'A new life'
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By JENNETTE BARNES
Standard-Times Staff Writer
March 30, 2006 (reprinted with permission)
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Tiffany Machado undergoes Roux-en-y gastric bypass surgery in the operating room at Tobey Hospital in Wareham on March 29.
Photo by Peter Pereira/The Standard-Times | |
She arrived at Tobey Hospital just before 8 a.m., and two hours later the surgery was complete.
Today, the 21-year-old New Bedford woman has a new stomach and a new chance to live healthy and slim, if she adheres to lifelong dietary changes. Doctors hope she can reach 125 pounds, dropping 110 pounds of excess weight.
Dressed in a johnny and waiting for surgery, she was both nervous and upbeat, her mother sitting by her side.
The lead surgeon, Rayford Kruger, reviewed the final details. Ms. Machado agreed to accept the risks and commit to at least five years of follow-up care.
An anesthesiologist gave her two intravenous lines. IV access is often difficult in obese patients, and one line could fail at a moment when the patient needs it most.
By 8:45 a.m., Ms. Machado was under anesthesia and the surgery had begun.
Sterile blue draping covered her body, leaving her abdomen exposed. To keep her warm, an inflatable mat laid across her chest directed warm air over her face, neck and shoulders.
Dr. Kruger felt her abdomen carefully and marked the places where he and another surgeon, Dr. Thomas Streeter, would make six half-inch incisions and insert the tools of minimally invasive laparoscopic surgery: a camera, surgical instruments, and a rod to hold the liver aside.
Dr. Kruger commanded a voice-activated system to inflate Ms. Machado's abdomen so the camera could display a color picture of her abdominal organs on four high-resolution screens.
The surgeons gently moved the small intestine using tools that grab like needle-nose pliers.
Making the first internal cut, they severed the small intestine below the stomach and duodenum by pinching it with three rows of staples.
They took the portion of the small intestine that leaves the natural stomach and re-introduced it into the intestine farther down, creating a "Y" joint and allowing stomach bile to drain.
Most of what happens during the surgery is carefully planned. The assistants hand instruments to the surgeons before they ask, and they follow the same steps each time, barring any unusual events.
"It's almost a dance," Dr. Kruger said. "Every single one of those steps is a choreographed step."
Dr. Kruger commanded the computer to zoom in with the camera. He said Ms. Machado is "skinny on the inside," which means she does not have much fat around her organs. That makes it easier to operate.
She had lost eight of her 235 pounds after her first pre-surgery appointment, three pounds less than the required 10 percent of excess weight. But Dr. Kruger said she was a strong candidate for gastric bypass because she had lost about 50 pounds on her own in the last few years.
The most risky part of the operation is handling the stomach, because leaks from the stomach can send bacteria streaming through the abdominal cavity.
As the surgeons passed their instruments over Ms. Machado's stomach, a small cut appeared.
Dr. Streeter said one of his grabbing tools probably "scuffed" the stomach surface, causing it to bleed.
The surgeons quickly stitched it up, but Dr. Kruger said the cut was not a dangerous stomach perforation. No stomach contents could be seen in the cut.
"That's not a mentionable event for us," he said.
Again using staples, they separated a one-ounce pouch from Ms. Machado's stomach, then attached it to the part of her intestine cut from below the duodenum. They hand-sewed two rows of stitches to close the critical juncture where food can leak as it leaves the new stomach pouch.
At 10 a.m., Dr. Kruger and an assistant closed the incisions.
"That procedure, in an hour and a half, was about as perfect as these procedures get," he said.
When Ms. Machado woke up she complained of pain, her mother said, but the morphine helped right away.
"I feel great," Ms. Machado said at 2 p.m. "It's the beginning of my new life."
But she will have to alter her eating habits dramatically.
She blames much of her weight gain on depression from the death of her aunt, but her mother, Patty Machado, said the family's eating habits have sometimes been unhealthy.
Mrs. Machado said her daughter was a big baby and ate a lot of fast food in her late teens, both at the family table and on her own. The family's two other children work at a pizza chain where the family gets half-price food.
"To come home and make supper and make sure they're eating right," Mrs. Machado said, "it's almost impossible."
As a last hurrah before the surgery, Tiffany Machado ate two double cheeseburgers for lunch on Tuesday.
Today she will sip only clear liquids, and when she goes home tomorrow, she is expected to remain on a liquid or pureed diet for two months. Her new stomach holds just one ounce of food, and some foods, including sugar, can cause gastrointestinal distress.
Contact Jennette Barnes at jbarnes@s-t.com
Date of Publication: March 30, 2006 on Page A01
Copyright © The Standard-Times 2006. Reprinted with permission.
More Information ~ FREE Seminars
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- First Wednesday of each month
7 p.m.
The Cape Codder
1225 Iyanough Road & Bearse's Way, Hyannis - Second Tuesday of each month
6:30 p.m.
Medical Library on the first floor
Tobey Hospital
43 High Street, Wareham - Third Tuesday of every month
7:30 p.m.
Southcoast Center for Women's Health
300 Faunce Corner Road, North Dartmouth - Fourth Tuesday of each month
6:30 p.m.
Medical Library on the first floor
Tobey Hospital
43 High Street, Wareham
Important Note to Patients
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Like any major surgery, major abdominal surgeries such as procedures to treat morbid obesity bring a significant risk of complications. It is important to remember that those afflicted with morbid obesity may have additional elevated serious risks, or co-morbidities, including diabetes, hypertension and severe pulmonary issues, which can cause further complications during this or any surgical procedure. This surgery is only performed after patients participate in a lengthy screening and orientation process that involves their families and all of their existing health care providers, including their primary care physician. Patients are also required to undergo medical counseling and engage in health and lifestyle practices that are designed to reduce co-morbidities to whatever extent possible.
You should always contact your Primary Care Physician to discuss any questions or concerns related to your medical history and options for choice, particularly if you are planning to undergo any surgery or partake in a new medical regimen.
