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Glycemic control in morbidly obese rural population after Roux-en-Y gastric bypass
292
Abstracts: Students/Residents/Fellows Session/Surgery for Obesity and Related Diseases / 1 (2005) 291–294
Methods: The medical records of patients ⬍20 years of age who underwent LRYGBP for morbid obesity from 1999 to the present were reviewed. Outcome variables examined included preoperative body mass index (BMI); percentage of excess weight lost for those with at least 3 months’ follow-up; and the reduction of comorbid conditions. Data are presented as the mean ⫾ SEM. Results: Nineteen patients (13 females, 6 males) met National Institute of Health criteria for bariatric surgery. All procedures were completed laparoscopically. Mean time to follow-up was 9.3 ⫾ 2.39 months (range 1–36). Average age was 18 ⫾ 0.4 years, and average BMI was 52 ⫾ 1.78 kg/m2. The percentage of excess weight lost for patients with follow-up of ⱖ3 months was 53.4 ⫾ 5.41%. The average number of comorbidities was 4.5, with improvement of 56% of comorbidities in 12 patients and resolution of 38% in 10 patients. There were no mortalities. There were 3 complications: postoperative bleeding in 1 patient, and marginal ulcer in 2 patients. Surveys obtained from 13 patients reflected an overall perceived improvement in quality of life. Conclusions: Laparoscopic gastric bypass is an effective option for morbidly obese adolescents. Methods by which to maximize compliance in this population must be explored. PII: S1550-7289(05)00318-7
SRF4.
IS LAPAROSCOPIC GASTRIC BYPASS SURGERY SAFE IN THE ELDERLY? John Paul Gonzalvo, D.O., Priscila Antozzi, M.D., Richard Gordon, M.D., Conrad H. Simpfendorfer, M.D., Flavia Soto, M.D., Oliver Whipple, M.D., Samuel Szomstein, M.D., Raul Rosenthal, M.D., The Bariatric Institute, Cleveland Clinic Florida, Weston, FL. Purpose: As the American public age at an increasing rate and the problem of obesity escalates, age as an absolute contraindication to bariatric surgery is being challenged. The aim of our study was to examine the safety and weight reduction for patients ⬎60 years of age who underwent laparoscopic Roux-en-Y gastric bypass. Methods: The prospectively collected database was queried for patients ⬎60 years of age. Age, gender, preoperative weight, preoperative body mass index, postoperative weight, postoperative BMI, early complications, and late complications were then assessed. Results: From 1200 patients who had laparoscopic gastric bypass, 93 were ⬎60 years old, including 59 women (63%) and 34 men (37%), with an average age of 62.2 years (range 60 –74). The average preoperative weight and BMI were 300.6 lb and 48.54 kg/m2, respectively. The 12-month postoperative average weight and BMI was 237.9 lb and 38.4 kg/m2, respectively. A total of 55 patients had follow-up in our clinic. Early complications included anastomotic leak in 3 patients (3.2%), intraluminal bleeding in 1 (1.1%), pulmonary embolus in 1 (1.1%), pneumonia in 1 (1.1%), and atrial fibrillation in 1 (1.1%). Late complications were stenosis in 8 patients (8.6%), marginal ulcer in 3 (3.2%), hernia in 2 (2.2%), and small bowel obstruction in 1 (1.1%). There were no deaths. Conclusions: Laparoscopic gastric bypass can be safely performed in patients ⬎60 years old with no mortality and low morbidity. Chronologic age should not be a contraindication to laparoscopic gastric bypass surgery. PII: S1550-7289(05)00319-9
SRF5.
GLYCEMIC CONTROL IN MORBIDLY OBESE RURAL POPULATION AFTER ROUX-EN-Y GASTRIC BYPASS Salman Malik, M.D., Marc Rogers, M.D., Vittorio Lombardo, M.D., Parkash Paragi, M.D., Craig Woods, M.D., Christopher Still, D.O., Anthony Petrick, M.D., Geisinger Medical Center, Danville, PA. Purpose: Roux-en-Y gastric bypass (RYGB) has demonstrated improved glycemic control in studies done at urban medical centers. The aim of this study was to examine the effect of RYGB on glycemic control in morbidly obese patients with type 2 diabetes (DM-TII) in a rural medical center. Methods: Data were collected from 124 patients in from rural counties who underwent RYGB between 2001 and 2003. Patients with DM-TII, HbA1c 6, and BMI ⬎40 and who completed a 6-month evaluation in a comprehensive obesity clinic, were considered for RYGB. The pre- and postoperative HbA1c measurements, body mass index (BMI), percentage of excess body weight loss (%EWL), and number of antidiabetic medications were retrospectively analyzed. Data were examined using repeated measures mixed regression models to determine whether age, gender, or procedure type (laparoscopic RYGB vs. open RYGB) predicted for weight loss or glycemic control. Results: Pre-Op 2
⫺7.8* [7.2–8.3] 24.9* [12.0–37.8] 7.8 (SD⫽1.5) ⫺1.6* [1.3–1.9] 78.3% 24.2%* [16.2%–33.9%]
BMI (kg/m ) 50 (SD⫽7) EBWL (%) HbA1c (%) Anti–DM meds (%)
3-months [95% CI]
NA
6-months [95% CI]
12-months [95% CI]
Last follow-up [95% CI]
⫺11.7* [10.9–12.5] 38.2* [25.3–51.2] ⫺1.7* [1.4–2.1] 15.5%* [8.5%–25.0%]
⫺14.6* [13.5–15.7] 48.3* [35.2–61.4] ⫺1.8* [1.5–2.2] 6.4%* [1.8%–15.5%]
⫺14.8* [13.6–16.1] 53.8* [39.4–68.3] ⫺1.4* [1.0–1.9] 6.4%* [1.8%–15.5%]
* p-value ⬍ 0.001 as compared to pre-op
Conclusions: Rural DM-TII patient populations experienced similar weight loss and improved glycemic control after RYGB as urban populations. Patients also had a significantly reduced requirement for diabetic medications. This effect was durable up to mean of 18 months after surgery and validates earlier findings in urban medical centers. PII: S1550-7289(05)00320-5
SRF6.
ACUTE PREOPERATIVE WEIGHT LOSS: DOES IT IMPROVE EASE OF LAPAROSCOPIC GASTRIC BYPASS? Rockson C. Liu, M.D., Adheesh Sabnis, M.D., Bipan Chand, M.D., The Cleveland Clinic Foundation Department of General Surgery, Cleveland, OH. Purpose: Prohibitive liver size and massive intraabdominal adiposity result in poor visualization and complications in gastric bypass. We hypothesize that acute preoperative weight loss can reduce liver size and improve visualization, thereby facilitating the creation of the gastric pouch and gastrojejunostomy. Methods: Consecutive patients were included in this retrospective study if they had had no prior bariatric surgery and had undergone isolated laparoscopic Roux-en-Y gastric bypass (by a single surgeon) between July 2003 and September 2004. All patients par-
Abstracts: Students/Residents/Fellows Session/Surgery for Obesity and Related Diseases / 1 (2005) 291–294
Methods: The medical records of patients ⬍20 years of age who underwent LRYGBP for morbid obesity from 1999 to the present were reviewed. Outcome variables examined included preoperative body mass index (BMI); percentage of excess weight lost for those with at least 3 months’ follow-up; and the reduction of comorbid conditions. Data are presented as the mean ⫾ SEM. Results: Nineteen patients (13 females, 6 males) met National Institute of Health criteria for bariatric surgery. All procedures were completed laparoscopically. Mean time to follow-up was 9.3 ⫾ 2.39 months (range 1–36). Average age was 18 ⫾ 0.4 years, and average BMI was 52 ⫾ 1.78 kg/m2. The percentage of excess weight lost for patients with follow-up of ⱖ3 months was 53.4 ⫾ 5.41%. The average number of comorbidities was 4.5, with improvement of 56% of comorbidities in 12 patients and resolution of 38% in 10 patients. There were no mortalities. There were 3 complications: postoperative bleeding in 1 patient, and marginal ulcer in 2 patients. Surveys obtained from 13 patients reflected an overall perceived improvement in quality of life. Conclusions: Laparoscopic gastric bypass is an effective option for morbidly obese adolescents. Methods by which to maximize compliance in this population must be explored. PII: S1550-7289(05)00318-7
SRF4.
IS LAPAROSCOPIC GASTRIC BYPASS SURGERY SAFE IN THE ELDERLY? John Paul Gonzalvo, D.O., Priscila Antozzi, M.D., Richard Gordon, M.D., Conrad H. Simpfendorfer, M.D., Flavia Soto, M.D., Oliver Whipple, M.D., Samuel Szomstein, M.D., Raul Rosenthal, M.D., The Bariatric Institute, Cleveland Clinic Florida, Weston, FL. Purpose: As the American public age at an increasing rate and the problem of obesity escalates, age as an absolute contraindication to bariatric surgery is being challenged. The aim of our study was to examine the safety and weight reduction for patients ⬎60 years of age who underwent laparoscopic Roux-en-Y gastric bypass. Methods: The prospectively collected database was queried for patients ⬎60 years of age. Age, gender, preoperative weight, preoperative body mass index, postoperative weight, postoperative BMI, early complications, and late complications were then assessed. Results: From 1200 patients who had laparoscopic gastric bypass, 93 were ⬎60 years old, including 59 women (63%) and 34 men (37%), with an average age of 62.2 years (range 60 –74). The average preoperative weight and BMI were 300.6 lb and 48.54 kg/m2, respectively. The 12-month postoperative average weight and BMI was 237.9 lb and 38.4 kg/m2, respectively. A total of 55 patients had follow-up in our clinic. Early complications included anastomotic leak in 3 patients (3.2%), intraluminal bleeding in 1 (1.1%), pulmonary embolus in 1 (1.1%), pneumonia in 1 (1.1%), and atrial fibrillation in 1 (1.1%). Late complications were stenosis in 8 patients (8.6%), marginal ulcer in 3 (3.2%), hernia in 2 (2.2%), and small bowel obstruction in 1 (1.1%). There were no deaths. Conclusions: Laparoscopic gastric bypass can be safely performed in patients ⬎60 years old with no mortality and low morbidity. Chronologic age should not be a contraindication to laparoscopic gastric bypass surgery. PII: S1550-7289(05)00319-9
SRF5.
GLYCEMIC CONTROL IN MORBIDLY OBESE RURAL POPULATION AFTER ROUX-EN-Y GASTRIC BYPASS Salman Malik, M.D., Marc Rogers, M.D., Vittorio Lombardo, M.D., Parkash Paragi, M.D., Craig Woods, M.D., Christopher Still, D.O., Anthony Petrick, M.D., Geisinger Medical Center, Danville, PA. Purpose: Roux-en-Y gastric bypass (RYGB) has demonstrated improved glycemic control in studies done at urban medical centers. The aim of this study was to examine the effect of RYGB on glycemic control in morbidly obese patients with type 2 diabetes (DM-TII) in a rural medical center. Methods: Data were collected from 124 patients in from rural counties who underwent RYGB between 2001 and 2003. Patients with DM-TII, HbA1c 6, and BMI ⬎40 and who completed a 6-month evaluation in a comprehensive obesity clinic, were considered for RYGB. The pre- and postoperative HbA1c measurements, body mass index (BMI), percentage of excess body weight loss (%EWL), and number of antidiabetic medications were retrospectively analyzed. Data were examined using repeated measures mixed regression models to determine whether age, gender, or procedure type (laparoscopic RYGB vs. open RYGB) predicted for weight loss or glycemic control. Results: Pre-Op 2
⫺7.8* [7.2–8.3] 24.9* [12.0–37.8] 7.8 (SD⫽1.5) ⫺1.6* [1.3–1.9] 78.3% 24.2%* [16.2%–33.9%]
BMI (kg/m ) 50 (SD⫽7) EBWL (%) HbA1c (%) Anti–DM meds (%)
3-months [95% CI]
NA
6-months [95% CI]
12-months [95% CI]
Last follow-up [95% CI]
⫺11.7* [10.9–12.5] 38.2* [25.3–51.2] ⫺1.7* [1.4–2.1] 15.5%* [8.5%–25.0%]
⫺14.6* [13.5–15.7] 48.3* [35.2–61.4] ⫺1.8* [1.5–2.2] 6.4%* [1.8%–15.5%]
⫺14.8* [13.6–16.1] 53.8* [39.4–68.3] ⫺1.4* [1.0–1.9] 6.4%* [1.8%–15.5%]
* p-value ⬍ 0.001 as compared to pre-op
Conclusions: Rural DM-TII patient populations experienced similar weight loss and improved glycemic control after RYGB as urban populations. Patients also had a significantly reduced requirement for diabetic medications. This effect was durable up to mean of 18 months after surgery and validates earlier findings in urban medical centers. PII: S1550-7289(05)00320-5
SRF6.
ACUTE PREOPERATIVE WEIGHT LOSS: DOES IT IMPROVE EASE OF LAPAROSCOPIC GASTRIC BYPASS? Rockson C. Liu, M.D., Adheesh Sabnis, M.D., Bipan Chand, M.D., The Cleveland Clinic Foundation Department of General Surgery, Cleveland, OH. Purpose: Prohibitive liver size and massive intraabdominal adiposity result in poor visualization and complications in gastric bypass. We hypothesize that acute preoperative weight loss can reduce liver size and improve visualization, thereby facilitating the creation of the gastric pouch and gastrojejunostomy. Methods: Consecutive patients were included in this retrospective study if they had had no prior bariatric surgery and had undergone isolated laparoscopic Roux-en-Y gastric bypass (by a single surgeon) between July 2003 and September 2004. All patients par-