Doctor performs rare surgery in Cedar Falls

By CJ HINES, Courier Correspondent
CEDAR FALLS --- Of the 11 cases of a rare laparoscopic surgery reported worldwide, one has been performed here in the Cedar Valley.Dr. J. Matthew Glascock, medical director for the Midwest Institute of Advanced Laparoscopic Surgery located at Sartori Memorial Hospital, heads the team of medical professionals who recently performed a laparoscopic Roux-ex-Y gastric bypass with visceral malrotation.Visceral malrotation is the twisting of the intestines, which occurs in the womb, Glascock said. While 75 percent of patients with malrotation are diagnosed by the age of 1, 25 percent aren't diagnosed until adulthood. These are usually discovered when the patient is undergoing another procedure or during an autopsy.While Glascock routinely performs the Roux-ex-Y gastric bypass operation, it is rare to perform one with a patient with visceral malrotation."It is an anomaly," Glascock said. "In normal anatomy, the person's large intestine frames the small intestines with the appendix in the lower righthand side of the abdomen. A person with visceral malrotation, everything is opposite. The large intestine and appendix are on the left side of the abdomen and the small intestine is on the right. The supporting structure never develops."Visceral malrotation occurs in 1 in 500 births in the United States, according to the Nemours Foundation, a national children's health care system and beneficiary of the Alfred I. duPont Testamentary Trust.Most people diagnosed with this condition have a Ladd's procedure during childhood, which involves removing the appendix and cutting the Ladd's bands, which are adhesions that attach from the beginning of the intestine to the abdominal wall.
The first gastric bypass patient identified with visceral malrotation had the surgery canceled and returned later for a gastric banding procedure.Approximately a year ago, Glascock encountered a second bypass patient with visceral malrotation while performing laparoscopic surgery. While the patient was still in the operating room, he discussed options with the patient's wife."Options offered were discontinuing surgery, changing the operation to adjustable gastric banding or converting to a laparotomy and attempting gastric bypass. The patient's wife elected converting from laparoscopy (done with scopes) to laparotomy (open incision) and gastric bypass with Ladd's procedure," said Sherri Greenwood, Sartori Hospital administrator and institute co-director. "The procedure was successfully completed."

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