'Gastric bypass surgery' resumes at medical center
By Steve Pivnick, 81st Training Wing Safety Office
/ Published July 25, 2007
KEESLER AIR FORCE BASE, Miss. -- A life-changing surgical procedure is again being performed at Keesler Medical Center.
Bariatric surgery restarts this month after a hiatus of nearly two years, according to Lt. Col. (Dr.) James Dolan, the 81st Surgical Operations Squadron's chief of general surgery.
Better known as "gastric bypass" or "weight-loss surgery", Colonel Dolan last performed the procedure in August 2005, shortly before Hurricane Katrina ravaged the Mississippi Gulf Coast and forced the closure of Keesler Medical Center.
Ironically, the last bariatric operation in 2005 and the first one of the renewed program are both "open" procedures. Virtually all the procedures the colonel and his staff perform are done laparoscopically, through small incisions in the abdomen.
The procedure has become more common across the nation, according to Colonel Dolan, due to the majority of the population being considered overweight and the percentage of these being actually obese.
"There are different levels of obesity," the colonel observed. "The main clinical concerns for us are not only the patient's physical size but the major medical conditions, which we term comorbidities, associated with being obese. The top three are high blood pressure, diabetes and obstructive sleep apnea. There are a host of other conditions as well."
All of these conditions combine to reduce a person's life span, the Keesler surgeon continued. "They also make people very reliant on the health-care system over a long period of time and at a huge cost," he said.
There are medical and surgical avenues to assure weight loss in obese individuals, according to Colonel Dolan.
"It's been fairly well established that the surgical procedure not only leads to weight loss but also alleviates or considerably lessens serious medical conditions associated with morbid obesity," he said. "The most important information I tell my patients is that I can give them at least 10 years of life back."
Colonel Dolan noted bariatric surgery was a thriving, vigorous program at the medical center in the past. Col. (Dr.) David Jenkins, former surgery department chief (currently assigned to Eglin Air Force Base, Fla.), now-retired Lt. Col. (Dr.) Michael Mann and Colonel Dolan had completed 115 procedures, almost all laparoscopically, between the program's January 2004 start and August 2005.
"We are very excited we can resume the program here again," Colonel Dolan said. "We have seen and continue to closely follow all the patients we operated on before Katrina.
"Virtually all of them have lost at least 60 percent of their excess body weight," he continued. "The vast majority of them have resolved their comorbidities and discontinued or reduced their medications. Practically every one of them says they would undergo the surgery again if given the choice."
Colonel Dolan stressed the procedure is technically very difficult and requires the lead surgeon to have completed quite a few procedures and "go beyond the learning curve to do it safely."
The surgery usually takes more than two hours. The surgeon makes six small incisions in the patient's abdomen. A laparoscope (surgical camera) is inserted into the abdominal cavity. Carbon dioxide gas is used to inflate the abdominal cavity to allow the surgeon a larger work space,
"The most popular version of this type of surgery is the 'Roux-en-y' gastric bypass," Colonel Dolan noted. "We fashion a small gastric pouch, about the size of a fist, and then redirect some of the small bowel up to this pouch. Obviously, meal portion sizes for people who undergo the procedure subsequently are much smaller."
Patients are returned either to the intensive care unit or inpatient surgery unit, depending on such things as their body weight or having obstructive sleep apnea.
The colonel said patients generally resume a clear liquid diet on the first post-operative day, if tolerated, and a full liquid diet on the second day. Then they're sent home.
There's a highly selective process to determine suitable candidates for bariatric surgery at the medical center.
"Most patients have failed all attempts at weight loss," Colonel Dolan explained. "They must also undergo psychological as well as dietary counseling before the procedure. Certain individuals may need to be referred for cardiology or pulmonary evaluations if we suspect there is significant cardiology or pulmonary disease that could increase risk to the patient during surgery."
All patients receive very extensive pre-surgery counseling about the operation's risks and benefits, as well as its life-changing impact which isn't easily reversed. No one has ever asked to have the procedure reversed, according to Colonel Dolan.
"We have had to do some revision surgeries for people who have had it done in the past due to technical failures or renewed weight gain," he said. "These are the procedures that we usually do using the traditional 'open' approach."
Colonel Dolan anticipates performing one or two bariatric surgeries a week. His team already has a considerable number of people on a waiting list, causing them to stop taking names temporarily.
"Our ability to increase the number of surgeries relies on the arrival of more trained surgeons," he explained. "They must be trained on the procedure before they can be considered to perform the operations themselves. It probably takes almost a year to completely train a surgeon to perform independently."
Colonel Dolan has one surgeon on staff already well advanced in laparoscopic surgery, with a new surgeon scheduled to arrive in the next few weeks.