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Big Chance: Widow Makes Gastric Bypass Plea

Jan 15, 2004 | Patriot Ledger Mark Gratta looked the picture of health when he played on the Hingham High School football team 28 years ago.

‘‘I remember thinking, ‘He's so handsome and in such good shape,''' said Louise Gratta, who is now his widow.

Few people knew the truth. ‘‘He was dieting even then,'' she said. ‘‘Weight was always an issue.''

A year ago yesterday, the 43-year-old contractor from Hingham tried to solve his lifelong weight problem by having most of his stomach stapled shut, an increasingly popular operation.

He was 5 feet 6 inches tall and weighed 366 pounds, giving him a body-mass index of 58. An index of 40 or more is considered obese.

He died of a massive infection eight days after the surgery. His surgeon at Boston Medical Center, Dr. R. Armour Forse, left five surgical sponges inside Gratta's abdomen. But Forse denies that is what caused the infection.

His widow, who has filed a wrongful death suit, wants his death to serve as a cautionary tale for tens of thousands of Americans considering gastric bypass surgery.

‘‘People need to be warned,'' she said. ‘‘Ask yourself: ‘Would you rather be dead than live the way you are?' Mark didn't feel that way.''

At least six million Americans are morbidly obese, generally at least 100 pounds overweight. Many lose weight by dieting, but most gain it back within five years, studies show.

Extremely obese people face serious health problems, including diabetes, heart disease and high blood pressure. They also contend with societal disapproval and contempt.

The most effective and permanent solution doctors can offer is bariatric surgery, a group of procedures that limit food intake by shrinking the stomach or bypassing other parts of the digestive system.

Doctors began performing the most popular bariatric procedure, gastric bypass, about 40 years ago, said Georgeann Mallory, executive director of the American Society for Bariatric Surgery.

In that procedure, a surgeon staples off most of a patient's stomach, creating a small pouch that at first holds only a few ounces and eventually can hold about one cup. The stomach normally can hold about three pints of food.

Patients usually lose two-thirds of their excess weight within two years, but ‘‘it's not foolproof,'' Mallory said. They must eat sensibly, get checkups and change other habits to stay healthy, she said.

Risks range from death to nutritional deficiencies. Up to 5 percent of patients die within 30 days, studies show. Other potential short-term complications include damage to the intestine, bleeding, clots and wound infections.

Long-term problems can include breaks in the staple line, dehydration, iron and vitamin deficiencies, and gallbladder disease, according to a review of research by the Blue Cross and Blue Shield Association.

Six years ago, surgeons developed a way to perform the procedure by laparoscopy. This less invasive method allows a doctor to insert surgical instruments through tubes, staple the stomach and create a link to the intestine without opening the abdomen.

Laparoscopic gastric bypass now accounts for 55 percent of gastric bypass operations, Mallory said.

Mark Gratta turned to surgery after trying diet after diet and failing, said Louise Gratta, 44. He didn't yet have heart disease, diabetes or other serious health problems, but he didn't want to die young from the complications of obesity, she said. He wanted to see his children, Anna, 14, and Mark, 15, grow up. ‘‘He just loved his family and wanted to be around for them,'' she said.

His surgery began as a laparoscopic procedure. But he developed bleeding during the operation and Forse decided to open his abdomen for a conventional procedure.

Any ‘‘open'' operation can increase the risk of leaving sponges or instruments in a patient, according to a study by Brigham and Women's Hospital researchers.

Gratta developed a fever after the surgery, and he could not breathe on his own. All antibiotics failed, and his body temperature rose to 108 degrees state Department of Public Health found.

Forse reopened Gratta's abdomen and discovered five sponges behind his spleen. Gratta died the next day. Afterward, doctors re-examined X-rays taken two days after the surgery and found evidence of the sponges.

The radiologist who looked at the X-rays told the state investigator that he had been looking for evidence of leaks and had misinterpreted the sponges as surgical drains.

Nurses and technicians in the operating room had certified that no sponges were missing, records showed.

Louise Gratta names Boston Medical Center, Forse, the radiologist and three other doctors in the wrongful death suit.

All except two doctors who were recently added to the suit have filed answers to the suit denying wrongdoing.

At a hearing last month in Suffolk Superior Court, a lawyer for Forse said it was up to operating room nurses, not the surgeon, to keep track of sponges.

Besides, the surgical pads ‘‘are very difficult to see because of the enormous amount of abdominal fat'' in gastric bypass patients, the attorney said.

Forse couldn't look for sponges in some parts of Gratta's abdomen because the probing might have caused bleeding ‘‘that would pose a danger to the patient,'' the lawyer said.

The Grattas researched the surgery before Mark made his decision and found nothing to dissuade him, Louise Gratta said.

‘‘We want to stop this surgery until more work is done,'' said Mark's sister, Maria Pagnani of Hanson. ‘‘People are getting hurt and maimed. This has to stop.''

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