The Surgical Weight Loss program at St. Luke's- Roosevelt Hospital Center was established in 1999 and since then over twelve hundred operations have been performed. It was initially designed as a comprehensive program built around a multi-disciplinary team offering the open roux-en y Gastric bypass as the procedure of choice. Since 2001 the program has developed a focus in minimally invasive surgery offering an increasing array of surgical options and expanded its services, data management and oversight in order to continue to improve our success rates, patient satisfaction, and outcomes research. The program is a center of excellence for the SLRHC Department of Surgery, and as such it strives to provide leadership, at local and national scales in the treatment of obesity which is fast becoming the number one public health problem in the U.S. Our program is also affiliated with the New York Center for Obesity Research at St. Lukeâ€Ts which is nationally recognized for its expertise in the study and treatment of obesity.
Over the last decade surgery has witnessed dramatic transformation with the introduction of video endoscopic technologies and minimally invasive approaches to treating a variety of diseases. Laparoscopic techniques have significantly affected patient care resulting is less pain, faster recovery, lower complication rates and a faster return to normal activity and work. However, initially obesity was considered a contra-indication to the application of these techniques. Over the last several years many centers has demonstrated that bariatric patients stand to gain the most from these techniques and St. Lukeâ€Ts-Roosevelt has been on the forefront of this change.
Research is an important part of our mission in continuing to improve the safety and efficacy in the care of bariatric surgical patients and to find better solutions for the treatment of obesity. Our program is currently represented in every major national and international meeting in obesity and minimally invasive surgery with oral and video presentations and scientific posters, as well as very active in publishing papers in peer reviewed journals.
We have several IRB trials on going including multicenter safety and efficacy trial for the FDA. We have established a number of collaborations with the Obesity research Center with IRB-approved protocols in the areas of: Asthma, Diabetes, Body fat composition. Endoluminal techniques for de Novo procedures and IACUC protocols for new endoscopic procedures.
We are evaluating the use of Polyflex stents as a novel approach to the management of intestinal leaks after bariatric surgery. Metallic stents have been used in the esophagus for strictures, perforations, and anastomotic leaks. These stents, however, are difficult if not dangerous to remove. Recently, removable stents made of Polyflex, a silicone coated plastic, have been used to temporarily bypass anastomotic leaks after esophagectomy and colectomy. Polyflex stents are useful in bypassing upper intestinal leaks after various bariatric surgeries. They provide a temporary bridge for wound healing with continued oral intake. Stenting provides a minimally invasive option in the management of leaks, especially for those who are critically ill or have hostile abdomens.
The link between inflammation and obesity is still being elucidated. We aim to study differences in the inflammatory states in our obese patients undergoing weight-loss surgery in hopes of better understanding the role between these two conditions.
Stent in shown in proper position with proximal and distal marking clips. Stent was placed from distal esophagus extending past the Lower Esophageal Sphincter (where the leak was), through the gastric pouch to the jejunum.
Oral contrast is shown being injected via gastroscope. Note the easy passage through the stent, without any evidence of obstruction or extravasation indicating a continuing leak.