Beware Gastric Bypass with stapeling!

EastCoast · Nov 20, 2003

Developing Story

Patient dies while having gastric bypass surgery at local hospital

(Providence-AP) -- A 27-year-old Rhode Island man undergoing laparoscopic gastric bypass surgery has died, according to a Roger Williams Hospital spokesman.

It was unclear if the man died during the stomach stapling surgery or afterward.

He died yesterday. His name is not being released. Hospital spokesman Brett Davey says the hospital is investigating.

Roger Williams performs about 200 similar surgeries each year.

Davey says he can't remember the last time someone died as a result of the procedure.

mother/babyRN, RN · Nov 20, 2003

Operations of any sort involve risk. Still doesn't surprise or alarm me...If it keeps happening, I will , of course, be of a different opinion.....

LilgirlRN, ADN, RN · Nov 20, 2003

I have a friend that almost died from the laprascopic procedure. She had a ventral hernia that was undiagnosed and they nicked it when they did the surgery. She ended up staying in the hospital for over a month. She had to have some sort of repair surgery too. I have another friend who had the surgery and did very well, no complications and is losing weight hand over fist. There are risks to everything, pros and cons to each situation, to each his own. I think I would do it if it became essential for my health.

mother/babyRN, RN · Nov 20, 2003

I guess, because I have 6 nurse friends who have had various forms of this procedure with no complications other than nausea, I can't really speak from the other side...It reminds me of patients in delivery who have only heard of the bad things that happen, or the complications that can arise...Seems as though EVERYone has to tell all the horrible things and leave out the good....That is not what I am saying here, but I think I will have to give it awhile more to see what the investigation shows.....

Home Health Columnist / Guide · Nov 23, 2003

The death of a diabetic who underwent gastric-bypass surgery to improve his health prompts Roger Williams to halt the program while it investigates.

Providence Journal, Nov. 21, 2003

01:00 AM EST on Friday, November 21, 2003

BY FELICE J. FREYER

Journal Medical Writer

Online at: http://www.projo.com/news/content/projo_20031121_gastric21.1270dd.html

PROVIDENCE -- Roger Williams Medical Center yesterday suspended its weight-loss-surgery program until a hospital team determines why a 27-year-old man died during a stomach-stapling operation on Tuesday.

Dr. Paul Y. Liu, chairman of the hospital's Department of Surgery, said a preliminary review of procedures found "no deviation from our standard protocols" and no explanation for the death of Robert F. Messa Jr., of East Providence.

The incident drew intense media attention because it occurred one month after a 38-year-old woman died during a similar operation at Boston's Brigham and Women's Hospital. In that case, doctors said the staple gun may have malfunctioned. Liu said there was no evidence of mechanical errors or equipment malfunction involved in Messa's death.

Messa's death is the third to occur in connection with stomach-stapling at Roger Williams. A patient died this year and another last year within 90 days of the operation, Liu said at a hospital news conference yesterday.

The hospital has performed 340 stomach-stapling, or gastric-bypass, surgeries since its program began three years ago. Its death rate is in keeping with the national average of 1 to 2 deaths per 100 gastric-bypass surgeries.

"This is complicated surgery," Liu said. "Things do occasionally happen. . . . We are evaluating all aspects."

In gastric bypass, doctors reduce the size of the stomach to a small pouch by stapling part of it closed or putting a band around it. A portion of the small intestine is then attached to that pouch. The procedure is offered to people in danger of severe health problems because they are extremely obese -- typically more than 100 pounds overweight. In the months that follow, about two-thirds of patients lose about two-thirds of their excess weight.

The operation has soared in popularity in the past five years because a laparoscopic procedure -- which involves small incisions and a scope -- has been introduced, promising patients a quicker recovery and less pain. Surgeons, however, require additional training to perform laparoscopic surgery, which can be technically trickier than open surgery.

Liu could not specify how many of the 340 bypass operations were laparoscopic.

Liu provided few details of Tuesday's procedure, except to say that Messa had already been placed under anesthesia when he died.

But Kathy Lynch, a friend of Messa's family, told reporters at yesterday's news conference that Messa's "heart stopped" about 15 minutes into the operation, that heart experts from Miriam Hospital were summoned to try to revive him, and that no one knows why he died.

Lynch said Messa had suffered from type 1 diabetes since childhood and the diabetes had caused nerve damage. She said he wanted the operation not to improve his looks but for his health.

"He was thrilled to have this surgery," she said of Messa, who worked as a nurse's assistant at Roger Williams. "He loved this hospital."

One surgeon performs all the gastric-bypass surgeries at Roger Williams, Liu said. He declined to identify the surgeon but described him as "very experienced."

"We have suspended the procedure, not the surgeon," he said. Liu said that Roger Williams has a waiting list for the surgery. Gastric-bypass surgeries are also performed at Rhode Island Hospital.

There is no board certification specifically for weight-loss surgery, known as bariatric surgery, nor any accreditation process for bariatric-surgery programs. But the American Society for Bariatric Surgery has established guidelines for surgeons and hospitals, and also specifies which patients are appropriate candidates. Liu said all those guidelines had been followed.

"This is serious surgery with serious ramifications," Liu said in an interview. "We do what we can to make it as safe as possible. . . . This is a patient population that is very high risk. We know what the stakes are."

Liu and Lynch said the state medical examiner, Dr. Elizabeth Laposata, was investigating the death, but Laposata's office declined to confirm her involvement and would not say whether an autopsy would be performed.

A nurse from the state Department of Health went to the hospital yesterday morning to begin a review, according to Donald C. Williams, chief of health-services regulation.

Liu said a team of nurses, doctors and others who work at Roger Williams but who weren't involved in the surgery would review the medical records and interview the participants to determine exactly what happened. He could not estimate how long it would take.

Liu said Messa had undergone three months of preoperative evaluation with his primary-care doctor, a cardiologist, a nutritionist, a psychiatrist, and a gastroenterologist to make sure he had no condition that would make the surgery too dangerous.

Death on the operating table is rare. When a patient dies from gastric-bypass surgery, it typically occurs in the weeks after surgery. The most common cause is a major infection, often brought on by leakage from the stomach or intestine. Other causes are heart problems and blood clots that form in the leg and migrate to the lungs.

"It is life-threatening surgery," said Dr. John J. Kelly, director of the Section of Minimally Invasive Surgery at the UMass Memorial Medical Center, who recently published a study of complications from the procedure. "People should consider it to take life in their hands when they decide for such an extreme method of weight loss."

But for many morbidly obese people, being fat can be even more hazardous, leading to heart disease, diabetes, and other ailments, Kelly said. Carrying large amounts of fat "is a toxic condition to the body," he said. "The fat is not just on your body. It's in every tissue, in the muscle and the tissue of every organ."

Kelly's study found that the more experience a surgeon has at performing laparoscopic gastric-bypass surgery, the fewer complications the patient has. In Kelly's own practice, a common complication -- a narrowing of the stomach opening -- stopped occurring after he had done 120 procedures.

Kelly said he tells his patients that if they're not willing to risk severe injury and even their life, they should reconsider the surgery.

"They always say, 'My life's not worth living if I cannot take off this weight,' " he said.

For the morbidly obese, surgical treatment is the only proven method of achieving long-term weight control, according to the American Society for Bariatric Surgery.

With less room for food in their stomachs, patients must learn to chew slowly and eat small amounts. But the effect is not just mechanical. The surgery also decreases secretion of a hormone that induces hunger, while increasing another hormone that promotes feelings of fullness and improves insulin matabolism.

The International Bariatric Surgery Registry at the University of Iowa estimates that 100,000 gastric-bypass surgeries are performed nationwide each year. The registry also estimates that, with obesity rates soaring, there are now 8 million Americans fat enough to qualify for the surgery.

A study by the Rhode Island Health Department estimated that in 2001, 1.5 percent of Rhode Island adults, or about 11,000 people, weighed enough to be potential candidates for gastric bypass.

The study documented the sudden popularity of the procedure. There were only about 28 gastric-bypass surgeries performed in Rhode Island each year from 1995 to 1999. But starting in 2000, the rate increased exponentially, with 248 gastric-bypass surgeries performed in 2002, most of them at Roger Williams Medical Center and Rhode Island Hospital. In 2002, the average length of stay in the hospital for the surgery was 4.7 days, down from 21 days in the mid-'90s.

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EricTAMUCC-BSN, BSN, RN · Nov 23, 2003

This is an interesting thread. I do not know anything about Roux-en-Y Gastric Bypass, Lap-Band, or other procedures.

What are the most common types of bariatric surgery performed today?

What are the pros and cons of each?

Which procedure has been linked with the best prognosis?

FranEMTnurse, CNA, LPN, EMT-I · Nov 23, 2003

With less room for food in their stomachs, patients must learn to chew slowly and eat small amounts. But the effect is not just mechanical. The surgery also decreases secretion of a hormone that induces hunger, while increasing another hormone that promotes feelings of fullness and improves insulin matabolism.

Hi NRSKarenRN,

Very interesting article

.

I had no idea the surgery was that beneficial. I wish I was a candidate for it, but unfortunately I don't qualify because I have COPD.

But at least it gives hope for and helps others in need of it if they choose to do so. :)

Thank you for your input. This is one of the reasons I look forward to a brand new day when I awaken. I never know when or how I'm going to learn something very valuable and new.

Fran:nurse:

JockRN · Nov 23, 2003

The Roux-en-Y Gastric Bypass is the "gold standard" in surgical weight loss. The Lap Band, Vertical Banded Gastroplasty, Duodenal Switch, Biliary Pancreatic Divertion and other procedures may have value in some instances. We have completed >300 Laparoscopic Roux-en-Y procedures in the past year and have been VERY happy with the results. We are happy with the low incidence of complications and the resultant weight loss of our patients. We have performed the procedure on several patients with COPD, so that in and of itself is not an excluding factor.

JockRN · Nov 23, 2003

I forgot to let you know of some sites to visit if you want more info on Sugical Weight Loss. The "premier" site is Obesityhelp.com. Our site is Hickorysurgical.com, look in the specialties tab, then in Bariatrics.

Jock

FranEMTnurse, CNA, LPN, EMT-I · Nov 23, 2003

Wow! That's enlightening. Thank you. Then does the patient have a spinal anesthesia?

JockRN · Nov 24, 2003

Our patients do not have spinals, they all have general. I'm glad to have helped in your search.

Jock

FranEMTnurse, CNA, LPN, EMT-I · Nov 24, 2003

Wow again. The docs here all say they wouldn't give COPDers general anesthesia, including the specialists. Thanks again. :rolleyes: And to think P T thinks this board is boring. NOT! I've learned a lot here, and while I'm at it,

Welcome aboard, JockRN.

Fran:nurse: