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Bariatric surgery: Changing lives by improving health

Toronto, March 25, 2014

By Leslie Shepherd

The Rev. Pamela Lucas, a chaplain, confers with patient Tami Siver from Thunder Bay.
The Rev. Pamela Lucas, a chaplain, confers with patient Tami Siver from Thunder Bay. (Photo by Geoff Koehler)

Coming to a hospital for life-changing surgery can be a frightening experience.

Imagine also coming to Toronto for the first time to have the procedure, but first having to drive four to six hours to catch a plane to a city where you don’t know anyone and have no place to stay after being released.

St. Michael’s is a provincial resource for many conditions and procedures, requiring patients to travel long distances from their homes and families. This year 50 patients from Thunder Bay and far-flung parts of northwestern Ontario, joined that group when they were diverted to St. Michael’s for their weight-loss surgery by the Ontario Bariatric Network.

That meant St. Michael’s received government funding to perform a total of 180 bariatric surgeries in 2013-14. The bariatric program at St. Michael’s has been recognized by the Ontario Bariatric Network for its excellent outcomes, low infection rates and high patient satisfaction.

There are several different kinds of bariatric procedures. The most common one performed at St Michael’s is the laparoscopic Roux-en-Y procedure in which a small part of the stomach is used to create a new stomach pouch about the size of an egg. This pouch is connected to the middle of the small intestine, bypassing the rest of the stomach and the upper part of the small intestine, reducing the amount of fat and calories absorbed.

One of the things that differentiates St. Michael’s from other hospitals that do bariatric surgery is the fact that the patients are followed post-surgery by interdisciplinary team members such as a dietitian, Spiritual Care and clinical nurse educator. The patients often have many questions following surgery that are best answered at point of care rather than waiting for their follow-up appointment at the referral centre.

“This is one of the ways we really focus on the patient, our mark of excellent care,” said Katherine Mansfield, the clinical nurse educator for Specialized Complex Care.

Another difference is the emphasis on getting patients moving and drinking high-protein clear fluids as soon as possible. Dietitians Cristina Gandolfi and Fiona Press note the reality of drinking small amounts so frequently (30 ml every 15 minutes) hits patients on the first day post-op. Many patients are unaware of the need to bring their required protein and vitamin supplements to Toronto and may not have brought their bariatric nutrition handouts.They may also need help figuring out how to eat in a hotel with limited cooking facilities before flying home. Most bariatric patients are discharged from St. Michael’s on Day 3.

The Rev. Pamela Lucas, a chaplain, said bariatric patients need spiritual and emotional support, especially those coming from far away.

“Patients will share a sense of relief that their long wait for surgery is over, but this is often coupled with increased feelings of vulnerability,” she said. “Patients can travel over 2,000 kms for surgery and often experience apprehension and feel overwhelmed by coming to a large trauma hospital in a different city. Following surgery, patients often acknowledge traumatic memories and experiences regarding body image, and social stigmas with their weight. As a participating member of the health care team, chaplains affirm the intrinsic value of all our patients, focusing on building trust and establishing a rapport.”

Lucas recalls finding one patient, crying.

“She expressed that she could not help but feel overcome with tears with how kind people have been to her here at St. Michael's, where she has not experienced any judgments about her weight, and was treated professionally with care and compassion.”

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.