Bariatric Surgery Program

Transcription

1 Surgical Specialists of Western New England, P.C. Bariatric Surgery Program Andrew B. Lederman, M.D. Director of Bariatric Surgery Robert D. Fanelli, M.D., F.A.C.S. Director of Surgical Endoscopy Offered in conjunction with Berkshire Medical Center

2 Surgical Specialists of Western New England, P.C. Bariatric Surgery Program Your Weight Loss Surgery Team Surgeons Andrew B. Lederman, M.D. Director of Bariatric Surgery Robert D. Fanelli, M.D., F.A.C.S. Director of Surgical Endoscopy Bariatric Coordinator Jodi Szczepaniak, RN, BSN Office Staff Jean Bachli, RN Nancy Plantz Anne Wehry, RN Ro Daly Surgical Specialists of Western New England, P.C. 510 North Street, Suite 202 Pittsfield, MA voice FAX Hours: 9:00am 5:00pm Monday through Friday 2

3 Surgical Specialists of Western New England, P.C. Comprehensive Bariatric Surgery Program Bariatric surgery refers to a group of elective surgical procedures designed to improve the health and quality of life for carefully selected patients who. Patients must have a body mass index of 35 or greater, serious medical conditions due to their weight, and have failed to lose weight by other methods. The process of patient selection and lifestyle change is lengthy; however, the end result is a well-informed, happier and healthier patient. The process listed is an outline, and each patient s experience is tailored to meet his or her individual needs. 1. Attend an Interest Group Seminar These sessions are scheduled once or twice per month. You can check our website or call our office for upcoming meeting times. Please call our bariatric coordinator, Jodi Szczepaniak to pre-register at These sessions are an opportunity to learn about the surgical procedures and our process, as well has have all your questions answered. It will generally last two hours. You are encouraged to bring a support person. Space is limited, so please do not bring children. 2. Complete the Patient Information Packet All patients must complete a Patient Information Packet to enter the program. This packet is a very important part of the process. Your medical records are relevant to your surgery and insurance precertification process. Due to the volume of patients interested in weight loss surgery, we request that you mail your packet back to our office. Please do not fax packets to our office; packets sent via fax will not be accepted. Incomplete packets will be returned to you for completion. If you would like verification that the packet has been received, please send it certified mail with return receipt requested. Once your completed packet has been received, you will be contacted to schedule your first consultation appointment with the surgeon. 3. Enroll in the Program We encourage patients to enroll in the program prior to their first consultation with the surgeon. Enrollment will provide you with the written Program Guide so that you may review it before seeing the surgeon. It 3

4 will also give you access to our online resources and online community, as well as enroll you in our bariatric database so that we may track your progress once enrolled in our program. To enroll in the program, you must pay the program fee in full and receive our Program Guide. Please call our office at and Jodi Szczepaniak or a member of our support staff can help you. 4. Pre-Certification A surgery pre-certification packet will be sent to your insurance carrier after you enroll in the program, and after your consultation with the surgeon. Pre-certification is a lengthy process that may take up to six months for your insurance company to determine if it will provide coverage. Each insurance company has different rules, and the rules vary even among plans from the same insurer. We will not recommend procedures that we do not consider medically necessary, but insurance companies differ in their approach to determining what is a covered benefit. Your insurance company may require you to obtain additional testing or submit additional medical records prior to approval. Please be patient during this stage of the process. This is a great time to continue your research on the surgical options and the lifestyle changes. Begin an exercise program and continue to try to lose weight it may make your surgery safer and easier to recover from. 5. Initial Consultation You will be scheduled to see a surgeon on a first available basis. At your initial consultation, the surgeon and members of the healthcare team will review your medical history and perform a brief physical examination. After your consultation, additional appointments may be scheduled for you. You will be given information about the medical tests and other steps required before surgery. 6. Psychological Evaluation Psychological evaluations are required for all patients. There are no exceptions. Your psychological evaluation may determine that you would benefit from ongoing therapy prior to surgery or throughout the surgical process. You must abide by the treatment plan that is recommended during psychological evaluation in order to be considered a candidate for surgery. If you have your own mental health provider (social worker, psychologist or psychiatrist) you are to continue in whatever treatment course they have prescribed, and the details of that treatment should be shared with our mental health team members during consultation. However, your personal mental health provider MAY NOT perform the evaluations necessary for surgery. 4

5 7. Sleep Evaluation A sleep study may be necessary to test for the presence of sleep apnea. If you have sleep apnea, you may need to start on CPAP (a device to help you breath better while you are asleep) prior to surgery. If prescribed, you will need to get used to it before the surgery, and bring it to the hospital with you so you can use it after surgery while hospitalized. 8. Life Skills Workshops You must participate in a small group dedicated to gaining the skills you will need as you lose weight. This includes learning how to deal with food in a new way, how to cope with stress when you cannot use food for comfort, and how your personal relationships may change as your body changes. While not mandatory, you are highly encouraged to bring your support person to these groups. The groups meet for three sessions, each one-hour long. 9. Dietician Consultation A consultation with a dietician or nutritionist is required. The dietician will evaluate your current diet, so it is important to bring a food diary with you to this meeting. You will be given an idea of your dietary requirements after surgery, and instructions on the post-operative diets. 10. Medical Evaluation A thorough medical evaluation must be completed before you undergo surgery. This may include: EKG Cardiac stress test Chest X-Ray Pulmonary Function Tests Sleep Study Blood draw for labs EGD (upper endoscopy) Colonoscopy Physical Exam Gallbladder ultrasound Venous ultrasound 11. Pre-operative Visit With Surgeon After all tests, consultations and evaluations are completed, you will be scheduled for a second visit with the surgeon. At this visit, all test results will be reviewed, and you will go over your pre-operative and postoperative instructions. A date for your surgery will be set. 5

6 You will be asked to sign the informed consent form. It is crucial that you review this form and understand all of the benefits as well as risks of the surgery. As part of the informed consent process, you must also review materials prepared by the Massachusetts Department of Public Health in conjunction with the Betsy Lehman Center for Medical Error Reduction. These materials are included with this packet. When you sign the consent form, you are acknowledging that you studied all materials that have been provided for you. Your pre-admission testing (PAT) will be scheduled. You may also need to schedule a pre-operative history and physical examination with your primary care physician, as our philosophy is to keep your regular doctor involved in your care throughout treatment. 12. Surgery Congratulations! This is a major step in your journey to a healthier life. 6

7 Weight Loss Surgery Patient Responsibilities Be at all scheduled appointments, tests or consultations on time. No-shows or last minute cancellations may require you to pay for the scheduled visit or be dropped from the program. Stop smoking! Smoking increases your risk of a life-threatening complication with surgery, including intestinal leak, heart attack and DVT (blood clots). We will not operate on any patient who reports using tobacco in any form. We ask that you quit for two months prior to your surgery, and may require a urine sample to test for the presence of tobacco in your system if we suspect that you are continuing to use tobacco. Continue to try to lose weight! Even if you can lose a small amount of weight before surgery, it will make your surgery safer and your recovery easier. It makes a big difference, and failure to lose weight during the pre-operative period may actually exclude you from surgery. Start to exercise. Anything you can do to increase your physical activity is important. Walking, swimming, dancing find something that you can do every day and do it. If you have knee or back problems that make some exercises difficult, you can chair dance by moving just your arms to music. It is amazing that even chair dancing can help you lose weight. Educate yourself. Weight loss surgery is a tremendous tool to help improve your health, but you need to know how to use this valuable tool. Study the program guide, and understand how your life will change after surgery. Use the online resources to find out as much as you can about your new life. Understand the risks and complications of surgery, and formulate your questions. Read the materials provided in your Program Guide and from the Massachusetts Department of Health. Know the appropriate foods to eat after surgery, and learn how much protein you will require. Write down any questions you may have so you don t forget, and ask a member of the team. Learn about the permanent nutritional changes that you will experience. Establish your support network. You must have a support person to help you through this process. This is very important, and we will want to meet your support person before surgery. Please bring them to your appointments with the surgeon, the Interest Group Seminar, and to the Life Skills Workshops. We look forward to working with you to improve your health. If you have any questions, please contact Surgical Specialists of Western New England, P.C. at

8 Surgical Specialists of Western New England, P.C. 510 North Street, Suite 202 Pittsfield, MA Phone: Fax: YOUR BARIATRIC SURGEONS Andrew B. Lederman, M.D. Dr. Lederman has had a long-standing interest in bariatric surgery, and has dedicated his career to the care of the weight loss surgery patient. He currently serves as the Director of Bariatric Surgery at Berkshire Medical Center. He is certified by the American Board of Surgery. Before arriving in Pittsfield, Dr. Lederman spent two years at Emory University in an advanced training program dedicated to minimally invasive gastrointestinal surgery, including bariatric surgery. This training provided a vast experience in weight loss surgery. He has experience with both open and laparoscopic bariatric surgery procedures, and has performed complicated revisional bariatric surgery procedures as well. He has served as an instructor for advanced courses in bariatric surgery. Dr. Lederman spent his internship and residency at the University of Rochester, in Rochester, New York. In 2002 he served as Chief Resident in Surgery. While in Rochester, Dr. Lederman had the opportunity to study with both community based and academic bariatric surgeons, including some of the early pioneers in weight loss surgery such as Dr. René Menguy. Dr. Lederman was fortunate to begin his bariatric training under the mentorship of Dr. Bruce Schirmer, Chief of General Surgery at the University of Virginia, and past president of The Society of American Gastrointestinal and Endoscopic Surgeons. During his fourth year of medical school, Dr. Lederman studied with Dr. Schirmer in a one-to-one preceptorship, attending the bariatric clinic, studying the techniques of open surgery in the operating room, following post-operative bariatric surgery patients in the hospital, and attending surgical nutrition rounds. It was during this time that Dr. Lederman developed his interest in weight loss surgery. Dr. Lederman has dedicated the past 8 years of training to learning the science and skill of bariatric surgery, and has had the opportunity to learn from many experts in bariatric surgery, minimally invasive surgery, surgical nutrition, and metabolism. He is passionate about the care of the bariatric patient, and the tremendous positive change that weight loss surgery makes in the health and lives of his patients. 8

9 Robert D. Fanelli, M.D., F.A.C.S. Dr. Fanelli developed an early exposure to bariatric surgery while a surgical resident at Michigan State University, where a large number of patients treated with early jejunoileal bypasses were followed. Dr. Fanelli s expertise is in advanced minimally invasive surgery, gastrointestinal surgery, and gastrointestinal endoscopy. Not only did Dr. Fanelli have substantial training in these areas as a resident, but he was fortunate to have served a fellowship with Dr. Jeffrey Ponsky, one of the most recognized surgeons in these fields. Dr. Fanelli has taught many advanced laparoscopy courses and surgical workshops, and has introduced many advanced laparoscopic surgical techniques during his tenure at Berkshire Medical Center. Experts in the field of minimally invasive surgery have compared the relative difficulty of various procedures and have suggested that competency for a new procedure can be inferred by competency on equivalently difficult existing procedures. Dr. Fanelli is an expert in laparoscopic foregut (esophagus, stomach, duodenum) surgery, having performed hundreds of antireflux procedures, esophageal surgery for achalasia, and repair of incarcerated paraesophageal hernias. He has extensive experience with laparoscopic colon surgery dating from 1994, and has performed right colectomy, left colectomy, sigmoid colectomy, low anterior resection, total abdominal colectomy, and abdominoperineal resection frequently. In addition to the complex procedures outlined above, Dr. Fanelli has extensive experience with complicated bile duct surgery, and advanced laparoscopic biliary surgery, gastric surgery, and intestinal surgery of all descriptions. Dr. Fanelli s expertise in gastrointestinal endoscopy is fairly unique in that few minimally invasive surgeons have such extensive experience with flexible endoscopy. He is poised to offer patients full-spectrum care from initial evaluation through intraoperative analysis and postoperative surveillance. As bariatric procedures progress from laparoscopic to combined laparoscopicendoscopic procedures, and then to totally endoscopic procedures, Dr. Fanelli is equipped to transition patients to these increasingly less invasive treatment options. Dr. Fanelli, author of numereous scientific articles and presentations, served on the Surgical Care Task Force and the Informed Consent Task Force of the Massachusetts Department of Public Health/Betsy Lehman Center for Medical Error Reduction initiative on bariatric surgery. He also serves as the cochair for the Guidelines Committee of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), the pre-eminent surgical society for minimally invasive surgeons, including bariatric surgeons. Dr. Fanelli is the sole surgical representative to the Standards of Practice Committee for the American Society for Gastrointestinal Endoscopy (ASGE). Dr. Fanelli has experience with the creation of evidence-based guidelines that provide practice algorithms and patient management structures for surgeons, and has applied this knowledge to the design of this bariatric surgery program. 9