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P7
Abstracts: 2007 Poster Session / Surgery for Obesity and Related Diseases 3 (2007) 299 –344
Inc.) and endoluminal views of the gastric pouch were generated with perspective volume rendering. Pouch area was also measured from the standard postoperative upper gastrointestinal (UGI) contrast study. Results: All patients were female, with a mean preoperative BMI of 43.7 kg/m2 and a mean age of 44.3 years. Mean pouch height was 4.07 cm, mean pouch width was 3.79 cm, and mean pouch depth was 2.1 cm. The mean calculated pouch volume was 31.6 cm3. The calculated pouch area using 3-D CT was statistically indistinct from the pouch area calculated using the UGI study (15.2 cm2 vs. 16.9 cm2; p⫽0.549.) Conclusion: For the first time, we describe the use of 3-D CT to accurately measure post-operative pouch volume. Additionally, we were able to confirm the utility of area (postoperative UGI) as an accurate surrogate for pouch volume. PII: S1550-7289(07)00247-X P7.
EFFECT OF HISTAMINE-2 BLOCKERS OR PROTON PUMP INHIBITORS ON THE INCIDENCE OF ANASTOMOTIC ULCER AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS. Ioannis Raftopoulos, MD, PhD; Kambiz Zainabadi, MD University of Pittsburgh, Pittsburgh, PA Background: The impact of routine use of histamine-2 (H-2) blockers, or proton pump inhibitors (PPI) on the incidence of anastomotic ulcer (AU) and pouch gastritis (PG) is not known. Methods: 230 consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) and had a minimum of a 2 month follow-up were included in this study. Postoperative esophagogastroduodenoscopy (EGD) was performed selectively on patients with suspicious symptoms. P ⬍ 0.05 was significant. Results: Mean age and body mass index (BMI) were 44.9 (18-73) years and 49.7 (35.3-75.5) Kg/m2 respectively. The incidence of AU was 4.3% (10/230) and PG 0.9% (2/230). The following prophylactic treatment variations were observed: Histamine 2 (H2) blockers only (n⫽93), proton pump inhibitor (PPI) only (n⫽31), H2 blockers followed by PPI (n⫽27), PPI followed by H2 blockers (n⫽6), intermittent therapy (n⫽62), or no treatment (n⫽11). There was a significant reduction (p⫽0.02) of AU, or PG in patients who were on PPI therapy compared to patients on H2 blockers (7/141, 4.96%), or without prophylactic treatment (5/73, 6.84%). The incidence of AU, or PG was higher, but not statistically significant, in patients without prophylactic treatment than H2 blockers and in patients on ranitidine treatment compared to famotidine (2/20, 10% vs. 5/125, 4%). The length of time on no prophylactic treatment had no effect on the incidence of AU or PG. Conclusion: Prophylactic treatment, particularly with PPI, can decrease the incidence of AU and PG after LRYGB and should be recommended. PII: S1550-7289(07)00248-1 P8.
EFFECT OF LIMB LENGTH IN ROUX-EN-Y GASTRIC BYPASS IN PATIENTS WITH BMI 45-50KG/M2. Neelu Pal, MD; Robert Brolin, MD University Medical Center at Princeton, Princeton, NJ
301
Background: Published reports have demonstrated that increasing the length of the Roux limb in RYGB results in increased weight loss in super-obese patients. Conversely, extending Roux limb length in patients with BMI⬍50kg/m2 has not consistently shown an increase in weight loss. The purpose of this study was to determine if increasing Roux limb length would affect weight loss in a subset of patients with BMI 45-50kg/m2. Methods: A retrospective review of 272 patients with BMI 4550kg/m2 was performed. Patients operated on from 1984-2001 underwent open RYGB, whereas 2002-2004 had laparoscopic RYGB. All patients had ante-gastric Roux limb (75-150 cm), bilopancreatic limb of 20-30cm, and a circular stapled gastrojejunostomy. Weight loss at 6 and 12 months was compared between short and long limb patients. Results: 154 patients underwent long limb RYGB (58 open, 96 laparoscopic) and 118 short limb RYGB (76 open, 42 laparoscopic). The mean preoperative weight for the long and short limb patients was 135.7kg (BMI 47.kg/m2) and 124.2kg (BMI 46.3kg/ m2) respectively. Mean %EWL at 6 months in long and short limb groups were 58.3% and 54.5% and at 12 months 70% and 71.1%. There was no significant difference in post-operative complications or length of hospital stay between the two groups. Conclusion: The subset of patients with BMI 45-50kg/m2 does not benefit from an increase in Roux limb length. Further subset analyses may identify patient groups that could benefit by increase in limb length in patients with BMI⬍50kg/m2. PII: S1550-7289(07)00249-3 P9.
PREOPERATIVE WEIGHT LOSS IS NOT A PREDICTOR OF POSTOPERATIVE WEIGHT LOSS AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS. Arthur M Carlin, MD; Sameeh Kawar, MD; Elizabeth A O’Connor; Jeffrey A Genaw, MD Henry Ford Hospital, Detroit, MI Background: Identification of preoperative predictors of weight loss following laparoscopic Roux-en-Y gastric bypass (LRYGB) could lead to improved clinical outcomes. The purpose of this study was to determine if preoperative weight loss was associated with improved %EWL one year after LRYGB. Methods: A retrospective analysis was performed on 295 patients who underwent LRYGB at our institution from July 2004 thru November 2005. Routine preoperative weight loss goals were implemented to facilitate the laparoscopic approach and ensure compliance with an appropriate nutritional and exercise program. Patients with a BMI at initial consultation of ⬍50, 50 thru 59, and ⱖ 60 kg/m2 were given weight loss goals of 5 lbs, 5% of body weight, and 10% of body weight, respectively. Results: The mean age was 45 ⫾ 10; 89% were women and 70% white. The mean BMI at initial consultation was 51 ⫾ 7 kg/m2. There was a significant inverse correlation between preop BMI and %EWL at one year postop (p⬍0.001). When controlling for BMI there was no significant correlation between %EWL and % preoperative weight loss or attainment of weight loss goal. Weight loss goals were met or surpassed by 79% and the others achieved a median 82% of their weight loss goal. Patients achieving ⱖ150% of their weight loss goal had significantly greater %EWL one year postop (69% vs. 64%; p⬍0.008).
Inc.) and endoluminal views of the gastric pouch were generated with perspective volume rendering. Pouch area was also measured from the standard postoperative upper gastrointestinal (UGI) contrast study. Results: All patients were female, with a mean preoperative BMI of 43.7 kg/m2 and a mean age of 44.3 years. Mean pouch height was 4.07 cm, mean pouch width was 3.79 cm, and mean pouch depth was 2.1 cm. The mean calculated pouch volume was 31.6 cm3. The calculated pouch area using 3-D CT was statistically indistinct from the pouch area calculated using the UGI study (15.2 cm2 vs. 16.9 cm2; p⫽0.549.) Conclusion: For the first time, we describe the use of 3-D CT to accurately measure post-operative pouch volume. Additionally, we were able to confirm the utility of area (postoperative UGI) as an accurate surrogate for pouch volume. PII: S1550-7289(07)00247-X P7.
EFFECT OF HISTAMINE-2 BLOCKERS OR PROTON PUMP INHIBITORS ON THE INCIDENCE OF ANASTOMOTIC ULCER AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS. Ioannis Raftopoulos, MD, PhD; Kambiz Zainabadi, MD University of Pittsburgh, Pittsburgh, PA Background: The impact of routine use of histamine-2 (H-2) blockers, or proton pump inhibitors (PPI) on the incidence of anastomotic ulcer (AU) and pouch gastritis (PG) is not known. Methods: 230 consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) and had a minimum of a 2 month follow-up were included in this study. Postoperative esophagogastroduodenoscopy (EGD) was performed selectively on patients with suspicious symptoms. P ⬍ 0.05 was significant. Results: Mean age and body mass index (BMI) were 44.9 (18-73) years and 49.7 (35.3-75.5) Kg/m2 respectively. The incidence of AU was 4.3% (10/230) and PG 0.9% (2/230). The following prophylactic treatment variations were observed: Histamine 2 (H2) blockers only (n⫽93), proton pump inhibitor (PPI) only (n⫽31), H2 blockers followed by PPI (n⫽27), PPI followed by H2 blockers (n⫽6), intermittent therapy (n⫽62), or no treatment (n⫽11). There was a significant reduction (p⫽0.02) of AU, or PG in patients who were on PPI therapy compared to patients on H2 blockers (7/141, 4.96%), or without prophylactic treatment (5/73, 6.84%). The incidence of AU, or PG was higher, but not statistically significant, in patients without prophylactic treatment than H2 blockers and in patients on ranitidine treatment compared to famotidine (2/20, 10% vs. 5/125, 4%). The length of time on no prophylactic treatment had no effect on the incidence of AU or PG. Conclusion: Prophylactic treatment, particularly with PPI, can decrease the incidence of AU and PG after LRYGB and should be recommended. PII: S1550-7289(07)00248-1 P8.
EFFECT OF LIMB LENGTH IN ROUX-EN-Y GASTRIC BYPASS IN PATIENTS WITH BMI 45-50KG/M2. Neelu Pal, MD; Robert Brolin, MD University Medical Center at Princeton, Princeton, NJ
301
Background: Published reports have demonstrated that increasing the length of the Roux limb in RYGB results in increased weight loss in super-obese patients. Conversely, extending Roux limb length in patients with BMI⬍50kg/m2 has not consistently shown an increase in weight loss. The purpose of this study was to determine if increasing Roux limb length would affect weight loss in a subset of patients with BMI 45-50kg/m2. Methods: A retrospective review of 272 patients with BMI 4550kg/m2 was performed. Patients operated on from 1984-2001 underwent open RYGB, whereas 2002-2004 had laparoscopic RYGB. All patients had ante-gastric Roux limb (75-150 cm), bilopancreatic limb of 20-30cm, and a circular stapled gastrojejunostomy. Weight loss at 6 and 12 months was compared between short and long limb patients. Results: 154 patients underwent long limb RYGB (58 open, 96 laparoscopic) and 118 short limb RYGB (76 open, 42 laparoscopic). The mean preoperative weight for the long and short limb patients was 135.7kg (BMI 47.kg/m2) and 124.2kg (BMI 46.3kg/ m2) respectively. Mean %EWL at 6 months in long and short limb groups were 58.3% and 54.5% and at 12 months 70% and 71.1%. There was no significant difference in post-operative complications or length of hospital stay between the two groups. Conclusion: The subset of patients with BMI 45-50kg/m2 does not benefit from an increase in Roux limb length. Further subset analyses may identify patient groups that could benefit by increase in limb length in patients with BMI⬍50kg/m2. PII: S1550-7289(07)00249-3 P9.
PREOPERATIVE WEIGHT LOSS IS NOT A PREDICTOR OF POSTOPERATIVE WEIGHT LOSS AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS. Arthur M Carlin, MD; Sameeh Kawar, MD; Elizabeth A O’Connor; Jeffrey A Genaw, MD Henry Ford Hospital, Detroit, MI Background: Identification of preoperative predictors of weight loss following laparoscopic Roux-en-Y gastric bypass (LRYGB) could lead to improved clinical outcomes. The purpose of this study was to determine if preoperative weight loss was associated with improved %EWL one year after LRYGB. Methods: A retrospective analysis was performed on 295 patients who underwent LRYGB at our institution from July 2004 thru November 2005. Routine preoperative weight loss goals were implemented to facilitate the laparoscopic approach and ensure compliance with an appropriate nutritional and exercise program. Patients with a BMI at initial consultation of ⬍50, 50 thru 59, and ⱖ 60 kg/m2 were given weight loss goals of 5 lbs, 5% of body weight, and 10% of body weight, respectively. Results: The mean age was 45 ⫾ 10; 89% were women and 70% white. The mean BMI at initial consultation was 51 ⫾ 7 kg/m2. There was a significant inverse correlation between preop BMI and %EWL at one year postop (p⬍0.001). When controlling for BMI there was no significant correlation between %EWL and % preoperative weight loss or attainment of weight loss goal. Weight loss goals were met or surpassed by 79% and the others achieved a median 82% of their weight loss goal. Patients achieving ⱖ150% of their weight loss goal had significantly greater %EWL one year postop (69% vs. 64%; p⬍0.008).