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and others who would t y pica lly be approached with open surgery. "In 2010, the Agency for Healthcare Research and Quality analyzed the outcomes of bariatric surgery and found that the complication rate had gone down dramatically," Dr. Brathwaite says. "The agency ascribed this to the use of minimally invasive technology." The ex per tise achieved t hrough performing a high volume of bariatric procedures translates into other areas, he adds. Now, Winthrop is k now n for minima lly invasive approaches t o m a n y p r o c e d u r e s , i n c l u d i n g hernia repair, cholecystectomy and achalasia correction. "Bariatric surgery is so complex that the skill you develop performing a mini- mally invasive procedure translates into everything else," Dr. Brathwaite says. "You learn to handle other techni- cally challenging problems, especially diseases of the foregut, stomach, lower esophagus and diaphragm." Achieving Long-term Results with Gastric Bypass "Gastric bypass surger y is consid- ered the gold standard of bariatric procedures," says Keneth Hall, MD, minimally invasive and bariatric sur- geon at Winthrop-University Hospital. O v er t i me , g a s t r ic b y p a s s h a s Dr. Brathwaite helped New York state develop bariatric surgery guidelines, which were later adopted by other states. Winthrop-University Hospital patients benefit from a meticulous screening process that is a national touchstone for patient safety. "Surgeons come from across the country to train with us in minimally invasive, robotic and bariatric surgery. I travel to train surgeons at other locations, as well as teach national courses. If you are trying to make a decision about where to send a patient, go to the people who train the others." — Collin E. M. Brathwaite, MD, FACS, FASMBS COLLIN E. M. BRATHWAITE, MD, FACS, FASMBS CHAIR OF THE Department of Surgery and Chief of the Division of Minimally Invasive and Bariatric Surgery at Winthrop-University Hospital, Dr. Brathwaite is a national leader in bariatric surgery. He obtained his medical degree at Howard University and served his residency at St. Vincent's Hospital. He pursued a fellowship at the University of Maryland. Since 2007, Dr. Brathwaite has guided the Department of Surgery at Winthrop- University Hospital, recruiting and training up-and-coming surgeons as well as teaching and publishing in national and international venues. "We have evolved as leaders in minimally invasive gastroenterological surgery on Long Island primarily because of our extensive experience in bariatric surgery," Dr. Brathwaite says. "Bariatric procedures are highly complex in terms of technical requirements. This complexity allowed us to refine our skills and perform other complicated procedures using minimally invasive approaches." de velop e d f rom a n op en s u rger y with a high rate of complications to a minimally invasive procedure with significantly lower risk of mortality and morbidity. Wound healing issues became less significant with a laparo- scopic approach, for example. "Gastric bypass was developed in the 1960s," says Alexander Barkan, MD, FACS, D irec tor of t he M in ima l ly Inva sive Fellowsh ip at Wint h rop- Universit y Hospit a l a nd A ssist a nt Professor of Surger y at Stony Brook University School of Medicine. "The procedure has evolved considerably to be divided into two parts: the forma- tion of a small stomach, about the size of an egg, and the bypass of 2 feet of small bowel." Gastric by pass has demonstrated weight loss and metabolic benefits. Bypassing the duodenum often leads to control of diabetes, even before the patient loses weight, Dr. Barkan says, though physicians do not yet know the exact mechanism by which the metabolic change takes place. Other Options: Sleeve Gastrectomy and Gastric Banding Despite the proven effectiveness of gastric bypass surgery, many patients M D N E W S . CO M ■ MD NEWS Long Island | 1 7