Better gastric bypass surgery outcomes linke to preoperative weight loss

Trenton, NJ

Preoperative weight loss is associated with fewer complications after gastric bypass surgery, according to the results of a record review reported in the December issue of Archives of Surgery.

"Despite the improved ability to accurately predict an increase in surgical risk, the optimal preoperative preparation of such high-risk bariatric surgery candidates remains controversial," write Peter N. Benotti, MD, from Saint Francis Medical Center in Trenton, New Jersey, and colleagues.

"Proposed risk-reducing strategies supported by varying degrees of evidence include staged surgical procedures, preoperative gastric balloon placement for weight loss, and preoperative medical weight reduction....Because the major determinant of postoperative length of stay is operative morbidity, we hypothesized that preoperative weight loss will reduce the frequency of surgical complications in patients who undergo bariatric surgery."

At a comprehensive, multidisciplinary obesity treatment center at a tertiary referral center serving central Pennsylvania, the investigators reviewed records of 881 patients undergoing open or laparoscopic gastric bypass surgery from May 31, 2002, through February 24, 2006. Before surgery, all patients underwent a 6-month multidisciplinary program with the goal of achieving a 10% preoperative weight loss. The primary endpoints of the study were loss of excess body weight and rates of total and major complications.

Loss of 5% or more excess body weight was achieved by 592 (67.2%) of the 881 patients and loss of more than 10% excess body weight by 423 patients (48.0%). Compared with patients undergoing laparoscopic gastric bypass surgery (n = 415), those referred for open gastric bypass (n = 466) were generally older (P < .001), had a higher body mass index (P < .001), and were more often men (P < .001). In addition, they had higher total complication rates (P < .001) and major complication rates (P = .03) vs patients undergoing laparoscopic gastric bypass surgery. Increased preoperative weight loss was associated with decreased rates of total complications (P = .004) and, most likely, decreased rates of major complications (P = .06), based on univariate analysis. In a multiple logistic regression model controlling for age, sex, baseline body mass index, and type of surgery, increased preoperative weight loss predicted reduced rates of total complications (P = .004) and major complications (P = .03). "Preoperative weight loss is associated with fewer complications after gastric bypass surgery," the study authors write. "We hope that these findings will be confirmed by prospective, controlled trials and that bariatric surgeons will consider this modality for preoperative risk reduction in selected patients who are deemed high risk for complications after surgery." Limitations of this study include retrospective design, lack of a control group, referral bias, and possible unmeasured confounding variables. In an accompanying invited critique, Patricia L. Turner, MD, from the University of Maryland Medical Center in Baltimore, recommends emphasizing an aggressive preoperative weight loss regimen. "Overall, this article presents the largest study thus far, to our knowledge, which may demonstrate a significant advantage to preoperative weight loss," Dr. Turner writes. "Moreover, the authors did not experience the attrition feared by some surgeons should they require preoperative weight loss of their patients. These findings suggest that consideration be given to incorporating either a suggestion of or the requirement for modest weight loss prior to bariatric surgery as a means of decreasing postoperative complications."

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Gastric bypass surgery malpractice: Fatal malpractice at NY hpspital unreported

Coney Island, NY

On July 17, 2006, Robert Asta had gastric bypass surgery at Coney Island Hospital. Six days later, the 54-year-old cook was dead.

Internal hospital records reveal a "foreign object" was left inside his body postsurgery, but for the year 2006, Coney Island Hospital reported zero cases in which a foreign object was mistakenly left in a patient after surgery.

Robert's son, Michael, was devastated. It was a surgery Michael didn't want him to have, but Asta desperately wanted to lose weight. The 6-foot, 375-pounder had tried all kinds of diets with little success.

"My life has never been the same. We were supposed to go into business together," Michael Asta said. "My family is heartbroken."

Asta never told his family what he was planning.

"None of us would have let him go," Michael Asta said.

The son said his father told him about the surgery a day after the operation — and said he was in a great deal of pain.

Robert called the hospital, but was told that pain after such an operation is a normal part of the recovery process.

Then on July 20, Asta received a call from the hospital asking him to come in for some further testing after lab tests came back with abnormal results.

The hospital found a piece of surgical tubing in material removed from Asta's body — an indication something had been left inside Asta postsurgery.

A CT scan was taken and the results were inconclusive. On July 23, Michael Asta received a call from his father's long-time girlfriend.

"She told me to come over because, she said, 'He feels very cold and I think he's dead,'" Asta said. When Asta arrived, his father was dead.

In response to the News' questions, the city Health & Hospitals Corp. insisted it didn't need to report this incident as "foreign object left in body" – a specific reporting category. Instead it was reported merely as "unexpected death."

HHC said surgical tubing was not left inside Asta, but an internal Coney Island Hospital document dated Aug. 22, 2006, that the family obtained in its lawsuit states, "Foreign Object left in body during surgical operation."

The autopsy report lists the cause of the death as a postoperative infection in the abdominal cavity that involved "retention of surgical tubing" in a surgical specimen.

Manner of death is listed as "therapeutic complication." Though the hospital didn't admit wrongdoing, the family's malpractice claim was settled for $675,000.

Asta left behind three adult children and two grandchildren.

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Unreported gastric bypass malpractice at New York hospital results in patient death

Coney Island, NY

On July 17, 2006, Robert Asta had gastric bypass surgery at Coney Island Hospital. Six days later, the 54-year-old cook was dead.

Internal hospital records reveal a "foreign object" was left inside his body postsurgery, but for the year 2006, Coney Island Hospital reported zero cases in which a foreign object was mistakenly left in a patient after surgery.

Robert's son, Michael, was devastated. It was a surgery Michael didn't want him to have, but Asta desperately wanted to lose weight. The 6-foot, 375-pounder had tried all kinds of diets with little success.

"My life has never been the same. We were supposed to go into business together," Michael Asta said. "My family is heartbroken."

Asta never told his family what he was planning.

"None of us would have let him go," Michael Asta said.

The son said his father told him about the surgery a day after the operation — and said he was in a great deal of pain.

Robert called the hospital, but was told that pain after such an operation is a normal part of the recovery process.

Then on July 20, Asta received a call from the hospital asking him to come in for some further testing after lab tests came back with abnormal results.

The hospital found a piece of surgical tubing in material removed from Asta's body — an indication something had been left inside Asta postsurgery.

A CT scan was taken and the results were inconclusive. On July 23, Michael Asta received a call from his father's long-time girlfriend.

"She told me to come over because, she said, 'He feels very cold and I think he's dead,'" Asta said. When Asta arrived, his father was dead.

In response to the News' questions, the city Health & Hospitals Corp. insisted it didn't need to report this incident as "foreign object left in body" – a specific reporting category. Instead it was reported merely as "unexpected death."

HHC said surgical tubing was not left inside Asta, but an internal Coney Island Hospital document dated Aug. 22, 2006, that the family obtained in its lawsuit states, "Foreign Object left in body during surgical operation."

The autopsy report lists the cause of the death as a postoperative infection in the abdominal cavity that involved "retention of surgical tubing" in a surgical specimen.

Manner of death is listed as "therapeutic complication." Though the hospital didn't admit wrongdoing, the family's malpractice claim was settled for $675,000.

Asta left behind three adult children and two grandchildren.

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Woman files gastric bypass malpractice lawsuit vs. MaineGeneral

Augusta, ME

A northern Maine woman is seeking more than $3 million, alleging a laparoscopic gastric bypass surgery performed on her at MaineGeneral Medical Center in Augusta more than seven years ago was botched.

Opening statements began Wednesday in Kennebec County Superior Court in the case of Donna and Charles DeLong, whose mailing address is Westfield, vs. the hospital and Dr. Padiath A. Aslam.

The DeLongs claim Donna DeLong suffered numerous complications from the surgery and afterward was admitted multiple times to hospitals, including Aroostook Medical Center, for treatment.

The attorney for the DeLongs, Daniel Lilley, is seeking more than $3 million in compensation for the couple.

In one court document, the couple said they suffered an estimated economic loss of $816,452.

Aslam, represented by attorney Mark Lavoie, and the hospital, represented by Robert Newton, deny the allegations.

Lavoie told jurors that Aslam had done the surgery properly and that Donna DeLong suffered complications after straining herself playing with her son's dog within hours of being discharged.

Lavoie also said a medical practice screening panel -- set up to evaluate the merits of claims against physicians and surgeons -- found Aslam's actions met the standard of care.

In a ruling prior to the trial, Justice Nancy Mills ruled that Aslam was an independent contractor and not an employee of the hospital. "Defendant MaineGeneral Medical Center is not liable for any negligence on the part of Defendant Padiath A. Aslam, M.D.," she wrote.

Aslam was initially licensed as a medical doctor in Maine in 1970 and is currently working at Rumford Hospital with Rumford Hospital Surgical Associates. He is licensed to practice in Maine until Feb. 28, 2010.

He has not been subject to any disciplinary actions in Maine or in Vermont, where he also was licensed from 1970 to 2006.

Selecting the 11-member jury took all day Tuesday, and trial is expected to last three weeks. More than a dozen boxes full of files related to the case were stacked up against a railing in the back of the courtroom.

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Tearful testimony at gatric bypass malpractice trial in North Dakota

Fargo, ND

Tearful testimony dominated the second day of a malpractice trial at Wilkin County Courthouse Wednesday over one woman's claim of a problematic gastric bypass surgery.

In 2002, Dr. James Wasemiller, former surgeon at St. Francis HealthCare Campus, performed a gastric bypass surgery on plaintiff Mary Larson, a Fargo resident, in Breckenridge. But hospital records indicate several complications followed the surgery, some of which included an abdominal hernia and leaks from an exterior incision.

Before one male and six female jury members, Larson said she had been overweight her entire life but wanted to take a risk for her children. At the time of the operation, she said she weighed 376 pounds and has lost about 100 pounds since.

"I had two small kids, and...I wanted to be an active part of their life," she said, crying.

After one of her consultations with Dr. Wasemiller, Larson said she recalled thinking, "'I'm going to do this, he's going to help me become the woman I want to be.'"

Larson sought out Wasemiller after hearing the success story of her aunt, who had a gastric bypass surgery performed by him.

Dr. Paul Wasemiller, a brother to James Wasemiller and surgeon, performed exploratory surgery on Larson after nurses reported she had difficulty breathing and drainage was leaking from the incision on her stomach. He said he did not see Larson prior to surgery but gave orders on her care.

William Maddix, attorney for Larson, referred to Wasemiller's pre-operative diagnosis, which included leaking and the possibility of a serious infection. While operating, Wasemiller said he tried to "close the muscle, not the leak" because it would have been too risky for Larson's health. When called to the stand by Maddix, he said it was hard to tell when the infection started.

"My estimation would be a day or two, perhaps longer," he said.

After recuperating at St. Francis Healthcare Campus, Larson noticed her incision began to drain more liquid and she was transported to SCCI Hospital in Fargo by ambulance. After being advised she was free to drink liquids, she was offered cranberry juice and immediately had to go to the bathroom.

"I sat down...heard dripping, and I could see the cranberry juice coming out of the bottom of my stomach, from my suture," she said.

Dr. Brent Hella, MD, a witness for Larson, said he met her the evening she arrived at SCCI. Hella is an internal medical physician at Internal Medicine Associates in Fargo and can refer patients to the hospital.

"In the initial assessment I wrote, I was a little bit dismayed at how sick she was," he said. "Though it's not unusual (to see sick patients at SCCI), I could see she was extremely ill."

A colored-dye test performed on Larson indicated fluid was moving to the part of her stomach supposedly cut off after her gastric bypass surgery, rather than bypassing it, said Hella.

"Part of the gastric bypass wasn't as successful as it should be," he said.

Larson said she was informed of the risks, such as scarring and even death, but did not recall hearing about the chance of getting a hernia. During testimony, Larson's husband, Michael, said her present hernia is "the size of half a basketball in her abdomen." Larson had a hernia in 1997 that she later had surgically repaired.

Both Larson's husband and mother, Vicky Vincent, spoke about how much pain Larson experienced after surgery. But Mark Solheim, attorney for Dr. James Wasemiller, said she was aware the procedure was life threatening.

"You knew you would have the scar...the leaking and possibly undergo a second surgery...and Dr. Wasemiller said the approximate weight loss would be 100 pounds," he said.

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Student will be first adolescent to have gastric bypass as part of UM Health System program

Ann Arbor, MI

She wants to shop for a prom dress, buy clothing at a regular mall store and walk easily across the stage on graduation day.

"I don't want to wheeze when I grab my diploma," said Sarah White, 16, of Vandercook Lake. "I don't want to graduate in a really large gown."

With more than 410 pounds on her 5-foot, 4-inch frame, the Vandercook Lake High School junior is desperate to lose the weight that for years has restricted her activities, drawn sneers from some classmates and compromised her health.
About gastric bypass surgery

The surgery changes the anatomy of a patient's digestive system to limit the amount of food that can be eaten and digested. It redirects food to bypass most of the stomach and flow directly into the middle of the small intestine, which limits calorie absorption. The surgeon uses staples to create a walnut-sized pouch at the top of the stomach that holds about an ounce of food and sews part of the small intestine directly onto the pouch. Risks include death, blood clots in the legs, leaking at the staple lines in the stomach and dumping syndrome, caused by stomach contents moving too quickly through the small intestine. The syndrome causes diarrhea, abdominal cramps, vomiting, sweating and dizziness.

— Source: Mayo Foundation for Medical Education and Research

She is scheduled to undergo gastric bypass surgery Tuesday at C.S. Mott Children's Hospital at the University of Michigan in Ann Arbor. White will be the first adolescent to have the weight-loss surgery as part of the UM Health System's new Pediatric Comprehensive Weight Management Center program.

"Her health is so significantly affected that surgery is warranted," said Dr. Susan Woolford, a university pediatrician and the center's medical director.

The university set up the family-focused program a year ago to combat the growing problem of childhood obesity. White entered in February 2007 when she was at her peak weight of 423 pounds, said her mother, Patricia White.

Sarah White revamped her diet and started exercising more, but did not lose much weight due to underlying health conditions, including a thyroid problem, Woolford said.

The surgery, which restructures the digestive tract and shrinks the stomach to limit the intake of food, is becoming increasingly common among teens as more struggle with obesity. But it still is not performed often, doctors said.

Some children's hospitals do not offer the surgery, and Woolford said she doesn't know of gastric bypass ever having been performed on an adolescent at UM.

According to medical literature, there are concerns about the long-term effects and the ability of pediatric patients to give informed consent to an invasive procedure that involves a lifetime of follow-up care and dietary restrictions.

"I had no other option," said White, who with support from her mother made the decision to go ahead with the procedure despite some early reservations.

"I was scared about all my intestines looking like a modern-day Picasso," she said Friday at the high school. She plays clarinet in the band, belongs to Students Against Destructive Decisions and said she has a 3.79 grade point average.

She had some qualms about the permanency of the surgery, "But it's either face up to eternity or die at 20," she said.

Fighting the weight

For years, White's weight-loss attempts have failed.

"I remember in elementary school, she bought salads and white milk or water when she bought lunch every day; that didn't work. She walked three miles a day and that didn't work," said her friend, Kelsey Weathers, 16, a diminutive girl who has been friends with White since kindergarten.

White once joined Weight Watchers with her grandmother, but said it seemed weird to be with a group of older women. She didn't lose weight, became frustrated and quit.

She weighed 6 pounds, 13 ounces at birth but quickly gained weight, developing faster than average children, her mother said.

Sometimes it is just easier and cheaper to eat at McDonald's than buy healthier foods, said Sarah White, who listed her weaknesses as Mexican food and pizza. At times, she struggled with emotional eating, but wasn't the type who raided the refrigerator at night, her mother said.

"Her body just doesn't metabolize the food," Patricia White said of her daughter, who was diagnosed at an early age with a type of hypothyroidism, meaning her thyroid gland doesn't produce enough of certain hormones, which impact metabolism.
By Dave Weatherwax | Jackson Citizen PatriotSarah White collapses her head on her mother's shoulder, Patricia White, after finishing her workout Friday afternoon at Planet Fitness of Jackson.

Both sides of her family have overweight members, said Patricia White, whose brother had gastric bypass surgery about two years ago. "She is genetically screwed."

Her daughter was obese by age 8, said White, a single, working mother who is both fiercely protective and proud of her daughter.

The two are clearly close and tease each other continually.

Friday, Patricia White razzed her daughter about her weight-induced spinal curvature, calling her Quasimodo.

"Well, he got the girl in the end, so there is hope for me," Sarah White countered, smiling.

Struggling with pain

The surgery is expected fix some of her problems, such as the curvature and the weight-related pain she feels in her back and knees.

At 8, Sarah White was diagnosed with type 2 diabetes and metabolic syndrome, a cluster of conditions that occur together and increase risk of heart disease, stroke and diabetes.

The excess weight has affected her self-esteem, her friends said. She regularly endures strangers' stares. It also makes school occasionally difficult.

Though White is witty, reads regularly and impresses friends with her vocabulary, her classmates haven't always been accepting, she said. "Especially in middle school, when everyone is discovering the opposite sex."

She cried often then.

Before she got involved with the program at UM Health System, which taught her to change some of the behaviors that contributed to her weight issues, she said she felt like a panda.

"All I did was sit around and eat and look cute," said White, who likes pandas and has many stuffed versions of them in her oriental-themed bedroom.

By the time she got to high school, things got better as the focus turned to academics.
More info

For more information about the University of Michigan's Pediatric Comprehensive Weight Management Center, visit www.med.umich.edu/MPOWER

"I've always been the smart fat kid, which is better than just being the fat kid," said White, who speaks openly and often comically about her situation.

"What I can't do physically, I make up mentally."

Her band director, Chip Williams, called her a "very good student."

"She is one of my top players," he said after class Friday.

However, White said she cannot both play her clarinet and march because it requires too much air and energy.

Her size keeps her from sitting at classroom desks. Instead, she sits at a table outside the rows other students fill.

For school dances, she has worn a purple pin-stripe suit. "It is hard to be girly in this body," she said.

A new chapter

She is looking forward to shopping for a prom dress after her surgery, which could help her lose 100 pounds by her birthday in January.

Her goal is to lose at least 200 pounds.

The surgery is about 90-percent successful in spurring and maintaining weight loss, said Dr. Henry Buchwald, professor of surgery at the University of Minnesota in Minneapolis, who has specialized in metabolic or bariatric surgery for decades.

The mortality rate in surgery is about 0.5 percent, he said.

Long-term effects of the operation on teens have not entirely been explored because the surgeries have been performed for about 20 years. But the procedures have held up over five-, 10- and 20-year periods, Buchwald said.

"What we hope we are doing for these adolescents is giving them time. Obesity is a fatal disease," Buchwald said.

The Tuesday surgery likely will keep White in the hospital for a week and a half, she said.

Her diet will be seriously limited in the weeks after surgery, as it has been in the weeks leading up to surgery.

For lunch Friday, she ate applesauce, a protein shake and yogurt, in compliance with a liquid diet she has been required to follow since Aug. 26.

To avoid temptation, all solid food has been removed from the house, Patricia White said.

After surgery, patients have to stay on course and maintain healthy life style habits to be successful, Woolford said. "Weight-loss surgery is not a magic bullet."

White has made the necessary changes, including incorporating physical activity into her weekly schedule, Woolford said, and has a strong family support structure.

She is rarely, if ever, negative, her friend Weathers said.

Some of the dietary restrictions have been difficult, Sarah and Patricia White said, but the payoff will be worth it.

"It's a small sacrifice to live longer," Patricia White said.

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Gastric bypass surgeon and hospital face wrongful death medical malpractice lawsuit

Danbury, CT

The husband of a 39-year-old Ridgefield woman blames her surgeon and Danbury Hospital for her death on Christmas Day 2004.
Anthony Cataldo is suing Dr. Keith Zuccala, a Danbury doctor, and Danbury Hospital, claiming, among other allegations, that she was "improperly identified" as a candidate for gastric bypass surgery and that she wasn't properly cared for or monitored during a later hospital stay.

Lisa Ann Cataldo, a mother of two, had gastric bypass surgery Sept. 17, 2004, and was discharged three days later. One week later, she returned to the hospital, complaining of general abdominal pain, weakness and fever, and was seen in the emergency room, according to the complaint.

On Dec. 13, she had severe abdominal pain, the lawsuit says, and two days later she went to the emergency room, reporting her pain on a level of nine out of 10. She got there about 11:25 a.m. according to the lawsuit, which was filed in Superior Court in June.

She was moaning and appeared uncomfortable, and said she had been unable to eat or keep down fluids for two days.

About 2:30 p.m. that day she had a CT scan of her abdomen, and about 4:50 p.m. the films showed at least a partial small-bowel obstruction, according to the lawsuit.

Zuccala examined her in the emergency room and agreed to admit her for overnight observation on Dec. 15.

In the early morning of Dec. 16, she suffered from nausea, vomiting, dry heaving and increasing abdominal pain, the suit alleges. About 10:44 a.m. Zuccala performed a laparotomy to repair a perforated bowel.
Cataldo died on Christmas Day from sepsis caused by the perforated bowel, according to the lawsuit.

Hospital spokeswoman Andrea Rynn said there would be no comment.

Zuccala could not be reached.

Nor could Anthony Cataldo, who was appointed as executor of the estate on Jan. 12, 2005, be reached for comment.

Betty Ann Rogers, the plaintiff's Fairfield lawyer, declined to comment.

Cataldo time line Sept. 17, 2004 -- Lisa Ann Cataldo undergoes gastric bypass surgery. Dec. 16, 2004 -- she has surgery to repair a perforated bowel. Dec. 25, 2004 -- she dies. Source: a lawsuit filed in Superior Court by her estate

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Dozens of gastric bypass malpractice lawsuits against bariatric surgeon costs him medical license, leads to new law

Wilmington, NC

The case of former Wilmington surgeon Dr. Steven Olchowski, who for years performed the wrong surgery on dozens of patients, helped bring to light the need for changes at the North Carolina Medical Board. One change requires the Medical Board to publish more information about disciplinary action taken against physicians. But some think the law doesn't go far enough.

From 2000 to 2002, former Wilmington bariatric surgeon Steven Olchowski was performing gastric bypass surgery on dozens of patients. During that time, his North Carolina Medical Board record was clean. Olchowski promised his patients one form of gastric bypass surgery but instead performed a short-cut bariatric operation.

It took three years and three-dozen gastric bypass surgery malpractice lawsuits against Olchowski for the North Carolina Medical Board to revoke his license in 2005. While the gastric bypass malpractice lawsuits were litigated, the medical board was limited in what it could make public.

A state law that went into effect last Fall requires the Medical Board to release more disciplinary information. State Representative Lucy Allen sponsored the legislation.

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$2.9 million jury award for wrongful death following gastric bypass surgery

Philadelphia, PA

A Nov. 19 jury verdict finding the Hospital of the University of Pennsylvania guilty of medical malpractice and responsible for damages totaling $1.74 million will come under question on Feb. 5.

Following the death of her husband in 2003, Donna Traina, represented by attorney Timothy Lawn, filed a lawsuit against HUP, Mercy Suburban Hospital in Norristown and several doctors and medical personnel from both hospitals.

The jury awarded her $2.9 million for wrongful death, pain and suffering, and lost wages. HUP was found 60-percent negligent and liable for $1.74 million of the damages. The cases against the medical personnel were dropped before trial and all the doctors were found not negligent.

Both hospitals have since filed motions for post-trial relief, similar to an appeal, in order to argue to overturn the verdict. A hearing has been set for Feb. 5.

At the hearing, HUP attorney James Young will present an oral argument before the Philadelphia Court of Common Pleas.

"The treatment Traina received was entirely appropriate. There are sound legal reasons to undo the mistake made by the jury," Young said.

Traina's husband, Joseph Traina, 30, died Feb. 3, 2003 of a cardiac arrest due to a pulmonary embolism following treatment at HUP and Mercy Suburban. Traina had undergone gastric bypass surgery at HUP 13 days earlier and sought treatment for pain in his legs during the days following the surgery. More >>

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Another Complication For Gastric Bypass Patients

November 27, 2007

Obese patients who suffer complications after gastric bypass surgery may face further health risks because their weight exceeds the limits of diagnostic imaging equipment, according to a study presented November 27 at the annual meeting of the Radiological Society of North America. In the study, approximately 27 percent of patients weighing more than 450 pounds needed imaging to diagnose a problem after surgery and could not be accommodated because of their size.

---

See also:

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• Today's Healthcare
• Medical Imaging
• Obesity

Matter & Energy

• Ultrasound
• Biochemistry
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Reference

• Interventional radiology
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• Minimally invasive procedure

"When patients weigh more than 450 pounds, standard diagnostic imaging often cannot be used," said Raul N. Uppot, M.D., an assistant radiologist at Massachusetts General Hospital (MGH) and instructor of radiology at Harvard Medical School in Boston. "In these cases, physicians must resort to other means of diagnosis such as exploratory surgery or using less accurate or more invasive techniques."

According to the Centers for Disease Control and Prevention, obesity has grown dramatically in the last 20 years. Today, nearly one-third of the American population is obese. Along with the rise in obesity among American adults has come an increase in the number of gastric bypass procedures performed.

The American Society for Bariatric Surgery estimated approximately 140,000 gastric bypass procedures were performed in the United States in 2005. In a gastric bypass procedure, the stomach is surgically reduced, and part of the small intestine is bypassed. Like any surgical procedure, gastric bypass is not without risks. Most common complications include suture tears and leaks, pulmonary embolism, pneumonia and infection. Serious complications tend to be more prevalent among the severely overweight.

Dr. Uppot and colleagues conducted an eight-year retrospective study of all patients weighing more than 450 pounds who underwent a gastric bypass procedure at MGH between June 1999 and April 2007. Patient imaging usage and clinical course were tracked using electronic health records and evaluated to determine the outcomes of those who, based on their weight, were denied their physicians' first choice of imaging. The maximum weight limit for a computed tomography (CT) table is 450 pounds.

The researchers found that 12 (27 percent) of the 44 patients who weighed more than 450 pounds required postsurgical imaging because of a clinical condition, but were denied because they were above the weight restriction for the equipment. Four patients who could not be evaluated with imaging for suspected leaks were required to return for surgery.

Two additional patients with suspected lung blood clots could not undergo a chest CT. Of two patients who came in with nonspecific abdominal pain, one was evaluated with ultrasound and the other one had a barium swallow test. Because imaging was not an option, one patient who suffered trauma underwent exploratory surgery in lieu of noninvasive imaging. Another patient was denied a chest CT and received no further imaging evaluation.

"When obese patients cannot be diagnosed using standard-of-care imaging techniques, then other diagnostic measures have to be instituted," Dr. Uppot said. "Patient care may be ultimately affected due to a compromised diagnosis."

Dr. Uppot noted that the obesity trend cannot be ignored. "Unless major changes are made to the American diet or exercise habits, this is a problem that we will have to address," he said. "When an obese person is contemplating gastric bypass surgery, he or she should consider that they will need follow-up imaging but may not be able to get the appropriate tests."

Co-authors of the paper presented by Dr. Uppot are D.V. Sahani, M.D., D.A. Gervais, M.D., P.R. Mueller, M.D., P.F. Hahn, M.D., Ph.D., and S.I. Lee, M.D., Ph.D.

Adapted from materials provided by Radiological Society of North America.

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Gastric Bypass: Star Jones Opens Up About Her Weight Loss

November 22, 2007

For years, Star Jones Reynolds refused to reveal how she lost half of her body size, but now a confident and secure Star is talking in detail about her gastric bypass surgery --- to Access Hollywood’s Tim Vincent.

“The only reason I am talking to you today is to help other women understand they are not by themselves. They are not alone,” Star told Tim.

“Do you regret not having said something earlier?” Tim asked.

“I really wished, god, I could have. I really do. If there’s a regret that’s it,” Star said. “The regret is I wish I was stronger.”

Undergoing gastric bypass surgery in 2003, it wasn’t until August of this year that Star Jones Reynolds finally went public on how she dramatically lost 160 pounds. More >>

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$3.5 Million Malpractice Verdict Upheld in Gastric Bypass Malpractice Lawsuit

Gastric bypass malpractice lawyers won a $3.5 million jury verdict in Virginia for their client, who suffered a brain injury during gastric bypass surgery. Even though Virginia's insurance company protecting "cap" on malpractice awards immediately knocked the verdict down to $1.65 million (for no reason other than the insurance industry spends big money in Virginia's General Assembly) the defendants elected to appeal the verdict. About one year after the trial, they prevailed.

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