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Is LRYGB contraindicated for doctors?
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Abstracts: Plenary Session/Surgery for Obesity and Related Diseases / 1 (2005) 222–283
prior prostate surgery in men, or multiple pregnancies (⬎2), pelvic prolapse in women, cystocele, cystourethrocele, or rectocele were excluded. Results: 73 females and 59 males, mean age 53 (47–70), Mean weight was 295.7 ⫾ 87.9 lb, Mean BMI was 52.65 ⫾ 14.49 kg/m2. All patients underwent laparoscopic Roux-en-Y gastric bypass. Subjects completed the Incontinence Impact Questionnaire (IIQ-7) and Quality-of-Life Questionnaire (SF-36) at 12 months after surgery. 46 patients responded to the questionnaire. Results: Excess weight loss was 67.9% ⫾ 19.2%. Quality of life has greatly improved in 93% of patients. Incontinence episodes decreased to 1 per week after weight reduction in 4 patients, whereas in 42 resolved completely. Conclusions: The study demonstrated an association between surgically induced weight reduction and improved urinary incontinence. PII: S1550-7289(05)00245-5
P58.
USE OF CONTRAST STUDIES WITHOUT LOCAL DRAINAGE IN PATIENTS AFTER ROUX-EN-Y GASTRIC BYPASS Titus D. Duncan, M.D., Larry Hobson, M.D., Fredne Speights, M.D., Tihesha Wilson, M.D., Andre’ Scott, M.D., Atlanta Medical Center, Morehouse School of Medicine, Atlanta, GA. Purpose: The routine use of contrast examination (UGI) with or without the use of drains in patients undergoing Roux-en-Y gastric bypass (RYGBP) surgery remains controversial. In our early series we routinely performed postoperative contrast studies along with placement of local drains. The drains were removed once the UGI was confirmed as normal. Because most of the leaks occurring in this series presented after removal of the drains, their routine placement was discontinued. The authors sought to determine the usefulness of UGI contrast studies without routine drain placement in the management of patients undergoing RYGBP. Methods: Review of the last 500 consecutive patients who underwent RYGBP from January 2001 to January 2004 was performed. There were 471 females and 29 males in this review. Average BMI was 54.5 kg/m2. All patients had a laparoscopic RYGBP. Within 24 hours postoperatively, all patients underwent UGI to evaluate the gastrojejunostomy. If there was no obstruction and no leak, patients were given clear liquids. All patients with leaks were returned to the O.R. for placement of drains and NG tube. Results: 471 females and 29 males underwent laparoscopic RYGBP. Average BMI was 54.5 kg/m2. There were 3 postoperative leaks detected on contrast UGI series. Two leaks were detected 9 and 13 days postoperatively respectively. None of the 3 early leak patients had tachycardia or tachypnea. All 3 were treated by early return to the O.R. for placement of drains and guided NG placement and started on IVF’s and antibiotics and kept NPO. All leaks were resolved without further surgery. Conclusions: UGI series can be used to identify early postoperative leaks allowing the surgeon to withhold feedings that might result in clinically significant leaks. Early return to surgery allows rapid placement of drains in the small percentage of patients in which this complication occurs. Contrast UGI without routine
placement of drains, is an effective method of managing patients undergoing laparoscopic RYGBP surgery. PII: S1550-7289(05)00246-7
P59.
IS LRYGB CONTRAINDICATED FOR DOCTORS? Ricardo Cohen, M.D., Jose S Pinheiro, M.D., Jose L Correa, M.D., Carlos A Schiavon, M.D., Sao Paulo, Brazil. Purpose: The purpose of this study was to compare the results of LRYGB in physicians and non-physician patients. Physicians are a “special” group of patients. Generally, they are reluctant to receive or follow medical instructions. LRYGB for the treatment of morbid obesity requires multiple patient commitments and a strict and life-long follow-up. Methods: We reviewed the data of 19 physicians who underwent LRYGB (1.7% of our patients). OR time, intraoperative and postoperative complications, length of hospital stay, drain output, EWL, cure of comorbidities and follow-up were compared with non-physicians patients data when possible. Results: Most patients were women (15) and mean age was 38 years (30 – 45). Mean preoperative BMI was 42. Patients presented with a mean of 2 comorbidities. One general surgeon, 1 endocrinologist, and 17 from other medical specialties formed the group. There were 3 revisional bariatric procedures. Two due to adjustable gastric band erosion and one due to failed open gastric bypass (weight regain). Mean OR time was 51 minutes. There were no intraoperative complications. Mean length of hospital stay was 39 hours. These results were similar to non-physician patients. Drain was removed in the first preoperative visit (a Jackson-Pratt drain is placed in all patients). After this one visit, only 1 patient continued the regular follow-up (the endocrinologist). This patient’s BMI is 24 and diabetes and GERD are cured. Comparison of EWL and cure of comorbidities was impossible. Conclusions: OR time, intraoperative complications, length of hospital stay, and drain output were similar to non-physician patients. Follow-up was extremely low resulting in a shocking and worrisome situation. PII: S1550-7289(05)00247-9
P60.
CARDIOVASCULAR RISK FACTORS: ARE WE TARGETING THE RIGHT POPULATION FOR BARIATRIC SURGERY? Edward Livingston, M.D., Manisha Chandalia, M.D., Nicola Abata, M.D., University of Texas Southwestern School of Medicine and the VA North Texas Health Care System, Dallas, TX. Purpose: The current BMI threshold for obesity surgery is 40 or 35 with significant existing comorbidities. These values have been arbitrarily established but relate, in part, because of the obesitycardiovascular disease relationship. Obesity itself does not result in cardiovascular disease; rather it acts through intermediate risk factors. Most, but not all, studies examining the obesity-cardiovascular disease relationship have found them to be correlated. We hypothesized that inconsistencies between studies of the obesitycardiovascular relationship were attributable to a nonlinear rela-
Abstracts: Plenary Session/Surgery for Obesity and Related Diseases / 1 (2005) 222–283
prior prostate surgery in men, or multiple pregnancies (⬎2), pelvic prolapse in women, cystocele, cystourethrocele, or rectocele were excluded. Results: 73 females and 59 males, mean age 53 (47–70), Mean weight was 295.7 ⫾ 87.9 lb, Mean BMI was 52.65 ⫾ 14.49 kg/m2. All patients underwent laparoscopic Roux-en-Y gastric bypass. Subjects completed the Incontinence Impact Questionnaire (IIQ-7) and Quality-of-Life Questionnaire (SF-36) at 12 months after surgery. 46 patients responded to the questionnaire. Results: Excess weight loss was 67.9% ⫾ 19.2%. Quality of life has greatly improved in 93% of patients. Incontinence episodes decreased to 1 per week after weight reduction in 4 patients, whereas in 42 resolved completely. Conclusions: The study demonstrated an association between surgically induced weight reduction and improved urinary incontinence. PII: S1550-7289(05)00245-5
P58.
USE OF CONTRAST STUDIES WITHOUT LOCAL DRAINAGE IN PATIENTS AFTER ROUX-EN-Y GASTRIC BYPASS Titus D. Duncan, M.D., Larry Hobson, M.D., Fredne Speights, M.D., Tihesha Wilson, M.D., Andre’ Scott, M.D., Atlanta Medical Center, Morehouse School of Medicine, Atlanta, GA. Purpose: The routine use of contrast examination (UGI) with or without the use of drains in patients undergoing Roux-en-Y gastric bypass (RYGBP) surgery remains controversial. In our early series we routinely performed postoperative contrast studies along with placement of local drains. The drains were removed once the UGI was confirmed as normal. Because most of the leaks occurring in this series presented after removal of the drains, their routine placement was discontinued. The authors sought to determine the usefulness of UGI contrast studies without routine drain placement in the management of patients undergoing RYGBP. Methods: Review of the last 500 consecutive patients who underwent RYGBP from January 2001 to January 2004 was performed. There were 471 females and 29 males in this review. Average BMI was 54.5 kg/m2. All patients had a laparoscopic RYGBP. Within 24 hours postoperatively, all patients underwent UGI to evaluate the gastrojejunostomy. If there was no obstruction and no leak, patients were given clear liquids. All patients with leaks were returned to the O.R. for placement of drains and NG tube. Results: 471 females and 29 males underwent laparoscopic RYGBP. Average BMI was 54.5 kg/m2. There were 3 postoperative leaks detected on contrast UGI series. Two leaks were detected 9 and 13 days postoperatively respectively. None of the 3 early leak patients had tachycardia or tachypnea. All 3 were treated by early return to the O.R. for placement of drains and guided NG placement and started on IVF’s and antibiotics and kept NPO. All leaks were resolved without further surgery. Conclusions: UGI series can be used to identify early postoperative leaks allowing the surgeon to withhold feedings that might result in clinically significant leaks. Early return to surgery allows rapid placement of drains in the small percentage of patients in which this complication occurs. Contrast UGI without routine
placement of drains, is an effective method of managing patients undergoing laparoscopic RYGBP surgery. PII: S1550-7289(05)00246-7
P59.
IS LRYGB CONTRAINDICATED FOR DOCTORS? Ricardo Cohen, M.D., Jose S Pinheiro, M.D., Jose L Correa, M.D., Carlos A Schiavon, M.D., Sao Paulo, Brazil. Purpose: The purpose of this study was to compare the results of LRYGB in physicians and non-physician patients. Physicians are a “special” group of patients. Generally, they are reluctant to receive or follow medical instructions. LRYGB for the treatment of morbid obesity requires multiple patient commitments and a strict and life-long follow-up. Methods: We reviewed the data of 19 physicians who underwent LRYGB (1.7% of our patients). OR time, intraoperative and postoperative complications, length of hospital stay, drain output, EWL, cure of comorbidities and follow-up were compared with non-physicians patients data when possible. Results: Most patients were women (15) and mean age was 38 years (30 – 45). Mean preoperative BMI was 42. Patients presented with a mean of 2 comorbidities. One general surgeon, 1 endocrinologist, and 17 from other medical specialties formed the group. There were 3 revisional bariatric procedures. Two due to adjustable gastric band erosion and one due to failed open gastric bypass (weight regain). Mean OR time was 51 minutes. There were no intraoperative complications. Mean length of hospital stay was 39 hours. These results were similar to non-physician patients. Drain was removed in the first preoperative visit (a Jackson-Pratt drain is placed in all patients). After this one visit, only 1 patient continued the regular follow-up (the endocrinologist). This patient’s BMI is 24 and diabetes and GERD are cured. Comparison of EWL and cure of comorbidities was impossible. Conclusions: OR time, intraoperative complications, length of hospital stay, and drain output were similar to non-physician patients. Follow-up was extremely low resulting in a shocking and worrisome situation. PII: S1550-7289(05)00247-9
P60.
CARDIOVASCULAR RISK FACTORS: ARE WE TARGETING THE RIGHT POPULATION FOR BARIATRIC SURGERY? Edward Livingston, M.D., Manisha Chandalia, M.D., Nicola Abata, M.D., University of Texas Southwestern School of Medicine and the VA North Texas Health Care System, Dallas, TX. Purpose: The current BMI threshold for obesity surgery is 40 or 35 with significant existing comorbidities. These values have been arbitrarily established but relate, in part, because of the obesitycardiovascular disease relationship. Obesity itself does not result in cardiovascular disease; rather it acts through intermediate risk factors. Most, but not all, studies examining the obesity-cardiovascular disease relationship have found them to be correlated. We hypothesized that inconsistencies between studies of the obesitycardiovascular relationship were attributable to a nonlinear rela-