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Hospital set to resume gastric bypass surgeries

Procedure cleared in patient's death

PROVIDENCE -- Roger Williams Medical Center yesterday said it will resume gastric bypass surgeries, which were suspended for more than a month following a patient's death.

The hospital has reviewed the death of Robert Messa Jr. and found the so-called stomach-stapling procedure he was undergoing when he died Nov. 18 was conducted properly.

Messa, 27, died about a half-hour into a laparoscopic gastric bypass surgery. The procedure uses staples or stitches to drastically reduce the stomach's size, leading to weight loss.

Two days after Messa's death, the hospital suspended the procedure as well as the more invasive open gastric bypass surgeries. Both are again being conducted at the hospital.

Brett Davey, a Roger Williams spokesman, said two staff physicians conducted independent reviews of the episode, as did a hospital committee.

"They concluded there weren't any significant variations from the way the operation's supposed to be done and things are supposed to be conducted," Davey said.

The staff reports are confidential, Davey said, and the hospital wouldn't discuss the specifics of Messa's death.

The state Department of Health investigated two complaints regarding the surgeries -- one based on the hospital's mandatory report of Messa's death and the other filed by another gastric bypass patient. Don Williams, the department's associate director for health service regulation, but found no reason to take action.

An investigation into Messa's cause of death is still pending, according to the state medical examiner's office.

Davey said on average one in every 100 to 200 gastric bypass surgeries results in death. Messa's death was the third among 340 gastric bypass operations conducted at the hospital over the past three years.

Patients' health may contribute to the risks they face during surgery, according to Davey. The obese patients who qualify for the surgery may have diabetes, heart problems or other life-threatening medical issues, he said.

After Messa's death, a family friend said she had been told he suffered a heart attack as the procedure began. She said he had health problems including diabetes and nerve damage related to his obesity.

In October, Brigham and Women's Hospital in Boston suspended the laparoscopic method after a 38-year-old woman died when a staple gun apparently misfired during the procedure. A Brigham spokeswoman said the hospital intends to begin performing the operation again by mid-January, after it has implemented a "corrective action plan."

Gastric bypass surgery shrinks the stomach from the size of a football to the size of an egg. A portion of the intestine is also bypassed, reducing nutrient absorption. Typically, patients lose 70 to 80 percent of their excess body weight in about a year.

The surgery comes with risks, including the potential for blood clots in the lungs or leaking stomach juices that cause infections.

A March 2003 report from the state health department found that 360 patients in Rhode Island hospitals underwent gastric bypass surgery between January 2000 and September 2002. Of those, about 2 percent -- roughly eight patients -- died in the hospitals. The in-hospital mortality rate was nearly 12 percent for the 60 additional patients who had gastric bypass surgery and some other procedure during the same time period.

Davey said patients at Roger Williams must be approved for the surgery based on their weight, health, and previous efforts to lose weight. They're also required to undergo a two-to-three-month period of education and screening, he added. "For a lot of our patients, it's really medically necessary," he said.

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