Bariatric Program Expansion

 

Bariatric specialist Lindsey Sharp, MD, is constantly searching for the latest and most advanced minimally invasive laparoscopic surgical procedures for patients of Rex Bariatric Specialists.

Two months ago at Cleveland Clinic in Ohio, Sharp learned about an investigational new bariatric surgery procedure – the Greater Curvature Plication – that involves an “in-folding” of the stomach to reduce the stomach volume without the need for stapling the intestine or placement of a foreign object. Because there are only a few published studies with short-term results on less than 200 patients, Sharp said it was too early to suggest how or if the procedure will be incorporated into the standard bariatric surgery armamentarium.

 

To test its feasibility, several bariatric surgery groups practicing at Rex Hospital, including Rex Bariatric Specialists, are launching a research study in 2012 to incorporate aspects of the Greater Curve Plication with the Adjustable Gastric Banding procedure (Lap Band or Realize Band).

“The goal of the study is to determine if the addition of the ‘imbrication’ to the banding procedure can improve the effectiveness of weight loss and resolution of obesity-related medical problems,” said Sharp.

 

Expansions & Accolades

Not only is Rex Bariatric Specialists growing their offerings to bariatric patients, the multi-location practice is expanding geographically. Nine months after Raleigh Surgical and Wake Surgical groups merged on Aug. 1, 2009, the base of operations relocated to Rex Medical Office Building on Blue Ridge Road in Raleigh. In December, Rex held an open house for their newest clinic in Holly Springs, adding to existing locations in Wakefield, Garner and Knightdale. Sharp works from the main campus and also sees patients in Garner. His practice partner, bariatric surgeon Peter C. Ng, MD, also sees patients in Wakefield.

Also, Rex Bariatric Specialists received an impressive accolade with the Bariatric Surgery Center of Excellence (BSCOE) designation. The prestigious honor –awarded to both the surgeon and facility – enables patients, payors, and others to distinguish specific providers who have met requirements for delivering high quality perioperative and long-term follow-up care.

“For example, being a Blue Cross Blue Shield Center of Designation is certainly advantageous, mostly because probably greater than 50 percent of our patients have Blue Cross Blue Shield coverage,” said Sharp. “And also, I think Blue Cross Blue Shield is directing their bariatric patients to Centers of Excellence. The focus on improved outcomes in patient safety has been significant.”

The BSCOE designation was awarded in part because of the integrated efforts and resources of the surgeons, facility and practice. 

 

Patient Safety Focus

“When it comes to bariatric surgery, with the advent of Bariatric Centers of Excellence and all the data that has been collected, we’ve found that it has become very, very safe,” said Sharp. “In particular, when we talk about diabetes and obesity, the best treatment is the gastric bypass. Somewhere close to 85 percent of patients will come off all their diabetic medications and essentially have their diabetes cured by the operation. Aside from that, probably another 10 percent of patients will at least have their diabetes improved. In the new era of laparoscopic surgery, we’ve seen the complication rates of all the bariatric procedures go way down. The safety profile is, I think, similar to gall bladder surgery.”

Primary care providers with patients who have a BMI of greater than 35 with a severe medical problem related to obesity – high blood pressure, sleep apnea, diabetes, high cholesterol, asthma and even severe arthritis among many conditions – could benefit those patients by referring them to bariatric specialists like Sharp and Ng.

“At that (high BMI) level, surgery reduces patients’ risk of mortality long term, as well as their risk of developing medical problems in the future,” said Sharp. 

 

Addressing Misperceptions

Among several preconceived notions Sharp hears from patients who have not fully researched the bariatric surgery process is that it’s looked upon as “taking the easy way out.”

“I always say yes, surgery is the easy part of the process, but it requires a lot of work on the patient’s behalf to be successful long term,” said Sharp. “It’s part of a multi-modality approach to obesity that requires a complete change to an individual’s diet to healthy eating, becoming less sedentary and incorporating exercise in daily routines.”

Another misperception is that bariatric surgery patients eventually regain lost weight. 

“The reality is that 85 percent of the time, patients are successful with surgical weight loss,” he said. “Probably 5-7 percent of body weight will be regained, but that’s compared to 65-75 percent of weight loss. Rarely is there a failure of the operation.”

During his fellowship at Duke, Sharp worked on a research project, Predicting Outcomes in Weight Loss Surgery, which provided some interesting findings.

“We learned that at one month post surgery, we could predict with a highly reasonable percentage how well patients would do at the 1- and 3-year mark,” he explained. “Patients who were doing well were unlikely to turn around and end up doing poorly in terms of weight loss. The flip side is true, too. If patients weren’t doing well after a month, they were at risk of not doing well long term. While this hasn’t been studied, I suspect that many times, patients who do better longer term will be more successful losing weight because they’re taken the initiative before surgery to adopt healthier lifestyle changes.”

 

Team Approach

To ensure success, Rex Bariatric Specialists hosts support group meetings and posts dietitian-approved heart healthy recipes online such as seasonal Pumpkin Pie Oatmeal for the holidays, among other support efforts. (Staff dietitian Mary Gray Hutchinson provides nutrition therapy and education to bariatric patients.)

“Participating in support groups is very important because it helps people have the support of their peers who have also gone through the process,” said Sharp. “They have to recommit to those lifestyle changes, which does take some time and, without continuing support, it could be easy to slip back into old habits.”