germany,
Centre for Minimally Invasive Surgery
University of North Carolina USA
Hospital Hallein, Austria, Centre for Bariatric Surgery
Moabit Hospital, Berlin
Dr Hruby’s experience/complications until the end of March 2015:Total bariatric procedures; 1250
Sleeve resection: – total number 850, %EWL over 5 years; 72-74-73-72-70% complications: bleeding 7, late leak(fistula) 5(4 czech patients, all treated at Turnov. 1leak in foreign -Norway)
Plication – total number 150, %EWL low number for statistic, complications: loosening of the wrap – suture failure 2 (in the beginning, none recently), one wrap needed loosening on the 2 nd day post-op as too tight. 1 leak.
Gastric bypass: – total number 37, %EWL low number for statistic, complications: 1 bleed (conservatively treated)
Gastric band: – total number 203, %EWL 51, complications: port site infection 4, migration 1, slippage 12
Other complications in British clients;
1; it was not a surgical complication but very rare anaesthesiology complication – pneumo-thorax and subcutaneous emphysema. This complication needed several days of breathing support, the problem was treated within one week and the patient returned home. Treatment was included in the original price (no extras).