Obesity surgery

Posted on Sun, Jan. 04, 2004

HEALTH | WEIGHT REDUCTION

Stomach bypass surgeons need long experience

As hospitals increasingly offer gastric bypass surgery, studies show
grave risks when surgeons lack adequate training in the procedure.
BY LIZ KOWALCZYK
The Boston Globe

With thousands of obese Americans opting for gastric bypass surgery,
a growing collection of research suggests that this increasingly
popular operation can have a hidden risk: inexperienced surgeons.

Over the past several years, dozens of hospitals and physicians have
rushed to open weight-loss surgery programs. Most surgeons have begun
performing the surgery laparoscopically, guiding pencil-thin tools
and video cameras through tiny incisions, a gentler procedure that
lessens pain, recovery time and scarring.

”Gastric bypass is the hottest thing in surgery right now,” said
Dr. Steven Rothenberg, a surgeon at Presbyterian/St. Luke’s Medical
Center in Denver. “The thing that made it take off is that now it
can be done laparoscopically.”

Surgeons promote laparoscopic surgery to patients as safer than
traditional more invasive surgery. And it is — in the hands of
experienced doctors.

But the gastric bypass is so difficult, according to physicians who
have tracked the results of their cases, that patients of surgeons
who have done fewer than 70 to 100 operations have complications more
often — and a greater chance of death from those complications –
than patients of more experienced doctors.

These results are exacerbating worries that surgeons are rushing into
the field without adequate training. Some hospitals allow surgeons to
operate after one weekend seminar, during which they do a handful of
cases.

”Laparoscopic surgery has opened up this whole new problem,” said
Dr. Philip Schauer, director of bariatric surgery at the University
of Pittsburgh Medical Center, who has performed more than 2,000
laparoscopic bypasses. “Most surgeons didn’t get this training. It’s
a fundamentally different skill.”

Dr. Daniel Jones, a surgeon at Beth Israel Deaconess Medical Center,
tracked the first 140 cases at the University of Texas Southwestern
Medical Center in Dallas, finding that all major complications
dropped after 70 patients.

One of the most serious complications of gastric bypass surgery is
when the staples come lose and abdominal fluid leaks and infects the
patient’s other organs.

Surgeons use staples to reduce the stomach to the size of an egg,
restricting the amount of food patients can eat. During the surgeons’
first 70 operations at the University of Texas, four patients, or 5.7
percent, experienced leaks, compared with one patient, or 1.4
percent, in the second group.

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