Fifth-year surgical resident Matt Pittman, MD, already knew he would build his practice around minimally invasive surgery. When he was awarded the John J. Keeley, MD Traveling Surgical Fellowship, Dr. Pittman wanted to select an experience that would help him learn more about his area of specialty: diseases of the stomach and esophagus.  The high rates of gastric and esophageal cancer reported in Japan made it an excellent choice.

"My mentor, Dr. Chand, was able to put me in touch with surgeons and endoscopists in Tokyo, who are at the forefront of new treatment strategies," says Dr. Pittman. Bipan Chand, MD, FACS, is director of the GI/Minimally Invasive Surgery division at Loyola. "I really wanted to go somewhere known for novel treatment of cancers of the esophagus and stomach." In the span of eight days, Pittman maximized his time in Japan and was able to visit three hospitals, observing multiple endoscopic and laparoscopic procedures.

"So much of what we do in medicine is universal," says Dr. Pittman. "Even in a country where I didn't understand the written characters, nor speak the language, I still felt completely at home in the operating room." Keio University Hospital was the largest of the hospitals Dr. Pittman visited. He likened it to LUHS, a major academic institution with an associated medical school and residency programs.

One of the procedures he was most excited to see was the endoscopic submucosal dissection. The technique is used to remove early cancers of the esophagus, stomach, and rectum that are slightly deeper than those previously thought to be resectable endoscopically.  Currently, there are only five institutions in the entire United States performing this technique. "The method was originally developed in Japan, and I was lucky enough to get to observe one of its originators, Dr. Naohisa Yahagi, as he performed multiple endoscopic submucosal dissections of the esophagus and the rectum," says Dr. Pittman.

In order to obtain a more complete overview of the surgical practices in Japan, Dr. Pittman also visited two community hospitals where he witnessed several single-incision laparoscopic procedures, which are not currently performed by the surgery department at LUHS. The procedure is relatively common at hospitals of all sizes in Japan.

Dr. Pittman also saw a 3-D colon resection at one of the smaller hospitals, where an entire operating room was devoted to 3-D laparoscopic surgery. "We recently performed 3-D thoroscopic procedure at Loyola, but have not done much laparoscopic 3-D surgery," says Dr. Pittman.

One of the more notable differences between the academic and community hospitals was the observance of Japanese tradition. In one of the community hospitals, visitors to the operating room were asked to remove their shoes before entering and replace them with special "OR sandals." "Removing my shoes and remaining barefoot, or changing into slippers was expected at many places in Japan, from restaurants to my hotel room," adds Dr. Pittman.  

The intensive care units held as many as eight patients in each room, without any curtains between them. The length of hospital stays was also much different. For example, a patient undergoing an elective cholecystectomy would routinely stay an entire week post surgery. At Loyola, these patients frequently return home the day of the procedure.

Given Japan's reputation for advancements in technology, Dr. Pittman was surprised to learn how focused surgeons were on reducing operating room costs, in some cases even replacing expensive surgical devices with routine supplies. "One memorable example was the use of a latex surgical glove with the tips of the fingers cut off, used in place of a "gel port" device for performing single incision surgery," recalls Dr. Pittman. "Just because the high cost technology is available, surgeons still have a responsibility to regulate our contribution to health care costs."

Dr. Pittman adds that Asia had been at the top of his "bucket list" for quite some time, so being able to combine the opportunity to observe leaders in his field, take in some spectacular sites, and experience another culture made this trip truly memorable.

"I want to give my sincerest thanks to the Keeleys for this tremendous experience," says Dr. Pittman. The scholarship provides funding to a deserving general surgical resident or fellow to visit a prominent surgical program. The objective is to increase his or her knowledge base and to bring new or alternative surgical viewpoints back to Loyola. "I believe international partnerships are essential to the progress of medicine and this experience has inspired me to look globally to bring the best medical care to all patients."

The Loyola Center for Metabolic Surgery & Bariatric Care is designated a Level 1 facility under the Bariatric Surgery Center Network (BSCN) Accreditation Program of the American College of Surgeons (ACS). To achieve this accreditation, Loyola had to meet a number of rigorous institutional performance measures.

"Earning this accreditation demonstrates Loyola's commitment to excellence in providing the highest standard of patient care," said Bipan Chand, MD, FACS, FASMBS, FASGE, director of the Loyola center. "For most patients suffering from obesity, losing weight is truly a lifesaver that adds years to lives, eliminates or reduces many chronic conditions and improves quality of life."

Illinois is now the 24th most obese state in the nation. According to the Trust for America's Health, the adult obesity rate in Illinois is 28.1 percent, up from 23.2 percent in 2003 and from 12.1 percent in 1990. More than half of all Americans are overweight and more than 15 million people suffer from severe obesity.

"At Loyola, we treat obesity as a complex disease. Patients come to Loyola because we design a treatment solution tailored to each patient and offer lifelong support for weight management," Chand said. "Surgical options may be part of the care plan, but Loyola also offers several nonsurgical tools that for many are effective."

Since opening on July 10, 2012, at Loyola's Melrose Park campus, a multidisciplinary team of bariatric-certified professionals, including surgeons, psychologists, dietitians, exercise physiologists and physicians, has cared for hundreds of morbidly obese men, women and children.

Surgical procedures offered by Loyola include laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy.

To earn accreditation, the Loyola Center for Metabolic Surgery & Bariatric Care underwent a voluntary evaluation conducted by an independent team of experienced bariatric surgeons. Loyola was deemed to meet the following rigorous, nationally recognized standards outlined by the ACS BSCN:

* Safety of the bariatric surgery patient

* Documented, quality surgical outcomes

* Standards of practice

* Highly trained and experienced medical professionals

* Specially designed facilities to accommodate obese patients and their families

* Comprehensive medical, nutritional and psychological support throughout the treatment process