Nilesh Patel, MD, Medical Director of Bariatrics at Southwest General Hospital, and Deowall Chattar-Cora, MD, board-certified plastic surgeon, collaborate to provide a life-affirming patient experience and superior outcomes.
At Southwest General Hospital, patients undergoing bariatric surgery interact with experienced medical staff who adhere to a consistent and streamlined process, and demonstrate excellence in surgery as well as commitment to patient well-being. An affiliation between the hospital and Texas Bariatric Specialists offers patients care in their home communities in conjunction with surgery at an American Society of Metabolic Surgery and Bariatric Surgery-designated Center of Excellence.
“The bariatric surgery program at Southwest General is unique,” Dr. Patel says. “We are a true collaboration between physicians and a hospital program. Our team approach produces excellent results.”
Also collaborating with Southwest General Hospital and Texas Bariatric Specialists, Dr. Chattar-Cora completes the circle of care by offering patients reconstructive procedures that allow for improved health, hygiene and cosmesis after dramatic weight loss resulting from successful bariatric surgery.
“Patients who choose reconstructive procedures after bariatric surgery may have a lot of tissue removed. They will have scars. And while many people think of scars as something to hide, my patients are proud. They will show off their ‘battle scars’ to demonstrate the hard work they have done and the life-altering changes they have gone through.”
— Deowall Chattar-Cora, MD, board-certified plastic surgeon at Southwest General Hospital
Bariatric surgery is available at a Center of Excellence facility to a patient population across an increasingly wide geographic area through supporting offices in Corpus Christi, Laredo, Del Rio and Austin. Other locations include Killeen, Boerne and New Braunfels. To complement a corporate office in Shavano Park, a southwest San Antonio clinic and a Westover Hills clinic are in the planning stages. Patients receive screening, medical care, and dietary and psychological counseling at the local office and travel to Southwest General Hospital for their surgical procedures. Dr. Patel says the resulting process offers care close to home combined with the safety and technical experience of a certified Center of Excellence hospital.
Techniques in Bariatric Surgery
Dr. Patel most commonly performs the Roux-en-Y gastric bypass (accounting for approximately 60 percent of his recent surgeries), with laparoscopic sleeve gastrectomy as second most frequent.
“These percentages vary from month to month,” he says. “The sleeve is increasing in popularity because it is less invasive than bypass surgeries but offers similar results.” He adds that, meanwhile, laparoscopic banding surgery has become less common.
Roux-en-Y gastric bypass involves “rerouting” the digestive tract and reducing the capacity of the stomach. In this procedure, the surgeon also bypasses a portion of the small intestine. As a result, food absorption and metabolic patterns are changed. Additionally, as in restrictive-type bariatric surgeries, the patient becomes full after eating a small amount of food.
Many factors determine whether a bariatric procedure will be successful. Some determinants lie with the patient, some with the physician and others with the surrounding organizations and environment, Dr. Patel explains. At Southwest General Hospital, he works to optimize every factor for patient success.
An Effective System
“Patients need appropriate preparation for surgery,” Dr. Patel says. “We screen patients thoroughly, help them select the right procedure and conduct pre- and post-operative classes. Preparation and support before surgery is extremely important.”
Even referring physicians have a role to play, Dr. Patel says.
“Often patients will come to their primary physicians with sleep apnea, diabetes, infertility and other weight-related issues,” he says. “The patient may have tried unsuccessfully to lose weight. Weight loss surgery can be a sensitive topic to broach. At Southwest General Hospital, we have created brochures to place in primary care offices to make those conversations easier.”
Bariatric surgery is indicated for people with a body mass index (BMI) greater than 40 or for those with BMI greater than 35 with weight-related illnesses such as diabetes, high blood pressure and sleep apnea. Once patient express interest in bariatric surgery, they will receive a health screening with a clinician and education at one of Southwest General’s neighborhood bariatric offices. Financial counselors are also available at each office.
“It is a sad fact that insurance companies are not always willing to pay for bariatric procedures,” Dr. Patel says. “Only 50–60 percent of insured patients actually have weight-loss surgery coverage. We excel at identifying the medical benefits of bariatric surgery and helping patients access coverage.”
Patients whose insurance will not pay for the procedure find help in payment programs. Also, they may be eligible for BLIScare, a procedural insurance program available through Southwest General Hospital.
“Private-pay patients may not be ready for the extra costs of blood transfusions, overnight stays or other unforeseen circumstances,” Dr. Patel says. “BLIScare insures surgery-related events for up to three months following a procedure. My practice pays the premiums for our patients. While complications are very rare, this demonstrates that we are serious about patient safety and well-being.”
Dr. Patel estimates that he has performed 3,000 bariatric surgeries during his career, with 600 surgeries performed in 2013 alone.
“It is seldom I see anything that I cannot manage to the highest level,” he says.
High surgical volume is associated with quality, research finds. A 2013 study by Michigan bariatric surgeons correlated higher volume with greater skill and fewer adverse effects.
Additionally, Dr. Patel is one of the few fellowship-trained bariatric surgeons in the San Antonio area. His colleague, Dr. Chattar-Cora, is certified by the American Board of Plastic Surgery.
“Unfortunately, there are many physicians performing plastic surgical procedures who have not been adequately trained in the basics of plastic surgery,” Dr. Chattar-Cora says. “Board certification indicates a basic level of competency that patients and referring physicians should expect.”
Partners in Bariatric Medicine
Ultimately, Dr. Patel says, successful bariatric procedures require an appropriate facility partner.
“The hospital must stand behind you and be vetted in patient outcomes,” Dr. Patel says. “Southwest General Hospital offers a dedicated bariatric coordinator and an entire wing just for bariatric patients.”
Patients stay in private rooms provided with accommodations for overnight guests. Hospitalists, dietitians, endocrinologists and nurses, all specializing in the care of bariatric patients, attend them during their stay.
“It’s a multispecialty care team,” Dr. Patel says. “That entire unit demonstrates a tangible level of empathy.”
“The approach to bariatric patients must be one of empathy, guided by a firm belief that patients are experiencing a disease process. The stereotypical description of a patient with morbid obesity is that he or she is not disciplined enough to push away the plate or commit to exercise. This is categorically untrue. Most academic bariatric surgeons agree that obesity is a symptom of a poorly defined disease process.”
— Nilesh Patel, MD, Medical Director of Bariatric Services at Southwest General Hospital
The hospital also houses the Weight Loss Solutions Center, where patients can find resources related to their weight-loss journey. And, as a bariatric Center of Excellence, Southwest General Hospital maintains a high surgical volume, has facilities and equipment appropriate to bariatric patients, and demonstrates a commitment to top-quality care and excellent outcomes.
Revision surgery is an important part of Dr. Patel’s practice.
“Some people put on weight at unfathomable rates, yet physicians still blame it on their lack of commitment to health,” Dr. Patel says. “This is not the right approach. Many bariatric surgery programs propagate this unfair stereotype. When a patient undergoes a procedure at a lower-volume center, at times it may happen that he or she is not adequately prepared or given the proper support.”
In these cases, Southwest General Hospital and Dr. Patel stand ready to provide surgical and psychological care, as well as dietary management and education, to set the patient on the road to successful weight loss.
“Time and time again, we meet patients who have gone to their original surgeons for help with postoperative issues, only to find these surgeons turn their backs on them,” Dr. Patel says. “They say, ‘It is your fault you are in pain or have regained weight.’ In reality, a discerning surgeon who performs a thorough workup will, nine times out of 10, find a mechanical reason for postsurgical pain.”
Dr. Patel finds that working with these patients can be extremely gratifying.
“They are discouraged, but it is the most rewarding work we do,” he says. “We are fortunate to be able to help them.”
Body Enhancement Through Reconstructive Surgery
Some patients find their postsurgical bodies have excess skin. In addition to cosmetic issues, extra skin on the arms, chest, back, stomach and suprapubic region may cause chafing and infections. The extra skin may also make personal hygiene difficult.
“Extra skin may become a location for fungal infection,” Dr. Chattar-Cora says. “Patients may even need hospitalization.”
Because extra skin poses health concerns, Dr. Chattar-Cora sees his work as reconstructive rather than simply cosmetic.
“About two years after a bariatric procedure, or once weight loss has stabilized, patients may become interested in plastic surgery,” he says. “Our community is not wealthy, and insurance companies do not often understand that these are medically beneficial procedures, so we work hard with patients to contain costs and provide options for payment.”
Dr. Chattar-Cora prefers to perform reconstructive surgery on an outpatient basis. He offers myriad procedures, some in conjunction, depending on patient need, including brachioplasty, circumferential abdominoplasty, face lifts with neck tightening, and surgery for male and female breast ptosis, including repositioning nipples.
“Choosing the right bariatric medicine center with a dedicated support staff will lead to peace of mind,” Dr. Patel says. “As physicians, we need to organize within our community to drive home the message that there are solutions to the obesity epidemic. We need to be champions in this fight, taking an aggressive approach and working together.”
To refer a patient for a bariatric consult, please call 877-215-WELL or visit http://www.swgeneralhospital.com/.