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Sarah Mamis, a 21-year-old college student from Methuen, struggled her whole life with the physical limitations and emotional stresses of being overweight. “I just didn’t feel comfortable in my own skin,” said Mamis, who weighed 290 pounds last year. “I didn’t want to socialize. I didn’t even want to go to classes anymore.”
Last October, she underwent gastric bypass surgery at BWH, and the results were life-changing. “I lost 125 pounds over the last year,” Mamis said. “I’m taking classes again and I’m going out with friends a lot, too.”
The expert care delivered to hundreds of patients like Mamis earned BWH accreditation as a Level 1A Center of Excellence by the American College of Surgeons (ACS) in August. That means the hospital is equipped with the staff and resources to handle the most challenging and complex patients and provide the best care possible. BWH’s program is only the second in Massachusetts and eighth in the nation to receive this accreditation.
Road to accreditation
ACS began its bariatric surgery accreditation program to commend and recognize institutions with commitment, organization, leadership, human resources and physical resources to deliver optimal care.
“Many people from an array of departments played critical roles in helping us to prepare for and achieve this important distinction, and many more are vital to caring for these patients every day,” David Lautz, MD, director of Bariatric Surgery at BWH, said.
To earn accreditation, BWH underwent a comprehensive six-hour site review in August that involved everywhere a bariatric surgery patient could receive care. The reviewer visited the OR, Recovery Room, Emergency Department, intensive care units, Tower 15, Dialysis, Endoscopy, Diagnostic Imaging and CT Scan and other areas to interview staff and examine equipment and protocols. Prior to the review, sensitivity training for all areas that have contact with these patients was conducted to increase awareness of their needs.
The ACS reviewer met with hospital leadership and reviewed the program’s quality improvement initiatives, patient charts, the training of bariatric surgeons, patient selection process, patient education and counseling services.
The best in patient care
Most of the patients who undergo bariatric surgery at BWH have tried everything possible to lose weight and are unable to keep it off. “Their weight prevents them from doing things like climbing stairs, sitting in a movie theater seat or playing with their kids,” Lautz said. “They just want to live normal lives.”
BWH supports patients in their transformation from their initial visit, through the surgery itself and during the years after it. To prepare emotionally for surgery, patients are encouraged to attend support groups before and after surgery.
“We want patients to attend support groups pre-operatively so that they can hear from people who have had the surgery they are preparing for, and post-operatively so they can network with people going through the same thing,” Barbara Hodges, RD, MPH, LDN, program coordinator for the Program for Weight Management, said.
One option patients have for surgery is gastric bypass, through which surgeons staple the top part of the stomach to create a small pouch that limits food intake. Another option is LAP-BAND surgery, in which an adjustable band is fastened around the upper portion of the stomach.
Last fall, Lautz for the first time performed a laparoscopic gastric bypass with a surgical robot, which he directs to mimic his hand movements. BWH is the only hospital in the state to offer this procedure, which potentially can benefit extremely obese patients who have a thicker abdominal wall that can limit surgeons’ dexterity.
“The robot gives the surgeon 3-D vision and more mobility within the abdomen,” said Lautz, who performed the first surgery of this kind on Mamis.
Another innovative procedure was developed by Chris Thompson, MD, director of Developmental and Bariatric Endoscopy, to repair gastric bypass surgery complications endoscopically. About 15 percent of gastric bypass patients eventually regain weight due to post-surgical complications. This can happen if, over time, a hole opens between the pouch and the stomach. This prevents the patient from feeling satiated.
Thompson guides an endoscope—a tube with a tiny camera attached to one end—down the patient’s throat and uses tiny tools to tighten the outlet of the pouch with small stitches. He is training physicians at other institutions to conduct this procedure, which allows patients to go home the same day.
Ali Tavakkolizadeh, MD, left, and David Lautz, MD, were part of the team performing the first laparoscopic gastric bypass with a surgical robot last year.