UPdate Spring 2012 : Page 1

Physician Referral Line To refer a patient for a clinic appointment (800) 877-7197 (573) 882-7000 Consults/Transfers/ Admissions Line To transfer, admit or request a phone consultation with a specialist (888) 884-MU-DOC UNIVERSITY PHYSICIANS / UNIVERSITY OF MISSOURI HEALTH CARE Roger de la Torre, MD, left, performs laparoscopic surgery at University Hospital. In addition to traditional minimally invasive surgery, de la Torre performs single-and dual-incision bariatric procedures to treat obese patients and patients with other abdominal conditions. Single-incision surgery Technique can reduce recovery time, surgical pain SILS surgeries Procedures that can be performed with single-or dual-incision techniques include: • Bariatric surgery • Gallbladder surgery • Appendectomy • Hiatal hernia procedures • Refl ux treatment surgeries For more information, please call (573) 882-LOSE (5673). R oger de la Torre, MD, considers single-incision laparoscopic surgery (SILS) and dual-incision laparoscopic surgery the next generation of weight-loss surgery. In addition to providing the same weight-loss bene ts of traditional bariatric surgery, medical research shows that single-and dual-incision procedures cause patients less pain and shorten recovery time — in addition to providing a better cosmetic result. “Most physicians are aware of the medical bene ts of weight loss, whether from surgical options or other methods,” said de la Torre, a surgeon at Missouri Bariatric Services. “ e Roux-en-Y divided gastric bypass is associated with an 86 percent remission rate of Type 2 diabetes and an improvement in high cholesterol for more than 90 percent of patients. For many patients, weight-loss surgery also improves hypertension.” (continued on page 2)

Single-Incision Surgery

Single-incision surgery <br /> <br /> Technique can reduce recovery time, surgical pain<br /> <br /> Roger de la Torre, MD, considers single-incision laparoscopic surgery (SILS) and dual-incision laparoscopic surgery the next generation of weight-loss surgery. In addition to providing the same weight-loss bene ts of traditional bariatric surgery, medical research shows that singleand dual-incision procedures cause patients less pain and shorten recovery time — in addition to providing a better cosmetic result.<br /> <br /> “Most physicians are aware of the medical bene ts of weight loss, whether from surgical options or other methods,” said de la Torre, a surgeon at Missouri Bariatric Services. “ e Roux-en-Y divided gastric bypass is associated with an 86 percent remission rate of Type 2 diabetes and an improvement in high cholesterol for more than 90 percent of patients. For many patients, weight-loss surgery also improves hypertension.” <br /> <br /> In de la Torre’s experience, some patients are unwilling to consider the option of weight-loss surgery to treat obesity and its comorbidities because of worries about surgical pain and discomfort. Some patients also are concerned about encountering social stigma from turning to surgery to assist in weight loss. However, SILS and dual-incision bariatric surgery can address both concerns, de la Torre said.<br /> <br /> “We know that patients who have laparoscopic surgeries often experience less pain and are able to return to work more quickly than those with open surgery,” de la Torre said. “We also know that patients who have lower-abdominal incisions are quicker to ambulate and take deep breaths than those who have had upper-abdominal incisions. It also is associated with quicker recovery.<br /> <br /> “With fewer, smaller incisions, we also are better able to hide surgical scars,” de la Torre said. “Many procedures can now be done with virtually no visible scars, so on the beach or in the gym, other people don’t have to know if your patient has had surgery.That makes some people more comfortable with the idea of surgery as an option for achieving weight loss.”<br /> <br /> SILS Surgeries<br /> <br /> Procedures that can be performed with single- or dual-incision techniques include:<br /> <br /> • Bariatric surgery<br /> <br /> • Gallbladder surgery<br /> <br /> • Appendectomy<br /> <br /> • Hiatal hernia procedures<br /> <br /> • Reflux treatment surgeries<br /> <br /> <br /> Missouri Bariatric Services<br /> <br /> Missouri Bariatric Services is nationally recognized for quality of care as a Bariatric Surgery Center of Excellence by the American Society for Metabolic & Bariatric Surgery. Our comprehensive team includes four physicians, with three bariatric surgeons and an internal medicine physician.<br /> <br /> Kevin Suttmoeller, DO, an internal medicine physician who specializes in bariatrics, treats patients medically and works with them to make lifestyle modifi cations, such as exercise and diet. He also collaborates with the teamâ??s bariatric surgeons to prepare patients for their procedures. Bariatric surgeons Roger de la Torre, MD, Archana Ramaswamy, MD, and Norbert Richardson, MD, perform offer several options for bariatric surgery, including<br /> <br /> lap-band procedures<br /> <br /> Roux-en-Y gastric bypass procedures<br /> <br /> vertical sleeve gastrectomy procedures<br /> <br /> The surgeons work with patients to determine the best surgical approach, based on the patient’s preferences, co-morbidities and other considerations. Surgical options for lap-band, gastric bypass and vertical sleeve gastrectomy include traditional open procedures, laparoscopic procedures and single-incision or dual-incision procedures.<br /> <br /> For more information or to refer a patient to Missouri Bariatric Services, please call (573) 882-LOSE (5673).<br /> <br /> Technique <br /> <br /> When performing both single- and dualincision bariatric surgery, de la Torre starts at the navel. By centering the incision at the umbilicus, he is able to insert the laparoscopic instruments he needs to perform a SILS procedure through one surgical port. Siting the incision at the navel brings the additional benefits of hiding the incision scar and reducing pain for many patients.<br /> <br /> “Incisions in and around the umbilicus are perceived differently than those on the lateral and upper parts of the abdomen, so pain and recovery time seem to be even less than with traditional laparascopy,” he said.<br /> <br /> Once he inserts his instruments into the patient’s abdominal cavity, de la Torre views the surgical field to determine whether a singleincision surgery is possible or a second incision would provide a better treatment. For certain patients, such as those with large livers or scarring from previous surgeries, the ability to triangulate another instrument through a second incision is a better option than SILS. When making a second incision, de la Torre tries to hide the small, threemillimeter opening at the site of a mole or freckle, which will help hide the scar.<br /> <br /> After determining whether to perform a singleor dual-incision surgery, the surgeon performs the operation using the same basic technique as traditional laparoscopic procedures, with only slight modi cations because of the reduced number of surgical ports. De la Torre can perform multiple types of weight-loss surgery using the SILS and dual-incision approaches, including vertical sleeve gastrectomy, which reduces the size of the stomach; bands, which reduce the capacity of the stomach without surgically altering it; and Roux-en-Y divided gastric bypass surgery, which reduces the size of the stomach and bypasses a portion of the small intestine, reducing the amount of food absorbed by the body. Roux-en-Y is the most common form of weight-loss surgery performed in the United States.<br /> <br /> “Because these are the same surgeries, just with a single- or dual-incision approach, we find the same efficacy,” de la Torre said.<br /> <br /> WHEN TO CONSIDER BARIATRIC SURGERY<br /> <br /> The National Institutes of Health have developed these criteria for determining candidates for weight-loss surgery:<br /> <br /> • Body mass index (BMI) of at least 40 (35 with weight-related co-morbidities or 30 for gastric banding)<br /> <br /> • Patient’s willingness:<br /> <br /> • to accept risks of surgical procedures<br /> <br /> • to make dramatic lifelong lifestyle changes, including diet and exercise<br /> <br /> • to commit to medical follow-up care

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