Brigham will resume doing obesity surgery

Brigham and Women's Hospital will restart its laparoscopic obesity surgery program on Tuesday, following an investigation into a patient's death that found "no deficiencies in the overall quality of care," hospital executives said yesterday.

Executives said, however, that they will make several improvements to their bariatric surgery program, such as establishing dedicated operating rooms, overnight patient units, and medical teams for gastric bypass patients, similar to how the hospital treats cardiac surgery, neurosurgery, and orthopedic surgery patients.

The hospital suspended minimally invasive bariatric surgery after Ann Marie Simonelli, 37, died in her hospital bed Oct. 23.

Her surgeon, Dr. David Lautz, began the operation laparoscopically, threading pencil-thin tools and video cameras through tiny incisions in Simonelli's abdomen, a procedure designed to minimize pain, recovery, and scarring compared to traditional surgery.

During Simonelli's surgery, Lautz noticed that staples in one row had popped out, so he converted the operation to a traditional open surgery, resewing the section by hand.

Doctors use staples to close off most of the patient's stomach, leaving intact a small pouch that accommodates far less food.

After Simonelli collapsed and died two days later, surgery chief Dr. Michael Zinner said doctors believed the staple gun misfired, some additional staples came undone, and her stomach contents leaked out, all possibly contributing to her death.

Leaks can cause life-threatening infections.

Zinner said yesterday that an autopsy was inconclusive and doctors were unable to determine Simonelli's cause of death.

For example, she had no sign of massive infection, he said. The investigation found no problems with Lautz's technique or actions.

Paul Dreyer, deputy director of healthcare quality at the Department of Public Health, said state officials investigated Simonelli's death in November, but found no quality problems at the Brigham.

"We were impressed by the steps the hospital was taking to investigate this incident on their own," he said.

However, because three patients have died after obesity surgery in Massachusetts during the past year, health officials said Monday that they will convene an expert panel to review the quality of all hospital bariatric surgery programs and recommend improvements.

The most recent death occurred last week at Beth Israel Deaconess Medical Center, when Howard Reid, 37, of Dorchester, went into cardiac arrest immediately after surgery.

Growing numbers of obese patients are undergoing bariatric surgery, many of whom have failed in dieting and have developed serious health problems such as diabetes and heart conditions.

During their internal investigation of Simonelli's death, hospital officials poured through her medical records and the autopsy report, and interviewed surgeons and nurses involved in her care, looking for a root cause, Zinner said. While he does not believe a lack of dedicated operating rooms, patient units, and staff contributed to Simonelli's death, he said these initiatives clearly will improve care.

Bariatric surgery patients will have their own operating rooms to ensure "case-appropriate equipment" and specially trained anesthesia and nursing staff, a hospital statement said.

The hospital also is updating its daily checklist for these patients, also called "patient care pathways," to guide nurses and doctors.

"We have to recognize that the care of these patients is as specialized as that for orthopedic patients and cardiac patients," Zinner said.

Liz Kowalczyk can be reached at kowalczyk@globe.com.