MDNews - Mid Hudson

removal," Dr. Maffei notes. "We've developed safer procedures and less-invasive surgical techniques since bariatric surgery's incep- tion — thus far, 100 percent of the bariatric operations we performed at Putnam Hospital Center have been done laparoscopically, with zero mortality, leak or infection rate." A study published in the August 2011 issue of the Journal of the American College of Surgeons tracked the marked increase of laparoscopic bariatric procedures between 2003 and 2008. As laparoscopic surgeries increased, mortality rates decreased from 0.21 percent to 0.1 percent. The study's authors used data from the Nationwide Inpatient Sample and found that in 2003, little more than 20 percent of bariatric surgeries were performed laparoscopically. In just five years, the number had increased to 90 percent. In large part, misconceptions about the risks associated with bariatric surgery are relics from the discipline's infancy, when operations were performed with large incisions, which posed significant complication risks. "Because morbidly obese patients have more subcutaneous fat, which has low blood supply and poor resistance to infection, they tend to have higher infection rates and seroma formation — which is fluid leaking from the wound — after large inci- sions," Dr. Kaul says. "Additionally, because intra-abdominal pressure is greater, the rate of hernia development following a large, midline incision is as high as 30 percent. Approaching procedures laparoscopically, we reduce that risk to 1 percent." Furthermore, laparoscopic approaches actually improve visualization over open surgery, according to Dr. Kaul. "Open approaches to bariatric surgery are much more difficult on the larger patients," he says. "We have to start the surgery higher in the gastrointestinal junc- tion, and it's more difficult to achieve the amount of exposure that's possible with the laparoscopic camera." The move to laparoscopy also decreases postoperat ive pa in a nd facilit ates quicker recovery. "When sleeve gastrectomy and gastric bypass were performed with large incisions, it wasn't uncommon for patients to stay in the hospital for as long as two weeks," Dr. Maffei says. "Following laparoscopic surgery, the average hospitalization is two nights. Patients are out of bed and walking the same night as surgery, and they tend to require less pain medication." Because this is a high-risk patient population, bariatric surgeons at Putnam Hospital Center emphasize safety, and to that end, each surgeon maintains expertise in performing each operation. T H E U N S U N G B EN EFITS O F BA R I AT R I C S U RG ERY The bariatric surgeons of Putnam Hospital Center and Advanced Surgeons: (L-R) Ashutosh Kaul, MD, FRCS, FACS, minimally invasive and bariatric surgeon and Professor of Surgery and Co-Program Director of Minimally Invasive Surgery Fellowship Training at New York Medical College; Anthony Maffei, MD, FACS, Director of Bariatric Surgery, minimally invasive and bariatric surgeon; and Jonathan Giannone, MD, DABS, bariatric surgeon WEIGHT LOSS AND rapid resolution of metabolic disorders may be the best- known benefits of bariatric surgery, but a number of other health improvements result from these operations. "Many conditions you may not real- ize, such as infection rates and lifetime cancer risk, dramatically decrease with significant weight loss," says Ashutosh Kaul, MD, FRCS, FACS, minimally invasive and bariatric surgeon at Putnam Hospital Center and Professor of Surgery and Co-Program Director of Minimally Invasive Surgery Fellowship Training at New York Medical College. "A BMI greater than 40 increases cancer risk to one in two. Adjusted hormone levels are one of many processes improved by bariatric surgery that reduce the chance of cancer." Obesity is linked to many cancer types, including breast (after meno - pause), colon and rectum, esophageal, kidney and gallbladder, and is thought to contribute to more, including cervical and ovarian cancers. Obesity-related cases vary by cancer type but can be as high as 40 percent, according to the National Cancer Institute. Dr. Giannone and Dr. Maffei review patient records at Putnam Hospital Center. M D N E W S . CO M ■ MD NEWS Mid Hudson | 9

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