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Abstracts: 2007 Video Session / Surgery for Obesity and Related Diseases 3 (2007) 345–347
above, thought to envelope the proximal gastric pouch to prevent it from enlargement. Results: We operated 100 patients with a mean BMI of 39 kg/m2 and an excess weight of 84%. Six months, one year and two year BMIs were, respectively 32.7 (59 patients), 32.3 (30 patients) and 31.9 kg/m2 (6 patients) while at 6 months, 1yr and 2yrs %EWL was respectively 35%, 37% and 47%. These results are comparable to our series of 1025 regular AGB. There was no proximal gastric pouch dilatation in BB vs.. 6.6% in regular AGB group. No patient required a reoperation for complications. Conclusions: Although the two series are not comparable (1025 patients with 10 yr follow-up in AGB group vs. 100 patients with 2 yr follow-up for BB), low long-term complications and decreased vomiting and dysphagia with the BB are encouraging. PII: S1550-7289(07)00383-8 V6.
LAPAROSCOPIC REMOVAL OF ERODED GASTRIC BAND: A NOVEL APPROACH. Nicole R. Basa, MD*; SooHwa Han, MD*; Erik Dutson, MD*; Marvin Derezin, MD**; Amir Mehran, MD* *UCLA Department of Surgery, Los Angeles, CA **UCLA Department of Gastroenterology, Los Angeles, CA A common complication after placement of adjustable gastric bands for weight loss is band erosion into the stomach. Most gastric bands are removed either endoscopically within the gastric lumen or laparoscopically by dividing the band extra-luminally. This video will describe a novel approach not demonstrated in the literature to remove a band intraluminally via a gastrotomy performed laparoscopically. This can aid the surgeon who finds no access to the band externally due to multiple adhesions between the lesser curvature of the stomach and the liver or an inability to divide the band endoscopically due to the restriction of current endoscopic equipment. PII: S1550-7289(07)00384-X
green cartridges initially) over a 36 Fr boogie after entering the retro-gastric space 6cm away the pylorus on the greater curvature; this was oversewn with 2-0 PDS. The duodenum was transected with a stapler 2cm below the pylorus. The ileum was marked 100 cm proximal to ileocecal valve. An antecolic isoperistaltic (omega shape) loop was attached to the distal duodenal stump as a side-to-side stapled duodeno-ileostomy. An enteroenteric stapled anastomoses was constructed with the alimentary limb, the limb was divided and the anastomoses tested. The resected stomach and gallbladder were removed and drains left on the sleeve and duodenal sites. Results: This approach has the advantage of construction of the sleeve first, allowing better tissue stabilization, use of 6 trocars and a double-loop bypass which was a highly reproducible, simplified approach and may facilitate the learning curve for the laparoscopic BPD/DS. Conclusion: The laparoscopic BPD/DS is a simplified approach with double-loop and can help standardize this technique. PII: S1550-7289(07)00385-1 V8.
LAPAROSCOPIC REVISION OF GASTROJEJUNOSTOMY DUE TO REFRACTORY MARGINAL ULCER. Sam C Rossi, MD; Stacy Brethauer, MD; Jeff Landers, MD; Suthep Udomsawaengsup, MD; Matt Metz, MD; Philip R Schauer, MD Cleveland Clinic Foundation, Cleveland, OH This video shows a laparoscopic revision of the gastrojejunostomy from an open gastric bypass due to a refractory marginal ulcer. The patient was suffering from chronic abdominal pain, chronic malnutrition, and failure to thrive. The patient underwent a staged laparoscopic gastrostomy tube followed by laparoscopic revision after nutritional improvement PII: S1550-7289(07)00386-3 V9.
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SIMPLIFIED LAPAROSCOPIC DUODENAL SWITCH. Almino Ramos, MD; Manoel Galvao Neto; MD, Manoela Galvao, MD; Andrey Carlo, MD; Edwin Canseco, MD; Marcus Lima, MD; Abel Murakami, MD; Marcelo Falcao, MD Gastro Obeso Center, Sao Paulo, Brazil Background: There are procedures for the surgical treatment of severe obesity, one of which is the biliopancreatic diversion/ duodenal switch (BPD/DS), a highly effective weight loss operation performed either open or laparoscopically. This is considered to be a very complex laparoscopic procedure. We have used a simplified laparoscopic gastric bypass procedure (2005 ASBS video) in ⬎ 2,000 cases, which has been reproduced in Latin America, Europe and Asia with similar results. As the BPD/DS may be more effective for super-obese patients, we have also developed a simplified and reproducible approach for this operation. Methods: 6 trocars (3, 12mm and 3, 5mm), similar to a Nissen procedure, were inserted with the patient in a semi-lithotomy position. A vertical gastrectomy was performed with staplers (2
LAPAROSCOPIC MANAGEMENT OF CHRONIC POUCH FISTULA FOLLOWING A LEAK AFTER REVISIONAL SURGERY FOR POUCH DILATION AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS. Olga N Tucker, MD; Tomas Escalante-Tattersfield, MD; Emil Matei, MD; Samuel Szomstein, MD; Raul J Rosenthal, MD; Cleveland Clinic Florida, Weston, FL Fistula formation after laparoscopic divided Roux-en-Y gastric bypass (LRYGB) is uncommon. We present our experience with a chronic gastric pouch fistula following a leak after pouch revision for dilation following LRYGB. In 2002, a 42-year-old male underwent LRYGB with a 50cc pouch for super morbid obesity. Ten months later, a laparoscopic internal hernia reduction was performed for intestinal obstruction. Three months later, he had laparoscopic trimming of a dilated gastric pouch. A contrast study on postoperative day (POD) 1 was normal. On POD 7, he presented with shoulder pain and fever. Following radiological confirmation of a leak, he underwent laparoscopy, which demonstrated a purulent collection adjacent to the pouch
Abstracts: 2007 Video Session / Surgery for Obesity and Related Diseases 3 (2007) 345–347
above, thought to envelope the proximal gastric pouch to prevent it from enlargement. Results: We operated 100 patients with a mean BMI of 39 kg/m2 and an excess weight of 84%. Six months, one year and two year BMIs were, respectively 32.7 (59 patients), 32.3 (30 patients) and 31.9 kg/m2 (6 patients) while at 6 months, 1yr and 2yrs %EWL was respectively 35%, 37% and 47%. These results are comparable to our series of 1025 regular AGB. There was no proximal gastric pouch dilatation in BB vs.. 6.6% in regular AGB group. No patient required a reoperation for complications. Conclusions: Although the two series are not comparable (1025 patients with 10 yr follow-up in AGB group vs. 100 patients with 2 yr follow-up for BB), low long-term complications and decreased vomiting and dysphagia with the BB are encouraging. PII: S1550-7289(07)00383-8 V6.
LAPAROSCOPIC REMOVAL OF ERODED GASTRIC BAND: A NOVEL APPROACH. Nicole R. Basa, MD*; SooHwa Han, MD*; Erik Dutson, MD*; Marvin Derezin, MD**; Amir Mehran, MD* *UCLA Department of Surgery, Los Angeles, CA **UCLA Department of Gastroenterology, Los Angeles, CA A common complication after placement of adjustable gastric bands for weight loss is band erosion into the stomach. Most gastric bands are removed either endoscopically within the gastric lumen or laparoscopically by dividing the band extra-luminally. This video will describe a novel approach not demonstrated in the literature to remove a band intraluminally via a gastrotomy performed laparoscopically. This can aid the surgeon who finds no access to the band externally due to multiple adhesions between the lesser curvature of the stomach and the liver or an inability to divide the band endoscopically due to the restriction of current endoscopic equipment. PII: S1550-7289(07)00384-X
green cartridges initially) over a 36 Fr boogie after entering the retro-gastric space 6cm away the pylorus on the greater curvature; this was oversewn with 2-0 PDS. The duodenum was transected with a stapler 2cm below the pylorus. The ileum was marked 100 cm proximal to ileocecal valve. An antecolic isoperistaltic (omega shape) loop was attached to the distal duodenal stump as a side-to-side stapled duodeno-ileostomy. An enteroenteric stapled anastomoses was constructed with the alimentary limb, the limb was divided and the anastomoses tested. The resected stomach and gallbladder were removed and drains left on the sleeve and duodenal sites. Results: This approach has the advantage of construction of the sleeve first, allowing better tissue stabilization, use of 6 trocars and a double-loop bypass which was a highly reproducible, simplified approach and may facilitate the learning curve for the laparoscopic BPD/DS. Conclusion: The laparoscopic BPD/DS is a simplified approach with double-loop and can help standardize this technique. PII: S1550-7289(07)00385-1 V8.
LAPAROSCOPIC REVISION OF GASTROJEJUNOSTOMY DUE TO REFRACTORY MARGINAL ULCER. Sam C Rossi, MD; Stacy Brethauer, MD; Jeff Landers, MD; Suthep Udomsawaengsup, MD; Matt Metz, MD; Philip R Schauer, MD Cleveland Clinic Foundation, Cleveland, OH This video shows a laparoscopic revision of the gastrojejunostomy from an open gastric bypass due to a refractory marginal ulcer. The patient was suffering from chronic abdominal pain, chronic malnutrition, and failure to thrive. The patient underwent a staged laparoscopic gastrostomy tube followed by laparoscopic revision after nutritional improvement PII: S1550-7289(07)00386-3 V9.
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SIMPLIFIED LAPAROSCOPIC DUODENAL SWITCH. Almino Ramos, MD; Manoel Galvao Neto; MD, Manoela Galvao, MD; Andrey Carlo, MD; Edwin Canseco, MD; Marcus Lima, MD; Abel Murakami, MD; Marcelo Falcao, MD Gastro Obeso Center, Sao Paulo, Brazil Background: There are procedures for the surgical treatment of severe obesity, one of which is the biliopancreatic diversion/ duodenal switch (BPD/DS), a highly effective weight loss operation performed either open or laparoscopically. This is considered to be a very complex laparoscopic procedure. We have used a simplified laparoscopic gastric bypass procedure (2005 ASBS video) in ⬎ 2,000 cases, which has been reproduced in Latin America, Europe and Asia with similar results. As the BPD/DS may be more effective for super-obese patients, we have also developed a simplified and reproducible approach for this operation. Methods: 6 trocars (3, 12mm and 3, 5mm), similar to a Nissen procedure, were inserted with the patient in a semi-lithotomy position. A vertical gastrectomy was performed with staplers (2
LAPAROSCOPIC MANAGEMENT OF CHRONIC POUCH FISTULA FOLLOWING A LEAK AFTER REVISIONAL SURGERY FOR POUCH DILATION AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS. Olga N Tucker, MD; Tomas Escalante-Tattersfield, MD; Emil Matei, MD; Samuel Szomstein, MD; Raul J Rosenthal, MD; Cleveland Clinic Florida, Weston, FL Fistula formation after laparoscopic divided Roux-en-Y gastric bypass (LRYGB) is uncommon. We present our experience with a chronic gastric pouch fistula following a leak after pouch revision for dilation following LRYGB. In 2002, a 42-year-old male underwent LRYGB with a 50cc pouch for super morbid obesity. Ten months later, a laparoscopic internal hernia reduction was performed for intestinal obstruction. Three months later, he had laparoscopic trimming of a dilated gastric pouch. A contrast study on postoperative day (POD) 1 was normal. On POD 7, he presented with shoulder pain and fever. Following radiological confirmation of a leak, he underwent laparoscopy, which demonstrated a purulent collection adjacent to the pouch