- Email: [email protected]
DOUBLE ROW SUTURE TECHNIQUE TO PREVENT PETERSEN’S HERNIA AFTER GASTRIC BYPASS
S80
ASMBS E-Poster Abstracts / Surgery for Obesity and Related Diseases 13 (2017) S66–S226
DS: 74.23±0.71%EWL, po0.0001) after surgery. No significant change in the percentage of excess weight loss at 3, 6 and 12 months was recorded between the two groups (all p40.05). Nightshift workers displayed significantly higher levels of HbA1C preoperatively (NS: 7.13±0.30%; DS: 6.32±0.04%; p¼0.0005). A significant change occurred in HbA1C 12 months postoperatively (p¼0.0015) when comparing night-shift workers (pre, 7.1±0.30% to post, 5.6±0.13%) and day-shift workers (pre, 6.3±0.04% to post, 5.5±0.02%). Diabetes remission one year after surgery was similar in night-shift and day-shift workers. Night-shift workers, unlike dayshift workers, see no significant improvements in their levels of LDL (NS: 96.92±6.82 to 100.3±9.97 mg/dL, p¼0.6695; DS: 110.8 ±1.08 to 94.3±1.07 mg/dL, po0.0001), cholesterol (NS: 177.2± 7.97 to 165.6±11.06 mg/dL, p¼0.4303; DS: 182.8±1.21 to 168.5 ±1.27 mg/dL, po0.0001), triglycerides (NS: 161.5±30.09 to 99.54 ±12.21 mg/dL, p ¼ 0.096; DS: 150.6±3.61 to 96.47±2.20 mg/dL, po0.0001), lipoprotein-A (NS: 32.93±7.09 to 20.13±8.1 mg/dL, p¼0.085; DS: 27.98±1.32 to 21.75±1.27 mg/dL, p¼0.0078) and homocysteine (9.61±0.74 to 8.99±0.74 μmol/L, p¼0.372; DS: 10.03±0.15 to 8.98±0.18 mg/dL, po0.0001). Conclusions: Night-shift workers achieve similar benefit postoperatively in weight reduction and HbA1c reduction, but fail to see similar benefit in biochemical cardiac risk factors. Night shift workers may need additional therapy including change in work shifts to achieve similar benefits as day shift workers undergoing weight loss surgery.
A5029
ROUX EN Y GASTRIC BYPASS AS A PROPOSED TREATMENT OPERATION FOR PATIENTS WITH HEMOCHROMATOSIS- A CASE SERIES Yagnik Pandya1; Darius Ameri1; Jacqueline Paolino2; 1MetroWest Medical Center, Natick MA; 2Tufts Medical Center Background: Hemochromatosis is an autosomal recessive disease of iron overload affecting 1 in 200 Caucasian people. Up to one third of patients will manifest end organ dysfunction due to iron overload. Treatment consists of monitoring of ferritin levels and performing therapeutic phlebotomy as frequently as every few weeks, depending on the iron overload. Roux-en-y gastric bypass is known to induce iron deficiency due to bypass of the duodenum, where iron is absorbed. We describe a case series of three patients with hemochromatosis and iron overload who preoperatively required periodic phlebotomy. After undergoing laparoscopic Roux-en-y gastric bypass for morbid obesity, all three patients experienced an improvement in their ferritin levels and a decrease in the frequency of therapeutic phlebotomy. Two of three patients did not require any therapeutic phlebotomy, at any point after surgery. One patient needed therapeutic phlebotomy only twice a year after
surgery, for the first three years, in comparison to five times a year pre operatively. None of the patients needed phlebotomy at four years of follow up after Roux-en-y gastric bypass. Roux-en-y gastric bypass appears to confer a benefit to patients with hemochromatosis by reducing iron absorption. To date, only a few case series have reported the effect of malabsorptive weight loss procedures on the improvement or resolution of hemochromatosis. This case series, is one of the few such studeis, that specifically report the impact of Roux-en-y gastric bypass on iron overload and hemochromatosis. This could serve as a stimulus for larger studies in patients with this disease. Hemochromatosis requiring preoperative therapeutic phlebotomy may be considered an indication to perform Roux-en-y gastric bypass in patients with morbid obesity.
A5030
DOUBLE ROW SUTURE TECHNIQUE TO PREVENT PETERSEN’S HERNIA AFTER GASTRIC BYPASS Almino Ramos; Manoela Ramos; Thales Galvão; Nestor Bertin; Raphael Lucena; Eduardo Bastos; GASTRO-OBESO-CENTER ADVANCED INSTITUTE IN BARIATRIC AND METABOLIC SURGERY, Sao Paulo Sao Paulo Background: Although several studies have pointed the positive effect of the Petersen’s space closure during the Roux-en-Y Gastric Bypass (RYGB), this technical step is not a consensus and several surgeons do not regularly close the defect based in the possibility of the loss of the suture overtime. Objective: Evaluate the effectiveness of a new proposition to Petersen’s space closure to prevent the post-RYGB internal hernia. Methods: Between January 2013 and December 2014, 680 morbid obesity patients underwent RYGB with double layer closure of the Petersen’s defect using non-absorbable running suture were enrolled. These patients were followed for two years looking for signs or symptoms of internal hernia. The integrity of the Petersen’s defect closure was also checked in patients underwent to laparoscopic cholecystectomy during the follow-up period. Results: Among the 680 patients enrolled, 596 (87%) completed the 2 years follow up and were included. Female gender was observed in 78% of them. Mean age was 43.7 (±8.4 years) and mean BMI was 45.5 (38.3 to 58.8). Only 6 patients presented recurrent episodes of abdominal pain with suspicion of internal hernia. They were submitted to laparoscopy, and no herniation or Petersen’s space opening was found. The Petersen’s space was also revised in 155 patients underwent cholecystectomy, and previous surgical closure was intact. Conclusion: Double layer non-absorbable running suture seems to be effective to Petersen’s space closure, with no internal hernia up to 2 years follow up. A5031
RACIAL DIVERSITY AMONG WOMEN AFTER BARIATRIC SURGERY: OUTCOMES VARIATION BY ETHNICITY IN FEMALES FOLLOWING LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS (LRYGB) Lisa Pedevillano1; Kevin Engledow2; Cristina Nituica3; Gus Slotman3; 1Inspira Medical Center Vineland-Inspira Health
ASMBS E-Poster Abstracts / Surgery for Obesity and Related Diseases 13 (2017) S66–S226
DS: 74.23±0.71%EWL, po0.0001) after surgery. No significant change in the percentage of excess weight loss at 3, 6 and 12 months was recorded between the two groups (all p40.05). Nightshift workers displayed significantly higher levels of HbA1C preoperatively (NS: 7.13±0.30%; DS: 6.32±0.04%; p¼0.0005). A significant change occurred in HbA1C 12 months postoperatively (p¼0.0015) when comparing night-shift workers (pre, 7.1±0.30% to post, 5.6±0.13%) and day-shift workers (pre, 6.3±0.04% to post, 5.5±0.02%). Diabetes remission one year after surgery was similar in night-shift and day-shift workers. Night-shift workers, unlike dayshift workers, see no significant improvements in their levels of LDL (NS: 96.92±6.82 to 100.3±9.97 mg/dL, p¼0.6695; DS: 110.8 ±1.08 to 94.3±1.07 mg/dL, po0.0001), cholesterol (NS: 177.2± 7.97 to 165.6±11.06 mg/dL, p¼0.4303; DS: 182.8±1.21 to 168.5 ±1.27 mg/dL, po0.0001), triglycerides (NS: 161.5±30.09 to 99.54 ±12.21 mg/dL, p ¼ 0.096; DS: 150.6±3.61 to 96.47±2.20 mg/dL, po0.0001), lipoprotein-A (NS: 32.93±7.09 to 20.13±8.1 mg/dL, p¼0.085; DS: 27.98±1.32 to 21.75±1.27 mg/dL, p¼0.0078) and homocysteine (9.61±0.74 to 8.99±0.74 μmol/L, p¼0.372; DS: 10.03±0.15 to 8.98±0.18 mg/dL, po0.0001). Conclusions: Night-shift workers achieve similar benefit postoperatively in weight reduction and HbA1c reduction, but fail to see similar benefit in biochemical cardiac risk factors. Night shift workers may need additional therapy including change in work shifts to achieve similar benefits as day shift workers undergoing weight loss surgery.
A5029
ROUX EN Y GASTRIC BYPASS AS A PROPOSED TREATMENT OPERATION FOR PATIENTS WITH HEMOCHROMATOSIS- A CASE SERIES Yagnik Pandya1; Darius Ameri1; Jacqueline Paolino2; 1MetroWest Medical Center, Natick MA; 2Tufts Medical Center Background: Hemochromatosis is an autosomal recessive disease of iron overload affecting 1 in 200 Caucasian people. Up to one third of patients will manifest end organ dysfunction due to iron overload. Treatment consists of monitoring of ferritin levels and performing therapeutic phlebotomy as frequently as every few weeks, depending on the iron overload. Roux-en-y gastric bypass is known to induce iron deficiency due to bypass of the duodenum, where iron is absorbed. We describe a case series of three patients with hemochromatosis and iron overload who preoperatively required periodic phlebotomy. After undergoing laparoscopic Roux-en-y gastric bypass for morbid obesity, all three patients experienced an improvement in their ferritin levels and a decrease in the frequency of therapeutic phlebotomy. Two of three patients did not require any therapeutic phlebotomy, at any point after surgery. One patient needed therapeutic phlebotomy only twice a year after
surgery, for the first three years, in comparison to five times a year pre operatively. None of the patients needed phlebotomy at four years of follow up after Roux-en-y gastric bypass. Roux-en-y gastric bypass appears to confer a benefit to patients with hemochromatosis by reducing iron absorption. To date, only a few case series have reported the effect of malabsorptive weight loss procedures on the improvement or resolution of hemochromatosis. This case series, is one of the few such studeis, that specifically report the impact of Roux-en-y gastric bypass on iron overload and hemochromatosis. This could serve as a stimulus for larger studies in patients with this disease. Hemochromatosis requiring preoperative therapeutic phlebotomy may be considered an indication to perform Roux-en-y gastric bypass in patients with morbid obesity.
A5030
DOUBLE ROW SUTURE TECHNIQUE TO PREVENT PETERSEN’S HERNIA AFTER GASTRIC BYPASS Almino Ramos; Manoela Ramos; Thales Galvão; Nestor Bertin; Raphael Lucena; Eduardo Bastos; GASTRO-OBESO-CENTER ADVANCED INSTITUTE IN BARIATRIC AND METABOLIC SURGERY, Sao Paulo Sao Paulo Background: Although several studies have pointed the positive effect of the Petersen’s space closure during the Roux-en-Y Gastric Bypass (RYGB), this technical step is not a consensus and several surgeons do not regularly close the defect based in the possibility of the loss of the suture overtime. Objective: Evaluate the effectiveness of a new proposition to Petersen’s space closure to prevent the post-RYGB internal hernia. Methods: Between January 2013 and December 2014, 680 morbid obesity patients underwent RYGB with double layer closure of the Petersen’s defect using non-absorbable running suture were enrolled. These patients were followed for two years looking for signs or symptoms of internal hernia. The integrity of the Petersen’s defect closure was also checked in patients underwent to laparoscopic cholecystectomy during the follow-up period. Results: Among the 680 patients enrolled, 596 (87%) completed the 2 years follow up and were included. Female gender was observed in 78% of them. Mean age was 43.7 (±8.4 years) and mean BMI was 45.5 (38.3 to 58.8). Only 6 patients presented recurrent episodes of abdominal pain with suspicion of internal hernia. They were submitted to laparoscopy, and no herniation or Petersen’s space opening was found. The Petersen’s space was also revised in 155 patients underwent cholecystectomy, and previous surgical closure was intact. Conclusion: Double layer non-absorbable running suture seems to be effective to Petersen’s space closure, with no internal hernia up to 2 years follow up. A5031
RACIAL DIVERSITY AMONG WOMEN AFTER BARIATRIC SURGERY: OUTCOMES VARIATION BY ETHNICITY IN FEMALES FOLLOWING LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS (LRYGB) Lisa Pedevillano1; Kevin Engledow2; Cristina Nituica3; Gus Slotman3; 1Inspira Medical Center Vineland-Inspira Health