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Sleeve gastrectomy evolved into a stand- alone procedure from its origins as the first phase of the duodenal switch operation, Dr. Maffei explains. In the 1980s, surgeons performed sleeve gastrectomy to promote weight loss and resolve obesity-related comorbidities in the 12 to 18 months before the second phase, in which surgeons rerouted the intestines. "Surgeons found that patients were losing significant amounts of weight with the sleeve gastrectomy alone," Dr. Maffei says. "That's how it became a stand-alone procedure." Thus far, the bariatric surgeons at Putnam Hospital Center have successfully completed more than 360 cases since starting the program there in 2011. The laparoscopic procedure involves mak- ing five or six 1-centimeter-long keyhole incisions through which surgeons introduce cameras and instrumentation to the surgical site. This results in less pain and quicker recovery. Inflating the stomach with carbon dioxide allows optimal visibility, which has already been improved by reducing the liver's size through preoperative weight loss. The mechanical effect of sleeve gastrec- tomy comes from resizing the stomach, which not only restricts the amount of food patients can eat at one sitting, but also decreases hunger pangs. "We reduce the size of the stomach from a football down to a banana," Dr. Maffei says. "A sizing device introduced orally calibrates how large we want the stomach to be, and after we make the determination, we staple off the right side of the stomach, shrinking it by approximately 80 percent a nd reducing ghrelin production." Gh rel i n is a hor mone produced by cells lining the stomach. After a significant portion of the stomach is removed, patients see their appetites significantly abate. "We highly recommend sleeve gastrectomy for restric- tive procedures," Dr. Giannone says. "Gastric banding can result in com- plications that, while not life threatening, require revision operations to repair. There's definitely a population indicated for the gastric band — especially those patients who don't want 80 percent of their stom- ach removed — but if they're on the fence between sleeve gastrectomy and gastric band, we recommend the sleeve." Stacking Up Favorably Malabsorptive procedures — gastric bypass and duodenal switch — have tradi- tionally been thought to produce the most dramatic metabolic results. But as sleeve gastrectomy rose in popularity, a team of physicians, including Drs. Maffei, Kaul and Thomas Cerabona, MD, FACS, minimally invasive and bariatric surgeon at Putnam Hospital Center, sought to compare the pro- cedure's efficacy in resolving obesity-related comorbidities with that of gastric bypass. The team collected data from 558 patients who underwent gastric bypass or sleeve gastrectomy to treat morbid obesity at Westchester Medical Center within a two- year span. Data from 30-day, six-month and one-year outcomes showed that sleeve gastrectomy compared favorably with gastric bypass, and even exceeded resolution rates for some conditions. At one year postop, the team found that 86.2 percent of patients had resolution of one or more comorbidities after sleeve gastrec- tomy, while 83.1 percent saw remission after gastric bypass. When the team drilled down to specific disease processes, they found that sleeve gastrectomy improved remission rates for sleep apnea and hyperlipidemia, and achieved similar results in Type 2 diabetes, hypertension and musculoskeletal disease. Mortal Misconceptions No pharmaceutical intervention achieves quicker or more sustained resolution of obesity-related comorbidities, and yet the misconception persists that bariatric surgery is a dangerous endeavor. Considering that this patient population is at high risk for any surgical intervention, this is an understand- able assumption. But it's false. "While bariatric surger y has been portrayed as risky, and mortality rates have erroneously been reported as high as 1 percent, the chance of dying during a weight-loss surgery is roughly 30 times less than that of open-heart surgery and roughly five times less than that of gall bladder N AT I O N A L R EC O G N I T I O N Bariatric surgeons at Putnam Hospital Center have elevated the quality of care to a level that positions the facility among the top programs in the country. For five years in a row, Healthgrades has awarded the program its Bariatric Surgery Excellence Award and placed it among the top 5 percent of similar facilities in America. Dr. Kaul meets with former patient, Patricia Greenwood O'Keefe, Director of Critical Care services at Putnam Hospital Center, in her office. "Bariatric surgery is a life-altering treatment. Not only does an operation change patients' lives — in many cases, it saves them." — Anthony Maffei, MD, FACS, Director of Bariatric Surgery, minimally invasive and bariatric surgeon at Putnam Hospital Center COV ER FE AT UR E 8 | Mid Hudson MD NEWS ■ M D N E W S . CO M

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