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Laparoscopic Roux-En-Y Gastric Bypass as Day Surgery Procedure
Poster Presentations / Surgery for Obesity and Related Diseases 11 (2015) S56–S211
pneumonia, hematomas, cardiac events, abscess and more), 6) 30-day mortality rates, and 6) weight loss success (% change in BMI at 6, 12, 24, and 36 postoperative months). Results: With TR-RYGB, intraoperative complication and conversion rates for all patients, i.e. 0.32% and 0.16%, respectively, were low, and, there were no differences in intraoperative complications or conversions for males vs. females, the superobese vs. non-superobese, or older (Z60 y) vs. younger (o60 y) patients. Total operative times averaged 123.7⫾27.2(SD) minutes and mean LOS was 2.2⫾1.0 days. Operative times were significantly (po0.0001) higher for the superobese (126.8 min) and males (130.1 min) than for their respective counterparts and LOS was longer for patients Z 60 y (2.4 days). Inhospital complication and reoperation rates for the population, at large, averaged 2.43% and 2.10%, respectively, and there were no significant differences (chi sq p40.05) between these rates for the high risk patients in comparison to their respective controls. In the all-inclusive population, 30-day readmission rates averaged 5.83%, with malaise responsible for the majority (64%) of cases. Similar readmission patterns occurred for the super- vs. non-superobese and for the males vs. females. However, patients Z60 y had considerably lower readmission rates resulting from malaise than did than did their younger cohort (1.60% vs. 4.44%, respectively). Out of the 1,234 cases, only 1 anastomotic leak occurred for a rate ¼ 0.08%. Risk status had no effect on 30-day mortality (rate ¼ 0.24%). As for weight loss success, total % changes in BMI (34%) for all patients peaked at 12 months and remained relatively unchanged, thereafter. Gender had no effect on weight loss. However, % changes in BMI were less for the older vs. younger patients at 6 and 12 months and greater for the super- vs. non-superobese at 12 and 24 months. Conclusions: TR-RYGB is a safe and efficacious procedure for high risk bariatric patients including those of male gender, the elderly and superobese. The robotic procedure is particularly beneficial in lowering the risk for intraoperative complications and conversions, as well as anastomotic
A5066
LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS AS DAY SURGERY PROCEDURE Philippe Topart, MD1; Carine Phocas, RN2; Franck Hamard, MD3; 1 Socit de Chirurgie Viscrale Clinique, Angers, France; 2Clinique de l'Anjou, Angers, France; 3Anesthesiology, Clinique de l'Anjou, Angers, France
S91
apnea. Our standard RYGB procedure was used with 7.5 mg/mL Ropivacaine port site infiltration. 7 ports were used, the gastric pouch was fashioned with 1 transversal 60 mm linear stapler/cutter application and 2 vertical applications towards the angle of His. A 100 cm biliopancreatic limb and 150 cm alimentary limb was measured. The gastrojejunal anastomosis was performed by a 30 mm linear stapler with the aperture closed by a 3-0 absorbable barbed running suture. The same technique was applied to the jejunojejunal anastomosis. The anesthesiology procedure avoided morphinomimetics. Pain killers were given exclusively per oral after return to the ward. Clear liquids and soft food were allowed 3 hours after surgery and were to be taken before returning home. Blood check as well a Chung score Z 9 were mandatory to clear discharge home. Patients were called the following day and the day after by the dietician and the bariatric coordinator. They were usually seen at the clinic between 3 and 4 days postoperatively. Low molecular weight heparin twice a day for 1 week and once for the raining 2 weeks was precribed in accordance with French anaesthesiology guidelines. Nurses at home were instructed to check heart rate as well as temperature when doing the injections during the first 3 days at home. As part of an ongoing experiment some patients were monitored for 72 hours for pulse rate, body temperature and respiratory frequency using a skin patch continuously transmitting data via the cellular network. Procedure duration was 76.6 ⫾ 15.0 minutes and a cholecystectomy was associated with 2 cases. 2 patients were kept overnight (9%): 1 at the beginning of the program reported diziness and the other was not allowed to return home because her gastrojejunal anastomosis had to be redone due to a technical failure. 2 patients were readmitted within 30 days: 1 had to be reoperated on for a peritonitis of unknown origin more than 3 weeks after surgery after an uneventful postoperative course and the other received blood transfusion for an hematemesis within the first 24 hours. Despite being limited by a number of factors, day surgery RYGB appears feasible with excellent pain control as well as the ability of resuming light food early. As outlined by some studies, pulse rate is the key parameter that can suggest bleeding or leakage when tachycardia is around 120 beats per minute. Ultimately, the implementation of this day surgery program has led to numerous changes in our bariatric program with a successful systematic discharge home the day after RYGB.
A5067
Although large series of 2000 patients returning home the day after their laparoscopic Roux-en-Y gastric bypass (RYGB) have been published, a very short hospital stay is far from being the norm. Concern about major complications developing at home and the analysis of the BOLD database suggesting higher risk and even higher mortality rate for day surgery. Since July 2013 we have performed 22 attempts of Roux-en-Y gastric bypasses (RYGB) as day surgery within a systematic discharge from hospital the day after surgery for every primary RYGB. The day surgery protocol was offered to BMIo50 patients, living less than 1 hour drive from our center. Except insulin requiring type 2 diabetes, comorbidities were not regarded as contraindications. All the patients were female aged 36.8 ⫾ 8.5 years with a body mass index of 41.1 ⫾ 2.3 kg/m² . 8 patients presented with at least 1 comorbidity: 6 had hypertension, 2 type 2 diabetes and 3 sleep
THE SAFETY AND EFFICACY OF LAPAROSCOPIC ROUX EN-Y GASTRIC BYPASS IN OLDER PATIENTS WITH MORBID OBESITY Waleed Al-Khyatt, PhD, MRCS; Sherif Awad, PhD, FRCS; Javed Ahmed, MBBS FRCSI; The East-Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK Background: The UK National Obesity Observatory reported bariatric surgery mostly performed in patients below age 55. Older patients may not be considered good surgical candidates due to concerns regarding increased operative risk and reduced effect on established co-morbidities. This study evaluated clinical outcomes of morbidly obese patients aged 455 years compared to younger counterparts.
pneumonia, hematomas, cardiac events, abscess and more), 6) 30-day mortality rates, and 6) weight loss success (% change in BMI at 6, 12, 24, and 36 postoperative months). Results: With TR-RYGB, intraoperative complication and conversion rates for all patients, i.e. 0.32% and 0.16%, respectively, were low, and, there were no differences in intraoperative complications or conversions for males vs. females, the superobese vs. non-superobese, or older (Z60 y) vs. younger (o60 y) patients. Total operative times averaged 123.7⫾27.2(SD) minutes and mean LOS was 2.2⫾1.0 days. Operative times were significantly (po0.0001) higher for the superobese (126.8 min) and males (130.1 min) than for their respective counterparts and LOS was longer for patients Z 60 y (2.4 days). Inhospital complication and reoperation rates for the population, at large, averaged 2.43% and 2.10%, respectively, and there were no significant differences (chi sq p40.05) between these rates for the high risk patients in comparison to their respective controls. In the all-inclusive population, 30-day readmission rates averaged 5.83%, with malaise responsible for the majority (64%) of cases. Similar readmission patterns occurred for the super- vs. non-superobese and for the males vs. females. However, patients Z60 y had considerably lower readmission rates resulting from malaise than did than did their younger cohort (1.60% vs. 4.44%, respectively). Out of the 1,234 cases, only 1 anastomotic leak occurred for a rate ¼ 0.08%. Risk status had no effect on 30-day mortality (rate ¼ 0.24%). As for weight loss success, total % changes in BMI (34%) for all patients peaked at 12 months and remained relatively unchanged, thereafter. Gender had no effect on weight loss. However, % changes in BMI were less for the older vs. younger patients at 6 and 12 months and greater for the super- vs. non-superobese at 12 and 24 months. Conclusions: TR-RYGB is a safe and efficacious procedure for high risk bariatric patients including those of male gender, the elderly and superobese. The robotic procedure is particularly beneficial in lowering the risk for intraoperative complications and conversions, as well as anastomotic
A5066
LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS AS DAY SURGERY PROCEDURE Philippe Topart, MD1; Carine Phocas, RN2; Franck Hamard, MD3; 1 Socit de Chirurgie Viscrale Clinique, Angers, France; 2Clinique de l'Anjou, Angers, France; 3Anesthesiology, Clinique de l'Anjou, Angers, France
S91
apnea. Our standard RYGB procedure was used with 7.5 mg/mL Ropivacaine port site infiltration. 7 ports were used, the gastric pouch was fashioned with 1 transversal 60 mm linear stapler/cutter application and 2 vertical applications towards the angle of His. A 100 cm biliopancreatic limb and 150 cm alimentary limb was measured. The gastrojejunal anastomosis was performed by a 30 mm linear stapler with the aperture closed by a 3-0 absorbable barbed running suture. The same technique was applied to the jejunojejunal anastomosis. The anesthesiology procedure avoided morphinomimetics. Pain killers were given exclusively per oral after return to the ward. Clear liquids and soft food were allowed 3 hours after surgery and were to be taken before returning home. Blood check as well a Chung score Z 9 were mandatory to clear discharge home. Patients were called the following day and the day after by the dietician and the bariatric coordinator. They were usually seen at the clinic between 3 and 4 days postoperatively. Low molecular weight heparin twice a day for 1 week and once for the raining 2 weeks was precribed in accordance with French anaesthesiology guidelines. Nurses at home were instructed to check heart rate as well as temperature when doing the injections during the first 3 days at home. As part of an ongoing experiment some patients were monitored for 72 hours for pulse rate, body temperature and respiratory frequency using a skin patch continuously transmitting data via the cellular network. Procedure duration was 76.6 ⫾ 15.0 minutes and a cholecystectomy was associated with 2 cases. 2 patients were kept overnight (9%): 1 at the beginning of the program reported diziness and the other was not allowed to return home because her gastrojejunal anastomosis had to be redone due to a technical failure. 2 patients were readmitted within 30 days: 1 had to be reoperated on for a peritonitis of unknown origin more than 3 weeks after surgery after an uneventful postoperative course and the other received blood transfusion for an hematemesis within the first 24 hours. Despite being limited by a number of factors, day surgery RYGB appears feasible with excellent pain control as well as the ability of resuming light food early. As outlined by some studies, pulse rate is the key parameter that can suggest bleeding or leakage when tachycardia is around 120 beats per minute. Ultimately, the implementation of this day surgery program has led to numerous changes in our bariatric program with a successful systematic discharge home the day after RYGB.
A5067
Although large series of 2000 patients returning home the day after their laparoscopic Roux-en-Y gastric bypass (RYGB) have been published, a very short hospital stay is far from being the norm. Concern about major complications developing at home and the analysis of the BOLD database suggesting higher risk and even higher mortality rate for day surgery. Since July 2013 we have performed 22 attempts of Roux-en-Y gastric bypasses (RYGB) as day surgery within a systematic discharge from hospital the day after surgery for every primary RYGB. The day surgery protocol was offered to BMIo50 patients, living less than 1 hour drive from our center. Except insulin requiring type 2 diabetes, comorbidities were not regarded as contraindications. All the patients were female aged 36.8 ⫾ 8.5 years with a body mass index of 41.1 ⫾ 2.3 kg/m² . 8 patients presented with at least 1 comorbidity: 6 had hypertension, 2 type 2 diabetes and 3 sleep
THE SAFETY AND EFFICACY OF LAPAROSCOPIC ROUX EN-Y GASTRIC BYPASS IN OLDER PATIENTS WITH MORBID OBESITY Waleed Al-Khyatt, PhD, MRCS; Sherif Awad, PhD, FRCS; Javed Ahmed, MBBS FRCSI; The East-Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK Background: The UK National Obesity Observatory reported bariatric surgery mostly performed in patients below age 55. Older patients may not be considered good surgical candidates due to concerns regarding increased operative risk and reduced effect on established co-morbidities. This study evaluated clinical outcomes of morbidly obese patients aged 455 years compared to younger counterparts.