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."

Glascock halted the third operation after discovering the patient's visceral malrotation through the laparoscopy. While the patient was still in the operating room, he discussed options with the patient's wife.

Glascock emphasized the second surgery provided the necessary background experience to complete the third case laparoscopically through very small incisions.

In terms of complexity, while a gallbladder operation would be rated a 1, a gastric bypass would rate a 10; one of the most difficult operations, he said.

"It's taking a complex operation that calls into play almost every laparoscopic surgery skill and puts an additional complexity on top of that. The things we've done hundreds of times become like a ballet and dance and none of that applies anymore," Glascock said. "We have to use sound principles. It's a testament to the people I work with. I absolutely love it. I've worked for premier centers for laparoscopic surgery, and I compare my team to the best anywhere."

Glascock, a Cedar Falls native who previously had worked at the University of Pittsburgh, returned to Cedar Falls in late 2002 and began working with Greenwood to develop the Midwest Institute of Advanced Laparoscopic Surgery.

"He is a phenomenal physician, and we have a great staff at this facility. The community is so lucky to have this here. I'm surprised at the number of people who don't know what we've got here," Greenwood said.

One-third to one-half of patients are referred from bigger facilities throughout Iowa and the Midwest; "It's nice," he said. "My overall plan is to become the premier regional center to do operations of this complexity."

The institute, Sartori Hospital and Dr. Glascock are all designated as a Center of Excellence with the American Society of Metabolic & Bariatric Surgery.

"When I was growing up, this hospital was considered a first aid station and the bigger and better hospitals were in Waterloo. That concept is still out there in the community. We have the perfect operating environment. Sartori is the only place we do these operations," Glascock said. "My staff spends hundreds of hours a year on in-service training and go through continuous updating of methods. Being credentialed as a center of excellence means we are required to show those hours and the training. Better outcomes have been documented at credentialed centers."

Glascock also addresses the misconception that all gastric bypass surgery is done for reasons of vanity or that the surgery is dangerous, because of the few that receive bad publicity.

"I take very seriously weight loss, being overweight is a very serious medical condition. Patients have to make a commitment to lifetime follow-up care, and we expect every patient to participate," he said. "One way that we measure their success is the dwindling of their medications. My only focus is to make people healthy. My guiding principle is to enhance people's quality of life. Those who come to me for gastric bypass have conditions such as diabetes, high blood pressure. There is an intermeshed web of conditions fueled by and playing a role in these conditions. I work to bring about a resolution to these problems. We have an 80 percent resolution rate for these conditions; people are off their meds, they no longer have diabetes or sleep apnea; it's marvelous."

For more information about the Midwest Institute of Advanced Laparoscopic Surgery, go to www.obesityhelpiowa.org.

Contact CJ Hines at newsroom@wcfcourier.com.