7 minute read
HOPE FOR A HEALTHIER LIFE
HOPE
FOR A HEALTHIER LIFE
Tampa General Hospital’s cutting-edge approach to bariatric surgery improves outcomes for high-risk patients
More than 228,000 Americans undergo bariatric surgery each year to help them lose weight. That may sound like a lot, but it turns out that fewer than 1 percent of eligible Americans are evaluated for bariatric surgery.
Studies show there’s a gap between Americans’ perceptions of bariatric surgery and the reality. Weight-loss surgery is actually more effective than nonsurgical methods for weight loss, according to systematic reviews of multiple studies conducted by the Cochrane Library. It’s also less risky than many people believe, said Dr. Christopher DuCoin, medical director of bariatric surgery at Tampa General Hospital and chief of gastrointestinal surgery at the
—Dr. Christopher DuCoin
Right: Dr. Christopher DuCoin is the medical director of bariatric surgery at Tampa General Hospital and chief of gastrointestinal surgery at the USF Health Morsani College of Medicine. Opposite page: DuCoin leads a team during a bariatric surgical precedure at the TGH + USF Health Bariatric Center.
USF Health Morsani College of Medicine at the University of South Florida.
“Some people might think that it’s a highrisk procedure, but it’s probably the safest elective surgery being done in the United States, with a risk profi le safer than a gall bladder surgery, a hysterectomy, or an elective knee procedure,” DuCoin said.
At the TGH + USF Health Bariatric Center, surgeons also perform these surgeries robotically, which translates into smaller incisions and faster recoveries. Most patients need to be hospitalized for less than 24 hours. Physicians generally perform the procedure on people for whom their excessive weight has become a serious health problem—and for whom diet and exercise have not worked—usually those who are considered severely obese, or have a body mass index (BMI) of 40 or higher.
More than 42 percent of Americans now qualify as obese, meaning they have a BMI of 30 or higher, and more than 9 percent are severely obese—numbers that have continued to rise over the past 25 years.
Bariatric surgery is typically performed on patients with a BMI of 40 or higher. Common procedures offered at the TGH + USF Health Bariatric Center include Roux-en-Y gastric bypass and sleeve gastrectomy, both of which are performed laparoscopically.
The TGH + USF Health Bariatric Center is equipped to care for a wide variety of patients seeking weight-loss solutions, DuCoin said.
“We have the infrastructure to take care of everybody; there is no patient we turn away, whether they need surgery, medical management, or one of the alternate procedures we offer,” he said. “We can take care of anybody.”
Gastric bypass, a procedure that involves changing the structure of the digestive system, enables patients to lose weight and can help reduce the risk of other health conditions correlated with obesity. The goal is to help the patient lose weight while also eliminating medical conditions such as diabetes, hypertension, and sleep apnea.
An extreme example of this is a patient who was experiencing heart failure and in need of a lifesaving heart transplant. He had received a left ventricular assist device (LVAD) in 2015 that helped his heart function. While that bought him time, he was obese and, in the subsequent four years, was unable to lose weight.
Due to his heart condition and the LVAD, several bariatric surgeons at other locations were reluctant to operate on him, making his situation ever more dangerous and frightening. But, as a leading academic medical center with multidisciplinary expertise, the TGH + USF Health Bariatric Center performs an array of complex procedures that many hospitals decline to offer.
DuCoin took on the case and performed the patient’s bariatric surgery in July 2020. Within three months, the man lost 75 pounds, which made him eligible for the transplant list. At the end of 2021, he was still awaiting a donor with the right blood type, but he has continued to lose weight, which increases his chances of living a healthy life.
“It’s amazing that he has lived fi ve years with an LVAD, but he will get his heart now,” DuCoin said. “It’s just a matter of fi nding the right donor.”
The patient will be able to have the transplant at the TGH Transplant Institute, providing continuity of care as well as a highly skilled medical team with a wide range of specialties that will likely improve his outcome.
“You have to have the bariatric team, the cardiologists, the cardiothoracic surgeons, and the cardiac anesthesiologists. It takes a full team and a high level of coordination to care for a patient this complex,” DuCoin said. “But more than that, it’s diffi cult to fi nd all of this in a single institute. The stars have aligned here just right.”
U.S. News & World Report has ranked TGH No. 26 in the nation and No. 1 in the state of Florida for gastroenterology and GI surgery for 2021-2022. TGH is where the state’s fi rst successful heart transplant was performed, in 1985. TGH also has one of the oldest accredited bariatric centers in Florida, which treats roughly 2,000 patients a month.
“We have one of the strongest transplant programs and strongest bariatric programs,” DuCoin said. “This is where patients should come to get optimized for transplant.”
Bariatric surgery either restricts the amount of food a patient can eat, by reducing the size of his or her stomach, or it diverts food from the stomach and limits the length of the intestine that comes in contact with the food. Some surgeries combine the two approaches. One procedure commonly used at TGH is Roux-en-Y gastric bypass, which limits intake, digestion, and absorption of food and can result in a 55 to 70 percent reduction in excess body weight over time. Another is sleeve gastrectomy, in which a stapling device is used to divide the stomach vertically, creating a banana-like tube that restricts food
intake. These procedures are performed laparoscopically so they are minimally invasive, which means recovery time is relatively short compared to standard operations.
DuCoin credits the multifaceted team at TGH for ensuring such procedures are possible for high-risk patients. “The success is the sheer volume of people we have—four nurse practitioners, three dietitians, two psychologists, and my surgical partners of the highest caliber, while we also have obesity medicine physicians and physicians dedicated to the care of adolescents,” he said. “We have an army of people working to get patients through the process in a safe manner with the highest quality outcomes. And the level of support at Tampa General Hospital is what makes all of this possible.”
He is also upbeat about other innovative procedures the gastrointestinal team is doing. These include employing minimally invasive robotics to treat conditions such as gastroesophageal refl ux disease (GERD) and achalasia, a condition in which the lower part of the esophagus fails to relax so food is unable to pass to the stomach.
After training in Germany, DuCoin now performs a procedure called peroral endoscopic myotomy (POEM) as well. This incisionless surgery involves extending a fl exible endoscope through the mouth and down the esophagus into the stomach to remove masses and obstructions. A procedure such as this would previously have been done through conventional surgery that requires abdominal incisions and much longer recovery times.
Beyond these innovative offerings, TGH is always exploring how it can help individuals with complex and unusual cases as well as minimize risks in whatever ways possible. And that’s what gives physicians the confi dence to tackle the tough cases.
“If no one takes them on, we know what the alternative is,” DuCoin said. “We give hope to people. If you are interested, or think you can live a better life, we would like to help you get there.”
