Revision Surgery
Special Study Enables Surgeon in Weight Loss Surgery "Re-Do's"
Morbidly obese people who want medical help tend to do thorough research on the internet, said David Greenbaum, M.D., medical director of the bariatric surgery program at Lourdes Medical Center of Burlington County. Partly because he is listed on the popular www.obesityhelp.com site, the surgeon finds himself awash in patients.
The reason: his expertise in performing the duodenal switch procedure, even on patients who have not had success with previous gastric bypass surgery. These "re-dos" are called duodenal switch revisions.
Stephanie Hopper, of Murphy, North Carolina, is a good example of Dr. Greenbaum's revision work. She was a teen 20 years ago when she had a vertical banded gastroplasty, which created a small stomach pouch to reduce food intake. She dropped 86 pounds, but almost immediately after the surgery she began throwing up after meals. This continued for 21 years.
"I had to have something done," she said. "I was miserable. I had ballooned up to 368 pounds."
She discovered Dr. Greenbaum on the internet and reached out. He responded. "Dr. Greenbaum was the only surgeon who picked up the phone and called me personally and answered my questions. I just clicked with him immediately," she said.
The result: She traveled to Lourdes Burlington, in Willingboro New Jersey, in April of 2008 and Dr. Greenbaum performed a "revision," converting the previous operation to a duodenal switch, removing two-thirds of the stomach and then bypassing a large portion of the small intestine. In two months, the woman had lost 50 pounds, had not thrown up once and was upbeat about the future.
Dr. Greenbaum's out-of-area patients say the phone consults, in conjunction with their hometown primary care appointments, make up for not seeing him in person. "Dr. Greenbaum calls to check in on me," Hopper said. "He's been wonderful. I can't wait to come back for my followup."
The surgeon developed his expertise in the complex surgery after studying it for six months during a West Coast fellowship program. He came back home to begin doing the procedures. Word of mouth and Internet exposure took root and patients from other parts of the country found him. "I talked to them online, on the phone and then the out-of-state cars started coming here," he said.
"Duodenal switch operations are complicated but the revisions are even more complex," Dr. Greenbaum said. "There still aren't a lot of doctors who can do this but we have to adapt, to keep up with the more effective procedures."
Because the surgery is so complicated, he has performed most of the duodenal switch revisions via open surgery, he said.
Patients seek a revision of a previous surgery for a number of reasons. There may have been an anatomic defect that was a barrier to success. The patient may have been unable or unwilling to stay with the prescribed diet. Or the operation itself may not have been adequate, he said.
"So they may have had gastric bypass or a gastric band and they are still 300 pounds," said Dr. Greenbaum. "When we operate we have to first undo what was done before and then we have to do the duodenal switch." (See here for a detailed look at the duodenal switch procedure.)
"The number of patients seeking a revision has been small in the past but it is growing because bariatric surgery is growing," he said.
To locate a Lourdes Health System bariatric surgeon by phone, call 1-888-LOURDES.
