VAAAHS Surgical Services

The VA Ann Arbor Healthcare System Bariatric Surgery Program’s goal is to help obese individuals improve their health through weight loss surgery. Bariatric surgery, also known as weight loss surgery, accomplishes dramatic and long-lasting weight loss. With modern minimally invasive surgical techniques, your recovery will be rapid, you will have less post-operative pain, and you will return to your normal activities quickly.

Our multidisciplinary approach offers treatment that goes far beyond surgery, including a full range of psychological, nutritional, and other specialty medical services to help you before and after your operation. Our surgeons are experts in bariatric surgery and provide state of the art care for our patients.

Our team consists of surgeons, nurse practitioners, registered nurses and registered dietitians who will accompany you on your journey to wellness through weight loss. Welcome to the Ann Arbor VA Hospital Bariatric Surgery Program!

 

ABOUT WEIGHT LOSS SURGERY, also known as BARIATRIC SURGERY

What is “obesity”?

Obesity is a medical term determined by calculating your body mass index (BMI). BMI=your body weight /your height squared. If your BMI is 30 or greater, you are considered obese.

You can click on this website to calculate your BMI.

What are the risks of obesity?

Obesity places extra strain on your heart, lungs and joints. It also increases your risk of many diseases and health conditions that will shorten your life.

These diseases include:

• Type 2 Diabetes
• Hypertension
• Sleep Apnea and respiratory problems
• Dyslipidemia
• Stroke / Heart disease
• Arthritis
• Gastroesophageal reflux disease
• Many Cancers

What are the benefits of bariatric surgery?

Among people who are overweight and obese, weight loss can help reduce the chances of developing these health problems. Studies show that reducing your body weight will improve your health.

Most obese patients are not able to lose weight and keep it off with diet and exercise alone. When such efforts fail, bariatric (weight loss) surgery is an option. Bariatric surgery is a major life-changing process. Patients considering bariatric surgery should seek out information and discuss their goals with family and their physicians. Our goal at the Ann Arbor VA Hospital Bariatric Surgery Program is to provide you with information regarding bariatric surgery and help you make an informed decision.

The results of bariatric surgery are dramatic. Most individuals undergoing bariatric surgery lose 50 - 70% of their excess body weight (about 100-150 pounds on average). Most bariatric operations can be performed through small incisions, otherwise known as laparoscopy. With laparoscopic surgery you will experience a much faster recovery, less pain and fewer wound healing complications than those recovering from traditional open surgery. Weight-related health factors such as Type II diabetes and sleep apnea are dramatically improved and are often resolved after weight loss surgery. Medical literature demonstrates that patients who undergo bariatric surgery live longer, and enjoy lower risks of cancer, diabetes, and many other obesity-related diseases.

AM I A CANDIDATE?

Bariatric surgery is reserved for patients whose BMI is >=40, or >=35 with serious obesity-related diseases such as diabetes, sleep apnea, high blood pressure, and high cholesterol. If you fall into one of these BMI categories and have not been successful with dieting to lose weight, you and your primary care doctor should consider bariatric surgery.

Our criteria for bariatric surgery include the following:

1. You must be between the ages of 18 and 65 years. For those 65-69 years of age, decisions will be made on a case by case basis. We do not offer surgery to patients 70 years of age or older.

2. You must have a Body Mass Index (BMI) of 40 or greater, or 35 or greater with obesity-related diseases such as hypertension, heart disease, diabetes, polyarthritis, pulmonary hypertension, sleep apnea, and hyperlipidemia.

3. You must have a primary care provider who you see regularly and who is supportive of bariatric surgery and who is willing to assist in pre-and post-operative care.

4. You must be enrolled in the Ann Arbor VA MOVE Program. This program will provide critical education and strategies for dietary and nutrition habits that will ensure your success before and after surgery.

5. You must not smoke cigarettes or use tobacco products in any form, including chewing tobacco, snuff, or nicotine patches.

6. Absolute contraindications to bariatric surgery include active substance abuse, end-stage cardiovascular or pulmonary disease, end-stage liver disease, history of a liver or heart transplant, severe or uncontrolled psychiatric disorders, and anorexia nervosa.

7. Relative contraindications which may exclude you from bariatric surgery include end-stage renal disease, active binge eating disorder, or bulimia nervosa. Patients with end-stage kidney disease being considered for transplant will be considered on a case by case basis.

IS WEIGHT LOSS SURGERY RIGHT FOR ME?

When considering bariatric surgery, you need to be well informed and understand how surgery will affect your life.

Surgery for weight loss is a serious undertaking and should be considered only after failed efforts to lose weight with diet and exercise. Bariatric surgery is reserved for patients with obesity-related disease who remain severely obese after failed attempts with weight loss with non-surgical approaches.

To see if you are ready to undergo weight loss surgery, answer the following questions.

Are you:

1. Unsuccessful at keeping weight off long-term through traditional diet and exercise programs?

2. Determined to lose weight and improve your health?

3. Willing to make permanent, major, life-long lifestyle changes including:

• accepting that food is no longer being a major focus in your life?

• monitoring what and how much you eat and counting calories?

• adhering to dietary restrictions and take daily vitamin/mineral supplementation for the rest of your life?

• exercising most days of the week?

• adhering to lifelong medical follow-up?

4. Aware of the potential for complications of surgery?

5. Well-informed about the surgical procedures and the effects of the surgery and extremely weight loss?

If you answered YES to all of these questions, you are ready to take the next steps towards surgery:

1. Check the criteria on this website. You must meet the criteria to be considered a candidate for Bariatric Surgery.

2. Do your own research on the internet- our website is a good place to start. Learn about bariatric surgery in general, and the specific options of sleeve gastrectomy and gastric bypass, and make a list of questions that we will help you answer when we meet you in person.

3. Make an appointment with your primary care provider (PCP) to discuss bariatric surgery. You will need to have a complete physical exam and will be screened for treatable causes of obesity. You will need to be prepared to discuss all your past attempts at weight loss. Your PCP will order blood work and testing which may include a sleep study as well as any age-appropriate cancer screening tests such as colonoscopy, mammography, and other tests.

4. Ask your PCP to put in a consult to the AAVA Bariatric Surgery Program for consideration for bariatric surgery.

Once your evaluations and medical tests are completed and your consult is placed, and your PCP submits a consult to the AAVA Bariatric Surgery Program, your case will be reviewed by our AAVA Bariatric Surgery Program Nurse Practitioners who will determine if you are an appropriate candidate for weight loss surgery. You will then be contacted to make an appointment in the AAVA Bariatric Surgery Clinic.

At your appointment in the AAVA Bariatric Surgery Clinic, you will meet our program Nurse Practitioners and one of our Bariatric Surgeons. They will perform a thorough examination and evaluation, to determine what steps must be taken to make you a safe candidate for surgery. You will also receive an outline of the next steps in the process.

SURGICAL OPTIONS

The VA Ann Arbor Healthcare System Bariatric Program offers two types of bariatric surgical procedures, gastric bypass and sleeve gastrectomy, which are the two most –time tested, well-studied bariatric operations worldwide. Gastric bypass has been performed for over 30 years, and has a long track record of safety and proven weight loss. Sleeve gastrectomy has been performed for close to ten years and has generated much enthusiasm among surgeons and patients because of its simplicity and excellent results. Both procedures result in significant improvement and in some cases complete resolution of obesity-related diseases including diabetes, high blood pressure, high cholesterol, and sleep apnea. Both operations achieve excellent weight loss ranging between 50-70% of excess weight.

Gastric bypass and sleeve gastrectomy operations are most commonly performed through a laparoscopic (small incision) approach. The decision of which operation is best for you will be made with your surgeon. For some patients, gastric bypass results in slightly greater weight loss than sleeve gastrectomy, and may be more effective in management of type 2 diabetes and severe gastroesophageal reflux disease.

Sleeve gastrectomy may be the preferred operation for some patients as it involves less anatomic rearrangement of the intestine and for this reason, may be associated with fewer long-term complications.

Both gastric bypass and sleeve gastrectomy significantly limit the amount of food patients are able to eat for the rest of their lives and require that patients monitor their caloric intake and take vitamin supplementations for life. Patients may drink alcohol only rarely after bariatric surgery, and may not smoke cigarettes or use any tobacco or nicotine products.

ROUX-EN-Y GASTRIC BYPASS

Roux-en-Y gastric bypass, sometimes called gastric bypass for short, involves creation of a small stomach pouch, about the size of an egg, followed by rearrangement of the small intestine to reconnect the stomach pouch to the intestinal tract. Food bypasses the lower stomach and the first portion of the small intestine. The gastric pouch limits the amount of food patients can eat, while the intestinal rearrangement reduces the amount of calories and nutrients the body absorbs.

SLEEVE GASTRECTOMY

Sleeve Gastrectomy, also known as Vertical Sleeve Gastrectomy (VSG) or Gastric Sleeve Resection, involves removing about 85% of the stomach, while keeping both ends of the stomach intact.

Unlike gastric bypass, sleeve gastrectomy does not involve cutting or rerouting the small intestine. The gastric sleeve significantly limits the amount of food patients can eat.

 

PREOPERATIVE WEIGHT LOSS

Why do we ask that you complete a weight loss program before surgery?

Weight loss programs start you on your path of healthy lifestyle changes. Studies have shown that a modest weight loss before your surgery decreases the risk of surgery and results in greater weight loss after surgery. Weight loss prior to surgery allows you to begin practicing the lifestyle changes that are necessary for success after surgery.

What is a weight loss program?

A weight loss program is any system which allows for you to safely loss weight through a healthy, balanced diet and exercise. While there are many diets and weight loss programs out there, you need to focus on a balanced diet of typically 1200-1500 calories per day to achieve your goal weight. Programs teach you how to “count calories”, make healthy, balanced low calorie meals, choose healthy alternatives when you cannot eat at home and provide support during your journey. The MOVE! Program is the official VA weight loss program. This program provides you direct contact with dietitians who are experts in nutrition and guide you on your way.

What is modest weight loss?

We ask for a preoperative weight loss of about 5%. For most people, this is about 10-20 pounds. Your surgeon and NP will discuss the right amount of pre-operative weight loss for your individual case to maximize safety and optimize results.

Why do we recommend you use a weight loss programs that involves exercise?

Exercise will not only help you lose weight, it will lower your risks during and after surgery. Exercise can be as simple as increasing the amount you walk every day. You should always discuss your ability to exercise with your primary care physician to find the correct program for you.

HOSPITAL STAY, HOME CARE

Most patients will go home 2-4 days after surgery. You will be up and walking right away, and will be able to get around your house immediately. Pain after surgery is modest, and usually easily controlled with pain medication for about 2 weeks after surgery, after which most patients do not require pain medication. Most patients are able to return to work within 2-3 weeks after surgery. You will not need a significant amount of home care, as you will be able to be up and about right away. You will need your family members and friends to be available to drive you to the hospital and other destinations in the first few weeks after surgery, as you will be on pain medication and not be able to drive.

POST-OPERATIVE CARE

Your surgery is over but your new life has just begun. Your success depends on you! It is critical that you follow all post-operative instructions carefully and take advantage of the support that the bariatric team has to offer.

After your surgery, you will see need to have appointments with your surgeon and dietitian. This is typically 2 weeks and 2 months from the date of surgery. Your PCP will then oversee your care along with the dietitian at the 6 month and 12 months following surgery. You will need to keep your yearly physical with your PCP for life.

Healthy Lifestyle Changes for Success After Surgery

Making healthy dietary choices

• Lower fat dairy foods

• Lower fat and lean high protein foods

• More fruits and vegetables

• More whole grain products

• Limiting / avoiding foods high in added sugars

• Limiting / avoiding fried foods

• Limiting / avoiding sweetened beverages

• Avoid drinking beverages with meals as this can flush the food out of your pouch leaving you feeling hungry again

• Caffeine-free before the surgery and after your surgery as caffeine contributes to dehydration

• Avoiding all carbonated beverages, for life, these contribute to expanding the pouch, requiring more food to make you feel full

• Limiting / avoiding alcohol, following surgery, your stomach no longer metabolizes alcohol therefore it enters your bloodstream at a much faster rate and stronger concentration, which can increase your risk of alcoholic liver disease

• Chewing all of your foods to applesauce consistency to avoid blockages

• Avoiding the use of straws which can cause expanding of the pouch

• Engaging in some form of exercise or activity with a goal of 45-60 minutes for most days of the week

Medications After Surgery

• More than 95% of patients can take pills after surgery and will go back to taking their regular medications within a day to two of surgery. For the few patients in whom pills are a problem for a few weeks after surgery, it may be necessary to crush pills or use a liquid replacement medication. It is important to be in close touch with your or primary care provider (PCP) in the first few months after surgery because he or she may need to adjust doses of your medications as you lose weight.
• You will be instructed to take an acid-blocking medication for 3 months after the surgery to decrease your risk of stomach and bowel ulcers.
• Vitamin and mineral supplements daily for the rest of your life.
• 1 multivitamins with minerals daily
• 4 calcium citrate tablets daily
• Vitamin B12 sublingual lozenge daily or monthly injection
• Additional vitamins and or minerals may be required based on your blood tests

Diet Advancement After Surgery

Liquids - you will be on a liquid diet for 2 weeks after your surgery. This allows you to heal and take in nutrients to avoid malnutrition. This also significantly decreases any discomfort or pain which is associated with eating solids this soon after the surgery. You will learn which liquids are recommended during this phase during the pre-surgery visits with the dietitian.

Pureed / mushy foods - you will be on these very soft foods for 4 - 6 weeks after your surgery. This allows the pouch to continue healing while gradually becoming accustomed to solid foods again. You will receive specific instructions on which foods are tolerated best during this phase when you meet with the dietitian.

Soft, Regular foods - As you become completely healed, your pouch is able to tolerate a greater variety of foods, which you will gradually add into your diet. It may take up to year before you become comfortable with what you can eat and how much you can eat.

Weight Changes After Surgery

• The rate of weight loss varies greatly between individuals. It is very important not to compare your rate of weight loss with others.

• The average amount of weight loss is typically 60% of excess body weight in the first 12-18 months after surgery. Your surgeon will discuss with you in clinic appropriate expectations for weight loss after surgery.
• Everyone experiences "mini-plateaus" throughout the first 6 months or so. If your plateau lasts longer than 6 weeks and you want to lose additional weight, adjustments in your diet and/or exercise regimen are required to restart your weight loss. Our dietitian can help you with these "stalls".
• It is common to regain a small amount of weight (10-20 pounds) before your weight finally stabilizes at your personal goal weight. Your body is readjusting to its new form and weight. Diet and exercise are essential to lose additional weight and/or maintain your weight loss.

• It is possible to gain weight back after surgery if you do not change your lifestyle to include healthy dietary choices, eating in moderation and incorporating activity/exercise into your daily life.

LEARN MORE - LINKS

To learn more about weight loss surgery at AAVA, , please read our Frequently Asked Questions. You may also be interested in the information provided by the related links below.

Centers for Disease Control and Prevention BMI Web Calculator
www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm

Obesity Help.com
www.obesityhelp.com

National Institute of Diabetes and Digestive and Kidney Diseases
www.niddk.nih.gov

Prevention-Smart Ways to Live Well
www.prevention.com

United States Department of Agriculture
www.nal.usda.gov - (search 'obesity')

FAQ

1. Why should I have my weight loss surgery at the Ann Arbor VA Hospital?

The VA Ann Arbor Healthcare System offers a specialized, multi-disciplinary Bariatric Surgery team who works with you on an individual basis to provide you with the knowledge and skills needed to be successful after your weight loss surgery. We provide pre- and post-operative nutritional education and counseling to help you deal with the nutritional, lifestyle, and emotional changes you will experience. Our staff includes surgeons, nurse practitioners, registered nurses, dietitians, and psychologists, all of whom specialize in bariatric surgery and obesity medicine and are available for life-long care and support. Our surgeons are nationally known experts in bariatric surgery with many years of experience and a track record of excellent outcomes.

2. How much weight will I lose after bariatric surgery?

Weight loss is variable from patient to patient but on average you can expect to lose 65-70% of excess body weight following Gastric Bypass or Sleeve Gastrectomy.

3. Which weight loss procedure should I choose?

The choice between gastric bypass and sleeve gastrectomy is an important one, and one your surgeon will help you make. Sleeve gastrectomy is rising in popularity, but gastric bypass remains the most commonly performed bariatric operation worldwide. Depending on your medical and surgical history, one operation may suit you better than the other. We will help you make this important decision in the preoperative evaluation.

4. What is laparoscopy?

Over 95% of bariatric operations are performed via laparoscopy, which involves making several (5-6) small 1cm incisions on the abdomen, through which your surgeons places a camera and instruments that allow him to perform the operation while viewing it on a video monitor., Laparoscopy has tremendous benefits over traditional open surgery, in that it avoids the large incisions associated with open surgery and patients thus recover much more quickly with less pain and few complications. Laparoscopic bariat4ric surgery has thus become the standard of care. Your surgeon will discuss with you the issue of laparoscopy and whether you are a candidate for a laparoscopic approach- the majority of patients will be candidates for laparoscopy.

5.What is the recovery time following surgery?

For both procedures you are generally up and walking on the first day. The day after surgery you are able to begin a liquid diet. For most individuals pain is well controlled with liquid oral pain medication after the first day and you are sent home on day 3 or 4 after surgery, and return to normal activities and back to work within 2 to 4 weeks.

6.How often am I required to see the surgeon/nurse practitioner and dietitian after surgery for follow-up?

Following surgery you will see the surgery team and dietitian at 2 weeks and2 months. Further appointments with the surgery team vary with your needs. Most patients will resume follow up with their PCP and our dietitian at 6 months, 12 months and annually. You can schedule additional appointments with our dietitian, as you feel you need.

OUR SERVICES

Nutrition Education & Counseling

Our dietitians are experienced in the unique needs of those going through bariatric surgery. You will receive nutrition education to be successful before and after your operation during visits with our experienced registered dietitians. We will schedule these visits for you once you are enrolled in the program.

CONTACT INFO, NEXT STEPS

If you are interested in bariatric surgery at the Ann Arbor VA, please ask your Primary Care provider to place a consult into CPRS for Bariatric Surgery. The Bariatric Surgery Team will be in touch. We look forward to working with you to help you accomplish your health goals.

The Cardiothoracic Section of the VA Ann Arbor Healthcare System provides surgical care working in close partnership with the University of Michigan Department of Cardiac Surgery and Section of Thoracic Surgery. As such, our Section offers the entire spectrum of world class state-of-the-art surgical care, including advanced open, minimally-invasive, transcatheter, and robotic surgical techniques. Our outpatient and procedure clinics provide ambulatory surgical services to Veterans from across our region in the state of Michigan and beyond. VA Cardiothoracic providers are also involved in innovative surgical research and can provide referrals to numerous on-site specialty clinics staffed by other UM faculty physicians.

All members of the Cardiothoracic Section strive to serve our American Veterans with timely, safe, state-of-the art Cardiothoracic care.

SERVICES OFFERED

As Cardiothoracic Surgeons, we provide sub-specialty surgical care to adults for surgical conditions affecting the heart and lungs in cardiac and thoracic patients. We work in coordination with the specialists in cardiology and pulmonary medicine to provide care to cardiac and lung patients with coronary artery disease, aortic stenosis, mitral stenosis and insufficiency, lung nodules, lung cancer, para-esophageal hernia, and pneumothoraces.

The Cardiothoracic Surgery Section of VA Ann Arbor Healthcare System provides medical and surgical care for basic and complex heart and lung conditions:

• Small cell and non-small cell lung cancers with VATS as well as radiation therapy with Radiation Oncology at VA Ann Arbor

• Artery Disease – requiring coronary artery bypass grafting with minimally invasive vein harvesting

• Aortic Valve replacement- open or TAVR (transcatheter aortic valve replacement)

• Mitral Valve repair or replacement for mitral valve disorders

• MAZE and Left atrial appendage ligation for patients with atrial fibrillation

• Thoracic aortic aneurysm work up with referral to U/M for surgery

• Sternal plating for sternal non-union

• VATS (Video assisted thoracoscopic surgery) for lung nodules, cancer

• Mediastinoscopy

• Robotic myotomies

• Robotic diaphragm plications

• Bullectomies

• Para-esophageal hernia repairs

• Esophageal dilations

• Robotic diaphragm plications

• Pleurex catheter placement

• Pleurodesis

• Pleural biopsies

MAKE AN APPOINTMENT

Veteran can be referred by the Primary Care Provider (PCP) for an initial consultation. Veterans, who are followed in Cardiothoracic Surgery can use the numbers to the individual clinics listed. A Veteran should bring any non-VA records including imaging on CDs with them when coming to their appointment.

RESOURCES

The Society of Thoracic Surgeons (STS)

American Association of Thoracic Surgeons (AATS)

American College of Cardiology (ACC)

The General Surgery Section of the VA Ann Arbor Healthcare System provides surgical care for Veterans in close partnership with the University of Michigan Section of General Surgery. All members of the VA General Surgery Section strive to serve our Veterans with timely, safe, state-of-the art surgical care.

The VA General Surgery Section offers the entire spectrum of surgical care, including open, minimally-invasive, endoscopic, and robotic surgical techniques for a wide range of general surgery diseases. Our outpatient and procedure clinics provide ambulatory surgical services to Veterans from across our country. All of our General Surgery Faculty hold joint appointments at the University of Michigan and the VA Ann Arbor Healthcare System and can provide referrals to numerous on-site specialty clinics staffed by other UM and VA faculty physicians.

Our VA General Surgery Faculty are on the cutting edge of developing new surgical techniques and approaches for general surgery problems, ensuring that our Veterans receive state-of-the-art care. Our VA General Surgery Faculty are also engaged in leading innovative surgical research efforts that are pushing forward the frontiers of medicine and science for the benefit of our Veteran patients today and in the future.

SERVICES OFFERED

As General Surgeons with additional fellowship training, we provide sub-specialty surgical care to adults for both benign and malignant surgical conditions affecting a wide range of organ systems, including the esophagus, stomach, small intestine, liver, pancreas, spleen, colon, and rectum. We also care for patients with inguinal, abdominal wall, and hiatal/paraesophageal hernias. We provide bariatric surgery for morbid obesity in the context of a multidisciplinary team-oriented program. Our surgeons have expertise in advanced hepatobiliary surgery for liver, pancreas, gastric, and bile duct cancers, and advanced surgical care for patients with colorectal cancer, inflammatory bowel disease, and anorectal disease.

The General Surgery Section of VA Ann Arbor Healthcare System provides medical and surgical care for basic and complex, benign and malignant conditions affecting all intra-abdominal organs:

• Liver Surgery, providing treatment for primary and secondary hepatic malignancies. Through the SCAN-ECHO program, Hepatology, and Surgery Clinics, we see 70-100 liver cancer patients each year. All patients are presented in a dedicated multidisciplinary tumor board comprised of radiologists, medical oncologists, hepatologists, radiation oncologists and surgeons. We perform a wide variety of surgical resections for liver cancers ranging from hepatocellular carcinoma, cholangiocarcinoma, gallbladder cancer and liver metastases, complex resections including two-stage hepatectomy, synchronous colon and liver surgery, and resection of bi-lobar disease. Our state of the art facility includes newly renovated operating rooms and dedicated anesthesia protocols and providers to ensure ideal intraoperative conditions. Our board-certified, surgical oncology and hepatobiliary pancreatic fellowship-trained surgeons utilize laparoscopic, robotic, and open approaches, along with intra-operative radiofrequency and microwave ablation to expand our capabilities for curative intent surgery.

• Gastrointestinal/Abdominal Surgical Oncology, providing treatment for gastric malignancies, small bowel adenocarcinomas, pancreatic/GI neuroendocrine, and biliary cancer, retroperitoneal sarcomas, gastrointestinal stromal tumors (GIST), and metastatic disease from organs outside of the abdomen. We perform the full range of intra-abdominal resections and reconstructions including pancreaticoduodenectomies (Whipple procedure), distal pancreatectomies, partial and total gastrectomies, biliary system resections and reconstructions, and small bowel and colorectal resections. Advanced diagnostic and interventional radiologic advanced endoscopy approaches for patients with gastric, biliary, pancreatic, and colorectal malignancies are fully integrated within oncologic care, including endoscopic ultrasound, endoscopic retrograde cholangiopancreatography (ERCP), and luminal endoscopic stent placement (biliary as well as gastric/small bowel/colon/rectal). Periprocedural and perioperative care is supported by a dedicated Surgical and Anesthesia Critical Care team. Our board-certified, surgical oncology fellowship-trained surgeons have extensive expertise in minimally invasive approaches to cancer including laparoscopic and robotic techniques, as well as expertise in standard open approaches. All patients are reviewed in our multidisciplinary tumor board that includes medical oncologists, radiation oncologists, and advanced practice providers with expertise in all types of cancer.

• Colorectal and anorectal disease, both benign and malignant, including colon and rectal cancer, inflammatory bowel disease (ulcerative colitis and Crohn’s disease), diverticulitis, and anorectal disease (including hemorrhoids, fistulas and fissures). We have expertise in pelvic floor disorders such as fecal incontinence, rectal prolapse and constipation, and we provide stoma care with the assistance of our certified wound, ostomy and continence nurses (WOCN). Our multidisciplinary team includes surgeons, medical and radiation oncologists, pathologists, radiologists, gastroenterologists, and experienced enterostomal and wound nurses who meet regularly to discuss complex cases and provide highly-individualized and specialized care. Minimally-invasive approaches are considered for all patients including laparoscopic colon and rectal resections for both benign and malignant diseases, and the most up-to-date techniques for the treatment of benign anorectal disorders such as hemorrhoids, fissures, and fistulas. We perform endoscopic evaluations (colonoscopy and flexible sigmoidoscopy) as well as advanced interventions (endoluminal stent placement and balloon dilation). Our board-certified, colorectal fellowship-trained surgeons provide expertise in the entire breadth of colorectal and anorectal diseases and utilize laparoscopic, robotic, and open surgical approaches.

• Bariatric surgery for morbid obesity, including sleeve gastrectomy, gastric bypass, and advanced revisional bariatric surgery for patients with complications from prior bariatric surgery. The VA Ann Arbor Healthcare System has one of the largest VA-based bariatric surgery programs in the country, with outstanding outcomes. Our hospital, clinics, inpatient rooms, and operating rooms are equipped with state of the art infrastructure for the care of patients with obesity. Our multidisciplinary team includes registered dieticians, clinical psychologists, surgeons, and advanced practice providers, with specialized training in the care of patients with obesity. Our board-certified, bariatric fellowship-trained surgeons are national leaders in bariatric surgery and perform the vast majority of bariatric procedures through a laparoscopic approach. Our advanced practice providers guide patients through the process from initial visit to surgery to rapid recovery and long-term weight loss.

• Benign General Surgery Disorders: We also perform all aspects of hernia surgery, including inguinal, abdominal wall, hiatal, and esophageal hernias. Our board-certified, minimally invasive surgery fellowship-trained surgeons perform the majority of hernia procedures through a laparoscopic approach. We provide treatment for gastroesophageal reflux disease (GERD), including Nissen fundoplication and paraesophageal hernia repair. Our board-certified, minimally invasive surgery surgeons perform the majority of these procedures through a laparoscopic approach, and work closely with gastroenterologists to integrate surgical and medical care for GERD. We provide treatment for gallbladder disease, including gallstones, gallbladder cancer, and gallbladder motility disorders. Our board-certified, minimally invasive surgery surgeons perform the majority of these procedures through a laparoscopic approach.

MAKE AN APPOINTMENT

Veterans can be referred by their Primary Care Provider for an initial General Surgery consultation. Veterans should bring any non-VA records or X-Rays with them to their appointment.

RESOURCES

American Society for Metabolic and Bariatric Surgery

American College of Surgeons

United Ostomy Associations of America

National Comprehensive Cancer Network

The Neurosurgery Section of the VA Ann Arbor Healthcare System provides surgical care working in close partnership with the University of Michigan Department of Neurosurgery. As such, our Section offers state-of-the-art surgical care, including advanced open and minimally-invasive surgical techniques. Our outpatient clinics provide ambulatory surgical services to Veterans from across our region. VA Neurosurgery providers are also involved in innovative surgical research and can provide referrals to numerous on-site specialty clinics staffed by other UM faculty physicians.

All members of the Neurosurgery Section strive to serve our American Veterans with timely, safe, state-of-the art neurologic care.

SERVICES OFFERED

As Neurosurgeons, we provide sub-specialty surgical care to adults for surgical conditions affecting the brain, spinal cord, and peripheral nerves. We are able to offer comprehensive care for spinal disorders. We work in coordination with the specialists in the neurology department to provide care to patients with movement disorders, such as Parkinson’s Disease, Essential Tremor, and Dystonia. We also work with the doctors in the pain clinic to provide advanced pain treatments, such as Spinal Cord Stimulation and Infusion Pump Placement.

The Neurosurgery Section of VA Ann Arbor Healthcare System provides medical and surgical care for brain, spine, and peripheral nerve conditions:

• Spinal Stenosis
  • Neurogenic Claudication
  • Cervical Myelopathy
• Radiculopathy (Pinched nerve in neck or back)

• Carpal Tunnel Syndrome (median nerve compression)

• Cubital Tunnel Syndrome (ulnar nerve compression at the elbow)

• Movement Disorders that are resistant to medication treatment
  • Parkinsons Disease
  • Essential Tremor

• Brain hemorrhage (bleeding)

• Brain and spine tumors with surgery, as well as chemotherapy with Medical Oncology, and radiation therapy with Radiation Oncology at VA Ann Arbor

MAKE AN APPOINTMENT

Veterans can be referred by their Primary Care Provider for an initial General Surgery consultation. Veterans should bring any non-VA records or X-Rays with them to their appointment.

RESOURCES

American Association of Neurological Surgeons (AANS)

The Ophthalmology Section of the VA Ann Arbor Healthcare System provides tertiary ophthalmic care working in close partnership with the University of Michigan Department of Ophthalmology. As such, our Section offers the entire spectrum of state-of-the-art surgical care, including small incision and minimally-invasive techniques. Our outpatient clinic provides ambulatory medical and surgical services to Veterans from across our region. VA Ophthalmology providers stay up to date with technological advances and new treatment options for various ophthalmic conditions. In addition, we can provide referrals to numerous on-site specialty clinics staffed by other UM faculty physicians.

All members of the Ophthalmology Section strive to serve our American Veterans with timely, safe, state-of-the art ophthalmic care.

SERVICES OFFERED

As Ophthalmologists, we provide sub-specialty surgical care to adults for surgical conditions affecting the eyeball, eyelids and lacrimal system in both male and female patients.

The Ophthalmology Surgery Section of VA Ann Arbor Healthcare System provides medical and surgical care for basic and complex ophthalmic conditions:

• Small incision cataract removal and lens implantation

• YAG capsulotomy for management of secondary cataract

• Glaucoma provides medical and surgical treatments including laser (selective laser trabeculoplasty; iridoplasty and peripheral iridotomy) and both traditional and select minimally invasive glaucoma surgery (iStent inject and Kahook Dual Blade)

• Medical retina provides a full range of treatment including intravitreal injections and laser (retinopexy, focal and pan-retinal photocoagulation)

• Surgical retina includes vitreoretinal surgery for retinal detachment, epiretinal membrane, macula hole, diabetic vitreous hemorrhage, as well as complex care for tractional retinal detachments, secondary IOL implants, and removal of intraocular foreign bodies

• Cornea provides a full range of medical and surgical Cornea & External disease care, including complex anterior segment surgery and reconstruction, and modern techniques of partial and full-thickness corneal transplantation

• Neuro-Ophthalmology provides medical management of disorders affecting the afferent and efferent visual system

• Strabismsus provides a full range of medical and surgical treatment options for disorders affecting the extraocular muscles

• Oculoplastics including management of drooping of the eyelids, eyelid malpositions (turning outwards or turning inwards), obstruction of tear ducts causing tearing, treating eyelid and orbital growths, managing changes to the eyelids and orbit from Thyroid Eye Disease

• Ocular trauma includes management of simple and complex lid repairs, globe repair and removal of intraocular foreign bodies

MAKE AN APPOINTMENT

Veteran can be referred by the Primary Care Provider (PCP) or Optometrist for an initial consultation. Veterans, who are followed in the eye clinic, can use the numbers to the individual clinics listed. A Veteran should bring any non-VA records with them when coming to their appointment.

RESOURCES

American Academy of Ophthalmology (AAO)

The Foundation of the American Society of Retina Specialists (FASRS) strives to support patients and the retina community through education, awareness and fundraising activities.

American Society of Cataract and Refractive Surgery (ASCRS)

ASCRS empowers Anterior Segment Surgeons to improve the vision, outcomes and quality of life for their patients through innovative approaches to Education, Advocacy and Philanthropy.

American Glaucoma Society (AGS)

The AGS serves as an important patient advocacy force to promote glaucoma awareness among policy makers and the general population.

American Retina Society (ASRS)

The Foundation of the American Society of Retina Specialists (FASRS) strives to support patients and the retina community through education, awareness and fundraising activities.

The Orthopedic Surgery Section of the VA Ann Arbor Healthcare System provides surgical care working in close partnership with the University of Michigan Department of Orthopedic Surgery. As such, our Section offers the entire spectrum of state-of-the-art surgical care, including advanced open, minimally-invasive, and robotic surgical techniques. Our outpatient and procedure clinics provide ambulatory surgical services to Veterans from across our region. VA Orthopedic Surgery providers are also involved in innovative surgical research and can provide referrals to numerous on-site specialty clinics staffed by other UM faculty physicians.

All members of the Orthopedic Surgery Section strive to serve our American Veterans with timely, safe, state-of-the art Orthopedic care.

SERVICES OFFERED

The Orthopedic Surgery section of the VA Ann Arbor Healthcare system offers surgical care for acute and degenerative musculoskeletal conditions. We are fortunate to have experts from the University of Michigan Department of Orthopedic Surgery, and fellowship-trained surgeons to help care for our veterans. We look forward to serving you!

The Orthopedic Surgery Section of VA Ann Arbor Healthcare System provides medical and surgical care for the following conditions:
 

Acute Conditions

• Major fractures requiring hospital stays, such as hip fractures

• Less severe fractures, such as broken ankles, shoulders, elbows, hands and fingers

• Tendon injuries including fingers, elbows (biceps, triceps), knee (quadriceps and patellar tendon) and Achilles

• Ligament injuries of the knee (ACL, PCL, MCL, LCL) and ankle (severe recurrent sprains)

• Meniscus tears (if minimal arthritis)

Chronic Conditions

• Pinched nerves (carpal tunnel, cubital tunnel)

• Dislocating shoulders

• Leg malalignment causing early arthritis (patients under 55)

Degenerative Conditions

• Hand and wrist arthritis

• Rotator cuff tears and tendonitis

• Shoulder arthritis - replacements

• Hip arthritis – replacements

• Knee arthritis - replacements

• Some types of ankle arthritis

Musculoskeletal Oncology

• Upper and Lower extremity Sarcomas

• Less severe fractures, such as broken ankles, shoulders, elbows, hands and fingers

• Tumors or growth involving bones and joints

• Pathologic fractures

MAKE AN APPOINTMENT

Veteran can be referred by the Primary Care Provider (PCP) for an initial consultation. Veterans, who are followed in Orthopedic Surgery can use the numbers to the individual clinics listed. A Veteran should bring any non-VA records including imaging on CDs with them when coming to their appointment.

RESOURCES

American Academy of Orthopedic Surgeons (AAOS)

American Association of Hip and Knee Surgeons (AAHKS)

The Otolaryngology – Head and Neck Surgery (ENT) Section of the VA Ann Arbor Healthcare System provides surgical care working in close partnership with the University of Michigan’s Department of Otolaryngology. As such, our Section offers the entire spectrum of state-of-the-art medical and surgical care, including advanced open and endoscopic surgical techniques. Our outpatient and procedure clinics provide ambulatory surgical services to Veterans from across our region. All of our providers are clinicians and trainees at the University of Michigan, and also involved in innovative surgical research and can provide referrals to numerous on-site specialty clinics staffed by other Michigan Medicine faculty physicians.

All members of the Otolaryngology – Head and Neck Surgery (ENT) Section strive to serve our American Veterans with timely, safe, state-of-the art care for head and neck concerns.

SERVICES OFFERED

As Head, Neck, and ENT surgeons, we provide sub-specialty medical and surgical care to adults for conditions affecting the ears, nose, throat and head/neck.

We work in coordination with the specialists in audiology, speech pathology, radiology, pathology, nuclear medicine, endocrinology, social work, dentistry, medical oncology, and radiation oncology provide care to patients.

We provide the most high-quality and innovative team-based treatment for cancers of the head and neck. Our patients have access to the newest research and clinical trials.

The Head, Neck, and ENT Section of VA Ann Arbor Healthcare System provides medical and surgical care for basic and complex conditions of the ears, nose, throat and head/neck:

• General otolaryngology (common ear, nose and throat complaints)

• Head and neck oncology (cancer) including:
• • • oral cancer (including gums and tongue)
    • throat cancer, also known as cancer of the pharynx or oropharyngeal cancer
    • voicebox cancer, also known as cancer of the larynx or laryngeal cancer
    • skin cancer of the head and neck
    • sinus cancer
    • salivary gland cancer
• Thyroid and parathyroid disorders and cancers
• Cochlear implants

• Diseases of the ear

• Hearing loss

• Balance disorders (vertigo, dizziness and unsteadiness)

• Facial paralysis (facial movement disorders)

• Cosmetic and reconstructive facial surgery

• Nose and sinus disorders including nosebleeds, nasal allergies, nasal polyps, sinusitis, deviated septums

• Vocal health and voice disorders

• Sleep disorders

• Facial and skull trauma

MAKE AN APPOINTMENT

Veteran can be referred by the Primary Care Provider (PCP) for an initial consultation. A Veteran should bring any non-VA medical records, radiology scans, or pathology reports with them when coming to their appointment.

RESOURCES

American Academy of Otolaryngology-Head and Neck Surgery

American Head & Neck Society

Support for People with Oral and Head and Neck Cancer

The Plastic Surgery Section of the VA Ann Arbor Healthcare System provides surgical care working in close partnership with the University of Michigan Department of Plastic Surgery. As such, our Section offers the entire spectrum of state-of-the-art surgical care including skin cancer management, hand surgery, breast reconstruction, microsurgery, wound care, and other reconstructive needs. We typically work closely with our colleagues in the other surgical disciplines to perform complex surgical procedures requiring soft tissue reconstruction. Our outpatient and procedure clinics provide ambulatory surgical services to Veterans from across our region. VA Plastic Surgery providers are also involved in innovative surgical research and can provide referrals to numerous on-site specialty clinics staffed by other UM faculty physicians.

All members of the Plastic Surgery Section strive to serve our American Veterans with timely, safe, state-of-the art surgical care.

SERVICES OFFERED

As Plastic Surgeons, we provide sub-specialty surgical care to adults for surgical conditions affecting our Veterans.

The Plastic Surgery Section of VA Ann Arbor Healthcare System provides medical and surgical care for basic and complex surgical conditions including:

• Skin cancers including melanoma, squamous cell carcinoma, basal cell carcinoma, and Merkel cell carcinoma

• Common hand conditions including carpal tunnel syndrome, ulnar nerve compression, trigger fingers, and ganglion cysts which are often managed in a clinic treatment room under local anesthesia (local numbing) and avoid more complex anesthesia

• Dupuytren’s contracture with both enzymatic injections and operative excisions

• Fractures of the fingers, hand, and wrists

• Tendon transfers and nerve transfers for patients with previous trauma or spinal cord injuries

• Breast reconstruction after cancer treatment including microsurgical flaps (DIEPs) and implant-based procedures

• Breast reduction surgery for patients meeting medical indications

• Post-bariatric skin and soft tissue reconstruction

• Lower extremity and pressure-sore related wounds

• Facial reconstruction following skin cancer treatment

• Painful neuromas following amputation

MAKE AN APPOINTMENT

Veteran can be referred by the Primary Care Provider (PCP) for an initial consultation. Veterans can use the numbers to the individual clinics listed. A Veteran should bring any non-VA records or X-Rays with them when coming to their appointment.

RESOURCES

American Society of Plastic Surgeons (ASPS)

The Urology Section of the VA Ann Arbor Healthcare System provides tertiary urologic care working in close partnership with the University of Michigan Department of Urology. As such, our Section offers the entire spectrum of state-of-the-art surgical care, including advanced open, minimally-invasive, and robotic surgical techniques. Our outpatient and procedure clinics provide ambulatory Urology services to Veterans from across our region. VA Urology providers are also involved in innovative urological research and can provide referrals to numerous on-site specialty clinics staffed by other UM faculty physicians.

All members of the Urology Section strive to serve our American Veterans with timely, safe, state-of-the art urologic care.

SERVICES OFFERED

As urologists, we provide sub-specialty surgical care to adults for surgical conditions affecting the kidneys, ureters, bladder, and urethra, as well as the prostate, seminal vesicles, testicles, epididymis and penis in male patients. We work in coordination with the specialists in Gynecology to provide care to female patients with urinary incontinence and other urogynecologic conditions.

The Urology Section of VA Ann Arbor Healthcare System provides medical and surgical care for basic and complex urologic conditions:

• Urologic cancers (bladder, prostate, kidney and testis) with minimally-invasive, robotic-assisted laparoscopic and open surgical procedures, as well as radiation therapy with Radiation Oncology at VA Ann Arbor.  

• Kidney stones including percutaneous and endoscopic surgery with lasers

• Benign Prostatic Hypertrophy (BPH) including minimally-invasive surgery

• Voiding Dysfunction & Incontinence using advanced Urodynamic testing and surgery

• Female Urology

• Erectile Dysfunction including medications, injections and Penile Implant Surgery

• Urethral/Bladder Reconstructive Surgery for urethral strictures and bladder dysfunction

• Infertility with microsurgical vasectomy reversals

• Neurogenic Bladder & Urologic Spinal Cord Injury Care

 

MAKE AN APPOINTMENT

Veteran can be referred by the Primary Care Provider (PCP) for an initial Urology Consultation. Veterans, who are followed in Urology, can use the numbers to the individual clinics listed.

A Veteran should bring any non-VA records or X-Rays with them when coming to their appointment.

RESOURCES

Urology Care Foundation of the American Urological Association (AUA) 
Urology Care Foundation provides educational materials on urologic health to patients, caregivers, community organizations, healthcare providers, students and the general public.

Bladder Cancer Advocacy Network (BCAN) 
Each year, BCAN provides thousands of patients, caregivers and the medical community with the educational resources and support services they need to navigate their bladder cancer journey. BCAN works collaboratively with the medical and research professionals who are dedicated to the prevention, diagnosis and treatment of bladder cancer and empowers the patient community by allowing them to share experiences with others, and to participate in building awareness of the need for a cure.

American Cancer Society 

The Vascular Surgery Section of the VA Ann Arbor Healthcare System provides care for a wide breadth of vascular disease. All four staff surgeons are also practicing surgeons in the University of Michigan Cardiovascular Center. At the VA Ann Arbor, our Section offers the entire spectrum of state-of-the-art vascular surgical care, including advanced open, endovascular (minimally invasive) and hybrid techniques. Our clinics provide longitudinal and comprehensive vascular disease management to Veterans from across our region. VA Vascular Surgery providers are also involved in innovative surgical research and can provide referrals to numerous on-site specialty clinics staffed by other UM faculty physicians.

All members of the Vascular Surgery Section strive to serve our American Veterans with timely, safe, state-of-the art vascular care.

SERVICES OFFERED

As Vascular Surgeons, we provide sub-specialty surgical care to adults for surgical and medical conditions affecting the cardiovascular system. We work in coordination with the specialists from infectious disease, cardiology and radiology to provide comprehensive care to vascular patients.

The Vascular Surgery Section of VA Ann Arbor Healthcare System provides medical and surgical care for basic and complex vascular conditions:

• Thoracic aortic aneurysms (TAA)

• Abdominal aortic aneurysms (AAA)

• Peripheral artery disease (PAD)

• Cerebrovascular occlusive disease (CVOD) and stroke

• Hemodialysis access creation

• Varicose veins and venous insufficiency

MAKE AN APPOINTMENT

Veteran can be referred by the Primary Care Provider (PCP) for an initial consultation. Veterans, who are followed in Vascular Surgery can use the numbers to the individual clinics listed. A Veteran should bring any non-VA records including imaging on CDs with them when coming to their appointment.

RESOURCES

Society for Vascular Surgery (SVS) – Patient Resources