Local surgeons develop hybrid technique to help obese patients With a new hybrid procedure recently developed at SJH, two South Jersey Healthcare surgeons are helping morbidly obese patients shed pounds—often 100 or more.

“SJH surgeons have performed bariatric procedures (surgery for the treatment of obesity) for the past 20 years,” said Condapuram Pasupathy, M.D. “For the past three years, we have performed a newer type of gastric bypass surgery called Roux en Y. Today we offer patients a modified version of Roux en Y that provides additional benefits.”

With the Roux en Y procedure a line of staples is inserted across the upper portion of the stomach, creating a “smaller stomach” or pouch. The small bowel is then divided, forming a “Y”, and one section is hooked to the pouch as an outlet. The remaining portion of the small bowel is attached back to the rest of the small bowel, about 100 centimeters away from its origin. This helps reduce food intake and absorption.

Around the country, Roux en Y has been performed both as an open procedure and laparoscopically. Each method offers its own advantages and drawbacks. Patients who undergo Roux en Y typically lose 60 to 80 percent of their excess body weight.

In open surgery, a 12-inch incision is made in the abdomen to perform the bypass. With the laparoscopic method, five or six small incisions are made, and long-handled laparoscopic surgical instruments, along with a tiny video camera and a light, are used to perform the procedure.

With the new hybrid technique, the surgeon makes a single four to six inch incision in the abdomen (as compared to 12 inches for the traditional open procedure) and then uses special surgical instruments (like those used in laparoscopic procedures) to perform the surgery.

This blending of techniques incorporates beneficial aspects from each of the existing methods. Advantages of the hybrid technique include:

• better visualization of the procedure by the surgeon;
• the opportunity to use additional surgical staple reinforcements, thus reducing the    potential for pouch leakage; and
• less post-operative pain and quicker healing due to the smaller incision.

“Patient outcomes have been successful with this new technique and our patients have been satisfied with their post-surgical weight loss,” said Nauveed Iqbal, M.D., a surgeon also performing the procedure at SJH.

The surgery typically requires a five-day hospital stay and six weeks of post-operative recovery. Patients are followed regularly by their surgeon for up to six months, and then periodically throughout their lifetime. They must adhere to a strict eating plan, take vitamin supplements and exercise to achieve and maintain weight loss after surgery. Patients are counseled by their surgeon, prior to surgery, about the lifestyle changes that will be critical to their success.

A gastric bypass support group, which meets at the Bridgeton campus,  provides an opportunity for people considering the surgery to speak with local residents who have already undergone similar procedures.

 “It should be noted that this surgery is a tool to assist with weight loss; patients must be motivated to carefully follow post-surgical instructions from their physician to achieve maximum results,” said Dr. Iqbal.

The hybrid procedure developed at SJH has attracted the attention of surgeons from outside the South Jersey region. Recently, Dr. Pasupathy was asked to speak to physicians in Connecticut who are interested in incorporating this technique. He has also given continuing medical education lectures on the technique to the medical staff at SJH.