Specialized Centers at Ascension Via Christi Provide Access to Quality Care

By Amy Geiszler-Jones
Wednesday, June 24, 2020

Ascension Via Christi St. Teresa: A Center of Excellence in Hernia Surgery

Earlier this year, the Hernia Center at Ascension Via Christi St. Teresa in Wichita was recognized as a Center of Excellence in Hernia Surgery by Surgical Review Corp., an internationally recognized, not-for-profit patient safety organization.

Ragnar Peterson, MD

According to SRC, the accreditation indicates that the facility and surgeons are among the best in the specialty and are dedicated to delivering the highest level of care possible.

Led by board-certified surgeon Ragnar Peterson, MD, the Hernia Center at St. Teresa uses an evidence-based approach to treat hernia and abdominal wall disease. Often some of the most complex diseases can be treated with minimally invasive procedures, including some newer, novel robotic-assisted hernia repair techniques which have been shown to result in shorter hospital stays and fewer mesh complications. The program also participates in a national quality improvement collaborative that follows patients’ outcomes after surgery to ensure that patients receive optimal care.

Complex Hernia Repairs the Norm at St. Teresa

Dr. Peterson notes that the most important part of the Hernia Center’s process is what happens before the operation.

“One of the keys to having good results in difficult situations is to make patients as healthy as they can be before operating,” he says. “This process of optimization is more important than any operative technique or tool or mesh that we may use. It is difficult to lose weight or to quit smoking. We spend a lot of time working with patients over months, and sometimes for more than a year, to get them into a position where the operation has the best chance of success.”

Many of the patients who undergo hernia surgery at St. Teresa have already had several abdominal surgeries and hernias that have come back, making their cases more complex. Dr. Peterson says that patients presenting to the Hernia Center with recurrent hernias have had, on average, five or more previous abdominal operations.

A recent patient had six prior abdominal surgeries and had been living with a hernia the size of a basketball for many years because she had been told a repair was not possible. Another patient’s hernia had grown so large that a family member knitted a special sling for the abdominal bulge that was affecting her gait. Both patients underwent successful operations.

According to Dr. Peterson, reinforcing a hernia repair with mesh reduces the risk of the hernia coming back, but is accompanied by a small, but very real, risk of mesh complication. Most surgeons doing hernia repairs place the mesh on the inside of the abdominal cavity, where the mesh can interact with the intestines and create a complication that may not present itself for many years. One of the Hernia Center’s primary goals is to perform procedures, like the robotic enhanced-view totally extraperitoneal repair (eTEP) procedure, that reduce this likelihood by placing the mesh in the layers of the abdominal wall using natural tissue to separate the mesh from the intestines.

Some people delay hernia surgery and opt to live with the hernia, sometimes at the recommendation of their physician. Although research shows that most people have hernia repair surgery within 10 years of diagnosis, delaying surgery until the hernia has grown larger and caused more damage can make treatment and recovery more difficult.

An untreated hernia also can lead to incarceration, where the herniated tissue is trapped in the wrong compartment; it also can result in strangulation, where the trapped herniated tissue is starved of its blood supply, causing the tissue to die off and requiring emergency surgery.

About 180 patients underwent hernia repair surgery last year at St. Teresa, Dr. Peterson says.

Ragnar Peterson, MD, consults a patient before he undergoes complex hernia repair surgery.

Using Robotic-Assisted Techniques

Because Dr. Peterson deals with complex cases, he is among those at the forefront of using new techniques in robotic hernia surgeries.

“As our robotic-assisted capabilities have expanded, so has our ability to perform even the most complex cases with the robot leading to shorter hospital stays, less pain, less narcotic use, quicker recoveries and less overall cost.”

In 2018, Dr. Peterson started using the relatively new eTEP technique using the da Vinci robotic system. He studied the eTEP technique with Igor Belyansky, MD, at the Anne Arundel Medical Center in Annapolis, Maryland, who has refined the technique.

“The eTEP procedure has been around for a while and surgeons have been doing it laparoscopically,” Dr. Peterson says. “The problem is it’s difficult to reproduce, it’s technically very demanding and, ergonomically, it’s very painful for the surgeon. Using the robot has allowed us to standardize the approach to make it reproducible in different scenarios and be used for all different types of hernias. Knowing the eTEP approach is a passport to access any part of the abdominal wall.”

“Under Dr. Peterson’s leadership, we have developed a first-class team and program that is drawing patients from all over Kansas,” adds Robyn Chadwick, St. Teresa’s Senior Executive. “Many are patients who previously have undergone surgical hernia or abdominal wall surgeries elsewhere without success and now need the highly specialized care that we are staffed and equipped to provide to have a successful outcome.”

The Hernia Center of Excellence recognition includes the Ascension Medical Group Via Christi clinic connected to St. Teresa, which is staffed and equipped for even the most complex hernia surgeries.

It takes a team to achieve Center of Excellence status for Hernia Surgery.

Contributing to Quality Care

Another factor that sets the hernia surgery program at St. Teresa apart from other programs is its participation in the Americas Hernia Society Quality Collaborative, Dr. Peterson says.

Information on all ventral and inguinal hernia surgical patients treated at Ascension Via Christi Hernia Center is entered into the AHSCQ patient registry. Follow-up data from patients is collected and submitted at regular intervals through the five years following their surgery.

More than 340 participating surgeons in academic and private practice settings in the U.S. contribute patient-centric data to the AHSQC registry, which has more than 50,000 hernia surgery cases in its database.

As a participant in the collaborative, Dr. Peterson and his team can review longitudinal patient outcomes and get information that can help with best practice decisions on patient safety and care.

“We want to continue to be our best for the people who feel they have nowhere else to go for their hernia or abdominal wall problem,” Dr. Peterson says. “These are hard and intimidating problems for patients and surgeons alike. We want to be the resource that changes their lives for the better.”

Referrals and consultations are available. To make a referral or consult with Dr. Peterson, call 316-613-4707.

Kansas’ Only CyberKnife Center

Ascension Via Christi’s CyberKnife Center — which offers noninvasive lifesaving and time-saving cancer treatment through highly precise, intense-dose radiation treatment — is expanding and getting an upgrade.

With its new upgraded CyberKnife robot, which will be operational this summer, Ascension Via Christi’s radiation oncology team will be able to treat 16 to 20 patients per day as compared to the eight or nine it treats with its current robot.

David Bryant, MD

Salman Hasan, DO

The Ascension Via Christi CyberKnife Center, the only one in Kansas, already ranks as one of the busiest U.S. centers for stereotactic radiosurgery for tumors outside the brain or spine. Medicare data places it at 32 out of more than 850 centers, according to Accuray, the high-tech system’s manufacturer.

In addition to helping keep up with patient and physician demand, it also will allow the team to further contribute to research on stereotactic ablative radiotherapy, says David Bryant, MD, Medical Director of Radiation Oncology for Ascension Via Christi’s Wichita hospitals. CyberKnife technology received FDA clearance for intracranial applications in 1999 and for full-body applications in 2001.

“We are helping improve radiation guidelines for cancer treatment using four goals,” Dr. Bryant says.

Along with Dr. Bryant, radiation oncologist Salman Hasan, DO, also treats patients at the CyberKnife Center.

Those goals are improving cancer control and survival, reducing side effects, improving a patient’s quality of life (with fewer treatments, for example) and reducing the cost of cancer care.

Part of the Ascension Via Christi Cancer Center, Dr. Bryant and other members of the CyberKnife Center team are available for video and telephone consultations with patients and physicians. Call 316-261-3200 to learn more.

Comprehensive Stroke Care

The Ascension Via Christi Comprehensive Stroke Center is one of two comprehensive stroke centers in Kansas certified by The Joint Commission, the nation’s predominant independent standards-setting and accrediting body in health care.

This is an important distinction because multiple research studies show a decreased mortality rate for hemorrhagic stroke patients treated at a comprehensive stroke center as compared to being treated at a primary stroke center, says James Walker, MD, who is board-certified in critical care, neurocritical care and anesthesia and serves as Medical Director for the Comprehensive Stroke Program at Ascension Via Christi St. Francis.

“Every member of our experienced team is dedicated to continuous improvement because we want the patients in the community we serve to receive the best care possible,” Dr. Walker says.

Approximately 800 hemorrhagic and ischemic stroke patients are treated at St. Francis each year, including many, ranging in age from teens to centenarians, who require more advanced endovascular surgical interventions.

The Comprehensive Stroke Center also received Get With the Guidelines Gold Plus Target Stroke Honor Roll Elite Plus recognition by the American Heart Association and American Stroke Association.

“When time is of the essence, patients deserve nothing less than the best care available, and that level of care is available at Ascension Via Christi,” Dr. Walker says.

To discuss treatment or transfer of a stroke patient, call 1-800-353-3111 and ask to speak to a stroke physician.

Accredited Epilepsy Center

Ricky Lee, MD

The Ascension Via Christi Epilepsy Center in Wichita is one of two Kansas centers accredited by the National Association for Epilepsy Centers.

“As an accredited center, we can offer patients more options than just traditional medication therapy,” says Ricky Lee, MD, the board-certified and fellowship-trained neurologist and epilepsy specialist who leads the team.

The center is staffed and equipped to offer the most advanced care in diagnosis and treatment, including medication management, device therapy, pre-surgical evaluations and the opportunity to participate in clinical trials, which gives patients early access to investigational medications and devices.

The center includes epilepsy monitoring at Ascension Via Christi St. Francis, allowing the center staff to more accurately diagnose hard-to-treat patients and design individual treatment plans.

Staff also provide electroencephalography support to inpatients in the Neurointensive Care Unit and Comprehensive Stroke Center, Dr. Lee says. n

James Walker, MD, and interventional radiologist Kumar Reddy, MD, at the Comprehensive Stroke Center at Ascension Via Christi St. Francis

The Hernia Center of Excellence recognition includes the Ascension Medical Group Via Christi clinic connected to St. Teresa, which is staffed and equipped for even the most complex hernia surgeries.

It takes a team to achieve Center of Excellence status for Hernia Surgery.