Bariatric revision experts teach at Fresno Heart & Surgical

More than 40 surgeons from around the nation and two from overseas came to Fresno Heart & Surgical Hospital to learn the latest techniques in bariatric revision surgery from pioneers in weight-loss and metabolic surgery. The two-day seminar included lectures, demonstration of the latest in laparoscopic equipment, a practice tissue lab and observation of two gastric bypass revision surgeries done by Dr. Kelvin Higa, medical director of the hospital's Metabolic & Bariatric Surgery Program.

Dr. Higa explained that because bariatric surgery has been around now more than five decades, some patients with older surgeries are encountering problems and many of the earlier types of surgeries aren’t being done anymore because they aren’t as effective.

Occasionally, as was the case in the revision surgery he demonstrated on Nov. 14, a patient will be malnourished but will have regained weight. Revision procedures are still rare, so few surgeons see enough cases to become revision specialists, Higa said. So many patients needing their weight loss procedures redone must come to places such as Fresno Heart & Surgical, which was recently accredited at a Bariatric Center of Excellence by the American Society of Metabolic and Bariatric Surgeons.

Dr. Higa, who is also a UCSF Fresno clinical professor of surgery, was joined by guest lecturers Dr. Raul Rosenthal, director of bariatric surgery at Cleveland Clinic in Weston, Fla., and an assistant professor of surgery at the University of South Florida and Ohio State School of Medicine, and by Dr. Alan Wittgrove, medical director of Wittgrove Bariatric Center at Scripps Memorial Hospital in La Jolla.

More than 40 surgeons from around the nation and two from overseas came to Fresno Heart & Surgical Hospital to learn the latest techniques in bariatric revision surgery.

“They’re world-renowned experts, no question about it,” said Dr. John Feng, a Redwood City bariatric specialist, who called Fresno Heart & Surgical’s new conference and education center “the perfect venue for this kind of course.”

On Nov. 13, during the first day of the seminar, Ethicon Endo-Surgery representatives demonstrated some of the company’s newest equipment for minimally invasive surgeries. Seminar attendees were able to try out the laparoscopic wands in a tissue lab. As surgeons clamped down on a trigger at one end of the rod cutting through the tissue, the new equipment deposited three rows of tiny staples like top-stitching along each side of the cut.

“What they’re showing here is the newest, state-of-the-art stapler,” explained Dr. Kevin Boone, a bariatric surgeon and Fresno Heart & Surgical's medical director, “and we’re one of the first hospitals to get to use it. It’s very, very nice. Since laparoscopic surgery has taken hold, the advancement of the staple and the technology has improved tremendously.”

Surgeons not only learned new surgical skills and experimented with high-tech equipment, but they also challenged each other to approach treatment of their bariatric patients in different ways.  Many times discussion after lectures wasn’t about what techniques or methods to use, but whether additional surgery was even warranted.

“A cancer surgeon will approach a disease much differently than a bariatric surgeon. Why? They’re still deadly diseases,” Dr. Higa argued. “They are still about quality of life. You’re willing to take someone who has a 10% chance of survival from cancer and do a major operation on them with 15% mortality rate. And yet for someone who’s young, has a long life to live, who’s single and has a BMI (body mass index) over 40, you’re not willing to take a chance on something like this?”

Dr. Higa said in the case of a young woman diagnosed with Crohn’s, an inflammatory bowel disease, after her gastric bypass, that now 10 years after the surgery she had regained 30 lbs, but more alarming she is unable to adequately absorb calcium and protein. Clearly, she needed to have more of her small intestine reattached and her stomach size reduced, he asserted. Other surgeons said maybe nutritional counseling was the answer rather than surgery here and in other cases.

Higa was passionate in his answer to those who favored trying another diet. “You’ve never walked in the shoes of someone who’s morbidly obese,” he said. “You’ve never lived in a society that looks at you with great disdain, that ridicules you and treats you like crap…Maybe we should help our patients live in harmony with a fast food world.”

This story was reported by Erin Kennedy. She can be reached at ekennedy@communitymedical.org.

Thursday, November 19, 2009