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Influence of bariatric surgery on pregnancy
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Poster Presentations / Surgery for Obesity and Related Diseases 11 (2015) S56–S211
LSG. Intraoperative complications included one patient during RSG with esophageal injury during boogie placement and one patient during LSG with a large liver laceration. Two patients undergoing LSG developed a stricture at the incisura versus one undergoing RSG. One anastomotic leak was noted in the LSG group versus zero in the RSG group. A single mortality occurred in the RSG cohort due to a myocardial infarction on postoperative day 3, with no mortalities in the LSG group. In 28 trainee performed cases, excluding the ten cases where the attending performed the procedure, and excluding cases where a concomitant procedure was performed; the first 14 of the 28 cases had an average time of 189 minutes versus 171 minutes (p¼0.03) in the last 14 cases. Conclusions: Implementing RSG into bariatric surgical fellowship training appears safe, feasible and successful with equivalent outcomes. Robotic sleeve gastrectomy was associated with few perioperative complications. Patients who underwent RSG had equivalent weight loss when compared with LSG. There may be a learning curve around 15 cases for RSG during adaptation of robotic training as shown by decreased operative times after an initial 15 cases. As robotic technology improves, robotic training should be considered during bariatric surgical fellowship programs. A5283
INFLUENCE OF BARIATRIC SURGERY ON PREGNANCY Ramona Sanani, MD; Ahmed Abrahim, MD; Christoph Sperker, MD; Martin Schermann, MD; Anton Landsiedl, MD; KA Rudolfstiftung, Vienna, Austria Background: Obese women are known to suffer from gestational pathologies like gestational diabetes, miscarriage and as well as fetal complications such as high birth weight and larger birth size, which might lead to delivery difficulties. Setting: Non-University General Hospital Materials and Methods: During a period of 8 years all patients, who gave birth to at least one child pre and post sleeve gastrectomy, were included into this study. Data concerning weight parameters, obesity associated comorbidities as well as gestational complications and birth related parameters were recorded prospectively and analyzed retrospectively. Results: A total of 16 patients could be identified to meet the criteria to be included in this study. Pre OP BMI showed a mean value of 47.43 kg/m2 while the mean BMI post OP was 31.19 kg/ m2 (po0.001). Two patients showed pathologic blood glucose levels preoperatively, while there were no pathologies concerning diabetes postoperatively. Babies showed a mean birth weight of 3827g and a mean size of 52.5cm preoperatively, while postoperative values where 3341g (p¼0.02) and 50.3cm (p¼0.03). Two patients showed delayed birth pre OP, while there were no difficulties post OP. Preoperatively a total of 20 miscarriages was recorded, while postoperatively only three miscarriages could be observed (p¼0.02). Conclusion: Bariatric surgery shows direct effects on pregnancy and gestational pathologies as well as on incidence of miscarriage. For obese patients with unfulfilled desire to have child, sleeve gastrectomy might be a considerable option.
A5284
ROUTINE INTRAOPERATIVE STAPLE LINE TESTING AND POSTOPERATIVE UPPER GASTROINTESTINAL STUDIES ARE NOT NECESSARY: A COMMUNITYBASED SURGEON’S INITIAL EXPERIENCE Mariana Chavez, MD; Nathaniel Stoikes, Md; David Webb, MD; Guy Voeller, MD; George Woodman, MD; University of Tennessee Health Science Center, MemphisTN, USA Introduction: Laparoscopic Sleeve Gastrectomy (LSG) is emerging as a safe and durable bariatric surgical option with proven weight loss outcomes and comorbidities resolution. It is a common practice to routinely perform intraoperative staple line tests for integrity and postoperative Upper Gastrointestinal (UGI) studies to screen for technical complications such as leak, obstruction or stenosis. However, these tests increase time and costs of the procedure and hospital stay. Objective: To determine if routine intraoperative and postoperative testing is cost effective in a high volume single surgeon community practice. We tested the hypothesis that these routine practices after LSG result in increased length and cost of stay, without impacting patient outcomes. Methods: A retrospective chart review of patients that underwent LSG by a single surgeon at two community hospitals in Memphis, TN from April 2008 to March 2015 was performed. Two groups were identified: those who underwent routine UGI study (UGI) and those who did not (non-UGI). Characteristics evaluated included age, sex, race, preoperative BMI, length of stay, cost of stay per day, complication and readmission rates. Results: A total of 565 patients were included, 210 in the UGI and 355 in the non-UGI group. Intraoperative staple line test was not performed in any patient. There were no postoperative leaks or bleeding in either group. There were 4 re-hospitalizations, none of which were related to the staple line. The cost of an UGI study at these institutions was $1,080 and on average delayed discharge for 3 hours. Also, intraoperative testing takes an average of 10 minutes to perform, resulting in prolonged OR time, anesthesia time and hospital charges. Conclusions: After LSG, routine use of intraoperative testing and postoperative UGI studies is not cost effective. Furthermore, surgeon experience and visual evaluation are sufficient to ensure adequate staple line integrity. We recommend that these studies only be performed when clinically indicated. A5285
IDIOPATHIC COMPLETE HEART BLOCK IN A PATIENT AFTER UNEVENTFUL LAPAROSCOPIC SLEEVE GASTRECTOMY (LSG) Anish Nihalani, MD, FACS; JFK Medical Center, Edison, NJ, USA Introduction: Laparoscopic Sleeve Gastrectomy (LSG) is a widely acccepted weight loss procedure in the United States. The greater curvature is mobilized and then 70% of the stomach is resected leaving a tubular stomach which is supplied by the left and right gastric vessels. The vagus nerve is preserved. An EGD is performed and usually on postoperative day 1, an upper gastrointestinal study is done using gastrograffin to rule out staple line leakage. A bariatric clear liquid diet is subsequently initiated.
Poster Presentations / Surgery for Obesity and Related Diseases 11 (2015) S56–S211
LSG. Intraoperative complications included one patient during RSG with esophageal injury during boogie placement and one patient during LSG with a large liver laceration. Two patients undergoing LSG developed a stricture at the incisura versus one undergoing RSG. One anastomotic leak was noted in the LSG group versus zero in the RSG group. A single mortality occurred in the RSG cohort due to a myocardial infarction on postoperative day 3, with no mortalities in the LSG group. In 28 trainee performed cases, excluding the ten cases where the attending performed the procedure, and excluding cases where a concomitant procedure was performed; the first 14 of the 28 cases had an average time of 189 minutes versus 171 minutes (p¼0.03) in the last 14 cases. Conclusions: Implementing RSG into bariatric surgical fellowship training appears safe, feasible and successful with equivalent outcomes. Robotic sleeve gastrectomy was associated with few perioperative complications. Patients who underwent RSG had equivalent weight loss when compared with LSG. There may be a learning curve around 15 cases for RSG during adaptation of robotic training as shown by decreased operative times after an initial 15 cases. As robotic technology improves, robotic training should be considered during bariatric surgical fellowship programs. A5283
INFLUENCE OF BARIATRIC SURGERY ON PREGNANCY Ramona Sanani, MD; Ahmed Abrahim, MD; Christoph Sperker, MD; Martin Schermann, MD; Anton Landsiedl, MD; KA Rudolfstiftung, Vienna, Austria Background: Obese women are known to suffer from gestational pathologies like gestational diabetes, miscarriage and as well as fetal complications such as high birth weight and larger birth size, which might lead to delivery difficulties. Setting: Non-University General Hospital Materials and Methods: During a period of 8 years all patients, who gave birth to at least one child pre and post sleeve gastrectomy, were included into this study. Data concerning weight parameters, obesity associated comorbidities as well as gestational complications and birth related parameters were recorded prospectively and analyzed retrospectively. Results: A total of 16 patients could be identified to meet the criteria to be included in this study. Pre OP BMI showed a mean value of 47.43 kg/m2 while the mean BMI post OP was 31.19 kg/ m2 (po0.001). Two patients showed pathologic blood glucose levels preoperatively, while there were no pathologies concerning diabetes postoperatively. Babies showed a mean birth weight of 3827g and a mean size of 52.5cm preoperatively, while postoperative values where 3341g (p¼0.02) and 50.3cm (p¼0.03). Two patients showed delayed birth pre OP, while there were no difficulties post OP. Preoperatively a total of 20 miscarriages was recorded, while postoperatively only three miscarriages could be observed (p¼0.02). Conclusion: Bariatric surgery shows direct effects on pregnancy and gestational pathologies as well as on incidence of miscarriage. For obese patients with unfulfilled desire to have child, sleeve gastrectomy might be a considerable option.
A5284
ROUTINE INTRAOPERATIVE STAPLE LINE TESTING AND POSTOPERATIVE UPPER GASTROINTESTINAL STUDIES ARE NOT NECESSARY: A COMMUNITYBASED SURGEON’S INITIAL EXPERIENCE Mariana Chavez, MD; Nathaniel Stoikes, Md; David Webb, MD; Guy Voeller, MD; George Woodman, MD; University of Tennessee Health Science Center, MemphisTN, USA Introduction: Laparoscopic Sleeve Gastrectomy (LSG) is emerging as a safe and durable bariatric surgical option with proven weight loss outcomes and comorbidities resolution. It is a common practice to routinely perform intraoperative staple line tests for integrity and postoperative Upper Gastrointestinal (UGI) studies to screen for technical complications such as leak, obstruction or stenosis. However, these tests increase time and costs of the procedure and hospital stay. Objective: To determine if routine intraoperative and postoperative testing is cost effective in a high volume single surgeon community practice. We tested the hypothesis that these routine practices after LSG result in increased length and cost of stay, without impacting patient outcomes. Methods: A retrospective chart review of patients that underwent LSG by a single surgeon at two community hospitals in Memphis, TN from April 2008 to March 2015 was performed. Two groups were identified: those who underwent routine UGI study (UGI) and those who did not (non-UGI). Characteristics evaluated included age, sex, race, preoperative BMI, length of stay, cost of stay per day, complication and readmission rates. Results: A total of 565 patients were included, 210 in the UGI and 355 in the non-UGI group. Intraoperative staple line test was not performed in any patient. There were no postoperative leaks or bleeding in either group. There were 4 re-hospitalizations, none of which were related to the staple line. The cost of an UGI study at these institutions was $1,080 and on average delayed discharge for 3 hours. Also, intraoperative testing takes an average of 10 minutes to perform, resulting in prolonged OR time, anesthesia time and hospital charges. Conclusions: After LSG, routine use of intraoperative testing and postoperative UGI studies is not cost effective. Furthermore, surgeon experience and visual evaluation are sufficient to ensure adequate staple line integrity. We recommend that these studies only be performed when clinically indicated. A5285
IDIOPATHIC COMPLETE HEART BLOCK IN A PATIENT AFTER UNEVENTFUL LAPAROSCOPIC SLEEVE GASTRECTOMY (LSG) Anish Nihalani, MD, FACS; JFK Medical Center, Edison, NJ, USA Introduction: Laparoscopic Sleeve Gastrectomy (LSG) is a widely acccepted weight loss procedure in the United States. The greater curvature is mobilized and then 70% of the stomach is resected leaving a tubular stomach which is supplied by the left and right gastric vessels. The vagus nerve is preserved. An EGD is performed and usually on postoperative day 1, an upper gastrointestinal study is done using gastrograffin to rule out staple line leakage. A bariatric clear liquid diet is subsequently initiated.