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Bone mineral density in women 12 months after bariatric surgery: Comparison between laparoscopic sleeve gastrectomy, gastric bypass and sleeve gastrectomy with jejunal bypass.
Poster Presentations / Surgery for Obesity and Related Diseases 11 (2015) S56–S211
initially a redo RYGBP, and 2 required early open re-operations due to leaks. There were no significant differences between patients with POVH recurrence and those without when considering preoperative factors, types of bariatric surgery, operative factors or postoperative adverse events. [Table #1] Surgical site infections at the hernia site occurred in 9/141 patients (6.4%), and only 1 of these was in the recurrence group. Median time to recurrence was 14 months (shortest 1 day, longest 30 months). 3 patients recurred o30d post-op and 2 of those 3 had another recurrence at a later time. Mean BMI and %EWL at recurrence was 36.5% and 22.9%, respectively. Conclusions: Ventral hernias range from single, simple defects to loss of abdominal domain. This range in POVH complexity has made it difficult to understand recurrence rates and therefore to create clear guidelines for management at the time of bariatric surgery. Mesh has been shown to improve recurrence rates with laparoscopic and open POVH repair but its use with concomitant bariatric surgical procedures increases the technical complexity and cost as well as creating the risk of mesh and surgical site infections. We collected data on 92% of patients with at least a 12 month follow up and a mean of 32 months undergoing concomitant primary ventral hernia repair. A primary sutured repair resulted in few complications and a very low recurrence rate of 7.8%. Our study suggests that when fascial approximation can be achieved with primary sutured repair of POVH, this results in a low recurrence rate and should be the first option in bariatric surgical procedures.
A5041
BONE MINERAL DENSITY IN WOMEN 12 MONTHS AFTER BARIATRIC SURGERY: COMPARISON BETWEEN LAPAROSCOPIC SLEEVE GASTRECTOMY, GASTRIC BYPASS AND SLEEVE GASTRECTOMY WITH JEJUNAL BYPASS. Matias Sepulveda, MD; Yudith Preiss, MD, MSc; Santiago Ximena Prat, MD; Andrea Morales, MD; Hospital Dipreca, Santiago, Region Metropolitana, Chile Background: Bariatric surgery (BS) generates high nutritional disorders caused by a decreased absorption of nutrients. One of them is an altered bone mineral density (BMD), which is affected by many factors such as weight loss secondary to either surgical or medical treatment. The goal of this study is to compare BMD in obese women at one year after Roux-en-Y Gastric Bypass (RYGB), Sleeve Gastrectomy (SG) or Sleeve Gastrectomy with Jejunal Bypass (SGJB) and to evaluate BMD association with calcium and vitamin D and/or multivitamins supplements and percentage of excess weight loss (%EWL). Methods: Analytic observational retrospective study. Records of 90 pre and postmenopausal women, who underwent bariatric surgery between 2009 and 2013, were reviewed. 30 patients for each technique were included. The following variables were registered pre and post-surgically (at 12 months): %EWL and use of calcium-vitamin D supplements. BMD at 12 months was evaluated according to ISCD criteria. For continuous variables Mann Withney or t-student test were used. For the primary endpoint presence or absence of BMD in different techniques, chi-square test was used. To analyze relation between BMD and the other variables, models of ordinal logistic regression were constructed, with a 95% of confidence.
S77
Results: Patients in RYGB group were significantly older than the other two groups (po0.05) and SG group presented a lower weight and BMI than the others (po0.05). Calcium intake was similar between the three groups. Normal BMD in RYGB, SG and SGJB are 75.9%, 96.7% and 86.7% respectively. The difference is significant between SG and RYGB. Older age and lower preoperative weight are strongly associated with altered BMD diagnosis, with no relation to calcium and/or vitamin D intake. At 12 months, there are no significant relation between weight loss and BMD. Regarding surgical techniques, SG has significantly lower risk of developing bone mineral disease when compared with RYGB and SGJB, which is consistent in every built model. Conclusion: SG compared with RYGB and SGJB has significant lower risk of BMD disease at 12 months after surgery. Explanation for these results are yet to be dilucidated with further studies, because of heterogeneity between groups.
A5042
IS THERE ANY RELEVANT ADVANTAGE USING A RING AMONG RYGBP PATIENTS? Silvia Faria, MSc, RD1; Orlando Faria, MD2; Mariane Cardeal, MD3; Larissa Berber Treinee2; 1Gastrocirurgia, Brasilia, DF, Brazil; 2Gastrocirurgia de Brasilia, Brasilia, DF, Brazil; 3University of Brasilia, Brasilia, Distrito Federal, Brazil Introduction: Roux-Y Gastric Bypass (RYGBP) is an effective tool for long-term weight loss success. However, Roux-en-Y Gastric Bypass patients generally suffer unexpected difficulties with food intake because of resultant physiological changes from the surgery. In some patients, a gastric containment ring is placed to avoid dilated gastrojejunostomy and, theoretically, reduce chances of weight regain. Currently, much of bariatric surgery is done without this ring due to evidence of its obstructing protein intake, critical to post-operative (post-op) nutritional recovery and the decrease of vomiting. Objective: Compare caloric intake, considering the quantity of protein and other macronutrients ingested, along with any occurrence of vomiting in two groups of operated patients, one with and the other without a containment ring. Methods: This retrospective study analyzed medical records collecting data from two groups of Roux-en-Y Bypass patients, one with and the other without the placement of the containment ring around the gastric pouch. Analyses of food consumption were based on four randomly chosen 24-hour post-op recall records during consultations with nutritionists. Percentage of excess weight loss data was collected based on the most recent weight in relation to the collection period. The occurrence of vomiting was recorded from the first post-op consultation until the most recent. All patients had more than 2 yeas of surgery. Exclusion criterias were: pregnant patients, patients with dental problems e/or any sign of infection. Results: 100 medical records were analyzed, 50 of each group mentioned. Mean time since surgery for the ring patients was 130.08 ⫾ 3.44 months, while for those without the ring it was 81.21 ⫾ 3.72 months. In the ring group, there was a significant increase in the average percentage of carbohydrates and lipids consumption along with occurrence of vomiting and a decrease in the average percentage of protein and fiber ingested. No statistical differences in excess weight loss were found between the two groups. Patients among the group without the ring consumed
initially a redo RYGBP, and 2 required early open re-operations due to leaks. There were no significant differences between patients with POVH recurrence and those without when considering preoperative factors, types of bariatric surgery, operative factors or postoperative adverse events. [Table #1] Surgical site infections at the hernia site occurred in 9/141 patients (6.4%), and only 1 of these was in the recurrence group. Median time to recurrence was 14 months (shortest 1 day, longest 30 months). 3 patients recurred o30d post-op and 2 of those 3 had another recurrence at a later time. Mean BMI and %EWL at recurrence was 36.5% and 22.9%, respectively. Conclusions: Ventral hernias range from single, simple defects to loss of abdominal domain. This range in POVH complexity has made it difficult to understand recurrence rates and therefore to create clear guidelines for management at the time of bariatric surgery. Mesh has been shown to improve recurrence rates with laparoscopic and open POVH repair but its use with concomitant bariatric surgical procedures increases the technical complexity and cost as well as creating the risk of mesh and surgical site infections. We collected data on 92% of patients with at least a 12 month follow up and a mean of 32 months undergoing concomitant primary ventral hernia repair. A primary sutured repair resulted in few complications and a very low recurrence rate of 7.8%. Our study suggests that when fascial approximation can be achieved with primary sutured repair of POVH, this results in a low recurrence rate and should be the first option in bariatric surgical procedures.
A5041
BONE MINERAL DENSITY IN WOMEN 12 MONTHS AFTER BARIATRIC SURGERY: COMPARISON BETWEEN LAPAROSCOPIC SLEEVE GASTRECTOMY, GASTRIC BYPASS AND SLEEVE GASTRECTOMY WITH JEJUNAL BYPASS. Matias Sepulveda, MD; Yudith Preiss, MD, MSc; Santiago Ximena Prat, MD; Andrea Morales, MD; Hospital Dipreca, Santiago, Region Metropolitana, Chile Background: Bariatric surgery (BS) generates high nutritional disorders caused by a decreased absorption of nutrients. One of them is an altered bone mineral density (BMD), which is affected by many factors such as weight loss secondary to either surgical or medical treatment. The goal of this study is to compare BMD in obese women at one year after Roux-en-Y Gastric Bypass (RYGB), Sleeve Gastrectomy (SG) or Sleeve Gastrectomy with Jejunal Bypass (SGJB) and to evaluate BMD association with calcium and vitamin D and/or multivitamins supplements and percentage of excess weight loss (%EWL). Methods: Analytic observational retrospective study. Records of 90 pre and postmenopausal women, who underwent bariatric surgery between 2009 and 2013, were reviewed. 30 patients for each technique were included. The following variables were registered pre and post-surgically (at 12 months): %EWL and use of calcium-vitamin D supplements. BMD at 12 months was evaluated according to ISCD criteria. For continuous variables Mann Withney or t-student test were used. For the primary endpoint presence or absence of BMD in different techniques, chi-square test was used. To analyze relation between BMD and the other variables, models of ordinal logistic regression were constructed, with a 95% of confidence.
S77
Results: Patients in RYGB group were significantly older than the other two groups (po0.05) and SG group presented a lower weight and BMI than the others (po0.05). Calcium intake was similar between the three groups. Normal BMD in RYGB, SG and SGJB are 75.9%, 96.7% and 86.7% respectively. The difference is significant between SG and RYGB. Older age and lower preoperative weight are strongly associated with altered BMD diagnosis, with no relation to calcium and/or vitamin D intake. At 12 months, there are no significant relation between weight loss and BMD. Regarding surgical techniques, SG has significantly lower risk of developing bone mineral disease when compared with RYGB and SGJB, which is consistent in every built model. Conclusion: SG compared with RYGB and SGJB has significant lower risk of BMD disease at 12 months after surgery. Explanation for these results are yet to be dilucidated with further studies, because of heterogeneity between groups.
A5042
IS THERE ANY RELEVANT ADVANTAGE USING A RING AMONG RYGBP PATIENTS? Silvia Faria, MSc, RD1; Orlando Faria, MD2; Mariane Cardeal, MD3; Larissa Berber Treinee2; 1Gastrocirurgia, Brasilia, DF, Brazil; 2Gastrocirurgia de Brasilia, Brasilia, DF, Brazil; 3University of Brasilia, Brasilia, Distrito Federal, Brazil Introduction: Roux-Y Gastric Bypass (RYGBP) is an effective tool for long-term weight loss success. However, Roux-en-Y Gastric Bypass patients generally suffer unexpected difficulties with food intake because of resultant physiological changes from the surgery. In some patients, a gastric containment ring is placed to avoid dilated gastrojejunostomy and, theoretically, reduce chances of weight regain. Currently, much of bariatric surgery is done without this ring due to evidence of its obstructing protein intake, critical to post-operative (post-op) nutritional recovery and the decrease of vomiting. Objective: Compare caloric intake, considering the quantity of protein and other macronutrients ingested, along with any occurrence of vomiting in two groups of operated patients, one with and the other without a containment ring. Methods: This retrospective study analyzed medical records collecting data from two groups of Roux-en-Y Bypass patients, one with and the other without the placement of the containment ring around the gastric pouch. Analyses of food consumption were based on four randomly chosen 24-hour post-op recall records during consultations with nutritionists. Percentage of excess weight loss data was collected based on the most recent weight in relation to the collection period. The occurrence of vomiting was recorded from the first post-op consultation until the most recent. All patients had more than 2 yeas of surgery. Exclusion criterias were: pregnant patients, patients with dental problems e/or any sign of infection. Results: 100 medical records were analyzed, 50 of each group mentioned. Mean time since surgery for the ring patients was 130.08 ⫾ 3.44 months, while for those without the ring it was 81.21 ⫾ 3.72 months. In the ring group, there was a significant increase in the average percentage of carbohydrates and lipids consumption along with occurrence of vomiting and a decrease in the average percentage of protein and fiber ingested. No statistical differences in excess weight loss were found between the two groups. Patients among the group without the ring consumed