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Laparoscopic gastric bypass has shorter length of stay and less narcotic usage compared with open gastric bypass
April 2000
be of benefit in these frequently malnourished and ill patients. However, potential difficulties are high risk of iatrogenic perforation and bleeding due to increased bowel friability and hypervascularity. Objectives To assess the feasibility and the safety of emergency Laparoscopic-Assisted Colectomy (LAC) in patients with TC and to compare morbidity with open colectomy (DC). Methods Between March '96 and October '99, 42 patients with TC underwent an emergency colectomy in 2 university hospitals. Ten patients had LAC and 32 had DC with end-ileostomy. Intra- and postoperative parameters, morbidity and mortality were retrospectively analysed. Results Groups were comparable for distribution of sex, age, Body Mass Index, steroid dosage, pulse frequency, albumin and haemoglobin. In the LAC-group pre-operative temperature and incidence of parenteral feeding were significantly higher. Operation time was significantly longer in the LAC-group than in the DC-group 271 minutes (range 165-360) versus 150 minutes (range 90-230); p
6825 LAPAROSCOPIC GASTRIC BYPASS HAS SHORTER LENGTH OF STAY AND LESS NARCOTIC USAGE COMPARED WITH OPEN GASTRIC BYPASS. 1. Chris Eagon, Dept of Surg, Washington Univ Sch of Medicine, St. Louis, MO. The laparoscopic approach to Roux-Y gastric bypass has been reported to be safe and effective at treating obesity, but detailed comparison of the laparoscopic and open approaches has not been reported. Our aim was to compare operative and early postoperative morbidity in sequential cohorts of patients who underwent open (OGB) or laparoscopic (LGB) gastric bypass. From 1/98 through 11/99,36 patients with BMI between 37 and 51 underwent Roux-Y gastric bypass by a single surgeon at a teaching hospital. The first 20 were OGB and the subsequent 16 were LGB, The majority received patient controlled IV narcotics, and patients were discharged based upon tolerance of oral intake. Outcome variables were operative time, EBL, IV narcotic use, length of stay (LOS), and presence of postop complications. The OGB cohort had a higher BMI (47 vs 44, OGB vs LGB), but did not differ in age, sex or comorbidity frequency: Women 75% vs 91%, Age 44y vs 43y, DM 15% vs 19%, HTN 30% vs 44%, Sleep apnea 30% vs 31%. There was a trend toward more frequent additional procedures in OGB including cholecystectomy (15% vs 12,5%), hernia repair (15% vs 6%), and one OGB also had resection of a previously unsuspected liver tumor. Operative time was longer in LGB (260min vs 308min), but LOS was shorter (5.2d vs 3.6d), The average daily use of IV narcotics did not differ, but the total dose was greater in OGB (Mean MS04 mg/day 62 vs 41, Total MS04 mg: 205 vs 100), There was no perioperative mortality. There was a trend toward more frequent morbidity with OGB (45% vs 25%, p=,07). Gastrograffin swallows in all patients between POD 4 and 9 showed no leaks. One LGB patient developed a subphrenic abscess requiring percutaneous drainage on POD 15. EBL did not differ between the groups. Transfusion was required in 3 patients, the OGB with the liver resection, and two LGB patients, one of whom developed GI bleeding on POD 2 that stopped spontaneously. Wound infection was equally frequent (20% vs, 25%). Excluding wound infections and bleeding, complications were more frequent in OGB (30% vs 6%). Classes of complications only seen in OGB included MI (I), partial SBO (I), incisional hernias identified by 3 months (2), and stomal stenosis (2). Percent loss of excess weight at 3 months was similar (46% vs 46%). LGB achieves similar weight loss with shorter LOS and less narcotic use, but operating times are longer, at least in a teaching hospital setting. Wound infection rates do not differ, but other complications may be less frequent.
SSATA1511
6826 PERIOPERATIVE ADMINISTRATION OF THE NOVEL IMMU· NOSUPPRESSIVE AGENT MYCOPHENOLATE MOFETIL (MMF) DOES NOT DECREASE MECHANICAL STABILITY OF HEALING COLON ANASTOMOSES IN RATS. Bernhard Egger, Roman A. Inglin, Joerg Zeeh, Olaf Dirsch, Nora E. Riley, Markus W. Buchler, Visceral and Transplantation Surg, Univ of Bern, Bern, Switzerland; Dept of Vis and Transplant Surg, Univ of Bern, CH3010 Bern, Switzerland; Dept of Gastroenterology, Univ of Essen, DE45147 Essen, Germany; Dept of Pathology, Univ of Essen, DE-45147 Essen, Germany; Div of Gastroenterology, Univ of Essen, DE-45147 Essen, Germany; Univ of Bern, CH-3010 Bern, Switzerland. INTRODUCTION: Inadequate healing and subsequent leakage from colonic anastomoses are a significant cause of postoperative morbidity and mortality. Immunosuppressive drugs such as steroids are known to disturb healing processes and to decrease the mechanical stability of bowel anastomosis postoperatively. MMF, a novel immunosuppressant, selectively inhibits the proliferation of T and B lymphocytes but also has significant side effects on the gastrointestinal tract. However, nothing is known about possible effects of MMF administration on healing of bowel anastomosis especially during the early postoperative period. The aim of this study was to evaluate the effects of systemic MMF administration on healing of colon anastomoses in rats. MATERIAL AND METHODS: Rats underwent laparotomy, division of the left colon and sigmoido-sigmoidostomy, MMF (25mglkg) or vehicle were administered intraperitoneally in two groups (n= 14 per group) 3 days prior to surgery, and then once daily until sacrifice (7 animals per group; 4 and 6 days after surgery). Bursting pressure (BP) measurements, histologic evaluation, morphometric analysis, mucin staining and BrdU immunohistochemistry were performed. RESULTS: Anastomosis of MMF treated animals show slightly lower BP's on postoperative day 4 compared to control animals (59::!::7 vs 84::!::8; p=0.06), however differences were not statistically significant on both, postoperative day 4 and 6 (day 6: 128::!:: 17 vs 147::!:: 10; p=0.21). Histology and mucin staining, measurements of the colonic crypt depth (CCD) as well as BrdU immunohistochemistry (only day 6) revealed no statistically significant differences. Again, there was a slight tendency of MMF treated animals having somewhat lower CCD's on postoperative day 4 compared to the control group. CONCLUSIONS: The novel immunosuppressive agent MMF does not significantly decrease the mechanical stability of colon anastomosis in rats during the early postoperative period.
6827 PRE-OPERATIVE CHEMORADIATION DOES NOT AFFECT LONG TERM BOWEL FUNCTION OF PATIENTS TREATED BY LOW ANTERIOR RESECTION WITH COLOANAL RECONSTRUCTION. Nj Espat, D. Wong, M. D' Allessio, W. Boiardi, 1. Guillem, B. Minsky, H. Thaler, Am Cohen, Pb Paty, Memorial Sloan-Kettering Cancer Ctr, New York, NY. Combination pre-operative chemoradiation (Preop CRT) and low anterior resection with cultural anastomosis (LAR CAA) in the treatment of rectal cancer enables sphincter preservation in many patients who would otherwise require abdominoperineal resection and permanent colostomy. However, the effect of Preop CRT on the long-term bowel function of patients so treated has not been well studied. Methods: Patients who underwent LAR CAA between 1/1111990 and 12/31/1996 were identified from a prospective database. Inclusion criteria were histology confirmed rectal adenocarcinoma with no evidence of metastatic disease at operation, LAR with straight CAA053cm from the anal verge and negative resection margins. Operative and clinical data were obtained from a prospective database. Patients were interviewed using a standardized questionnaire, which queried bowel movement (BM) frequency, incontinence, BM habits, satisfaction with function, and overall health. Statistics: Response data were analyzed using Fischer's Exact Test (2-Tail), and a significant difference was defined as (p= <0.05) Results: 75 patients were identified and 56 were available and completed the questionnaire. Of the 56, one patient who required permanent diversion and five others who received postoperative radiation were excluded from the analysis. In the total group analyzed (n=50), 23 patients had PCRT and 27 did not. Median follow-up was 57 months (range 26 to 105) Analysis of patient self-assessed responses to the survey revealed that significantly more Preop CRT treated patients reported < I BM! 24 hours compared to their non-radiated counterparts, but otherwise no differences between the groups were identified, Conclusion: Use of Preop CRT was associated with a significantly increased distribution of patients reporting less than one BM!24 hours, but no other differences in patient-reported measures of anorectal function were observed. Moreover, the small, statistically appreciated difference in BM frequency did not impact on patient-reported satisfaction between the groups. We conclude that Preop CRT is not a major negative determinant of long-term bowel function following LAR CAA for rectal cancer 8MI 24 hours
Continence
8M Urgency
Cluster 8M
Pad use
Med use
Overall Satisfaction
Overall Health
P=O.03
(NS)
(NS)
(NS)
(NS)
(NS)
(NS)
(NS)
be of benefit in these frequently malnourished and ill patients. However, potential difficulties are high risk of iatrogenic perforation and bleeding due to increased bowel friability and hypervascularity. Objectives To assess the feasibility and the safety of emergency Laparoscopic-Assisted Colectomy (LAC) in patients with TC and to compare morbidity with open colectomy (DC). Methods Between March '96 and October '99, 42 patients with TC underwent an emergency colectomy in 2 university hospitals. Ten patients had LAC and 32 had DC with end-ileostomy. Intra- and postoperative parameters, morbidity and mortality were retrospectively analysed. Results Groups were comparable for distribution of sex, age, Body Mass Index, steroid dosage, pulse frequency, albumin and haemoglobin. In the LAC-group pre-operative temperature and incidence of parenteral feeding were significantly higher. Operation time was significantly longer in the LAC-group than in the DC-group 271 minutes (range 165-360) versus 150 minutes (range 90-230); p
6825 LAPAROSCOPIC GASTRIC BYPASS HAS SHORTER LENGTH OF STAY AND LESS NARCOTIC USAGE COMPARED WITH OPEN GASTRIC BYPASS. 1. Chris Eagon, Dept of Surg, Washington Univ Sch of Medicine, St. Louis, MO. The laparoscopic approach to Roux-Y gastric bypass has been reported to be safe and effective at treating obesity, but detailed comparison of the laparoscopic and open approaches has not been reported. Our aim was to compare operative and early postoperative morbidity in sequential cohorts of patients who underwent open (OGB) or laparoscopic (LGB) gastric bypass. From 1/98 through 11/99,36 patients with BMI between 37 and 51 underwent Roux-Y gastric bypass by a single surgeon at a teaching hospital. The first 20 were OGB and the subsequent 16 were LGB, The majority received patient controlled IV narcotics, and patients were discharged based upon tolerance of oral intake. Outcome variables were operative time, EBL, IV narcotic use, length of stay (LOS), and presence of postop complications. The OGB cohort had a higher BMI (47 vs 44, OGB vs LGB), but did not differ in age, sex or comorbidity frequency: Women 75% vs 91%, Age 44y vs 43y, DM 15% vs 19%, HTN 30% vs 44%, Sleep apnea 30% vs 31%. There was a trend toward more frequent additional procedures in OGB including cholecystectomy (15% vs 12,5%), hernia repair (15% vs 6%), and one OGB also had resection of a previously unsuspected liver tumor. Operative time was longer in LGB (260min vs 308min), but LOS was shorter (5.2d vs 3.6d), The average daily use of IV narcotics did not differ, but the total dose was greater in OGB (Mean MS04 mg/day 62 vs 41, Total MS04 mg: 205 vs 100), There was no perioperative mortality. There was a trend toward more frequent morbidity with OGB (45% vs 25%, p=,07). Gastrograffin swallows in all patients between POD 4 and 9 showed no leaks. One LGB patient developed a subphrenic abscess requiring percutaneous drainage on POD 15. EBL did not differ between the groups. Transfusion was required in 3 patients, the OGB with the liver resection, and two LGB patients, one of whom developed GI bleeding on POD 2 that stopped spontaneously. Wound infection was equally frequent (20% vs, 25%). Excluding wound infections and bleeding, complications were more frequent in OGB (30% vs 6%). Classes of complications only seen in OGB included MI (I), partial SBO (I), incisional hernias identified by 3 months (2), and stomal stenosis (2). Percent loss of excess weight at 3 months was similar (46% vs 46%). LGB achieves similar weight loss with shorter LOS and less narcotic use, but operating times are longer, at least in a teaching hospital setting. Wound infection rates do not differ, but other complications may be less frequent.
SSATA1511
6826 PERIOPERATIVE ADMINISTRATION OF THE NOVEL IMMU· NOSUPPRESSIVE AGENT MYCOPHENOLATE MOFETIL (MMF) DOES NOT DECREASE MECHANICAL STABILITY OF HEALING COLON ANASTOMOSES IN RATS. Bernhard Egger, Roman A. Inglin, Joerg Zeeh, Olaf Dirsch, Nora E. Riley, Markus W. Buchler, Visceral and Transplantation Surg, Univ of Bern, Bern, Switzerland; Dept of Vis and Transplant Surg, Univ of Bern, CH3010 Bern, Switzerland; Dept of Gastroenterology, Univ of Essen, DE45147 Essen, Germany; Dept of Pathology, Univ of Essen, DE-45147 Essen, Germany; Div of Gastroenterology, Univ of Essen, DE-45147 Essen, Germany; Univ of Bern, CH-3010 Bern, Switzerland. INTRODUCTION: Inadequate healing and subsequent leakage from colonic anastomoses are a significant cause of postoperative morbidity and mortality. Immunosuppressive drugs such as steroids are known to disturb healing processes and to decrease the mechanical stability of bowel anastomosis postoperatively. MMF, a novel immunosuppressant, selectively inhibits the proliferation of T and B lymphocytes but also has significant side effects on the gastrointestinal tract. However, nothing is known about possible effects of MMF administration on healing of bowel anastomosis especially during the early postoperative period. The aim of this study was to evaluate the effects of systemic MMF administration on healing of colon anastomoses in rats. MATERIAL AND METHODS: Rats underwent laparotomy, division of the left colon and sigmoido-sigmoidostomy, MMF (25mglkg) or vehicle were administered intraperitoneally in two groups (n= 14 per group) 3 days prior to surgery, and then once daily until sacrifice (7 animals per group; 4 and 6 days after surgery). Bursting pressure (BP) measurements, histologic evaluation, morphometric analysis, mucin staining and BrdU immunohistochemistry were performed. RESULTS: Anastomosis of MMF treated animals show slightly lower BP's on postoperative day 4 compared to control animals (59::!::7 vs 84::!::8; p=0.06), however differences were not statistically significant on both, postoperative day 4 and 6 (day 6: 128::!:: 17 vs 147::!:: 10; p=0.21). Histology and mucin staining, measurements of the colonic crypt depth (CCD) as well as BrdU immunohistochemistry (only day 6) revealed no statistically significant differences. Again, there was a slight tendency of MMF treated animals having somewhat lower CCD's on postoperative day 4 compared to the control group. CONCLUSIONS: The novel immunosuppressive agent MMF does not significantly decrease the mechanical stability of colon anastomosis in rats during the early postoperative period.
6827 PRE-OPERATIVE CHEMORADIATION DOES NOT AFFECT LONG TERM BOWEL FUNCTION OF PATIENTS TREATED BY LOW ANTERIOR RESECTION WITH COLOANAL RECONSTRUCTION. Nj Espat, D. Wong, M. D' Allessio, W. Boiardi, 1. Guillem, B. Minsky, H. Thaler, Am Cohen, Pb Paty, Memorial Sloan-Kettering Cancer Ctr, New York, NY. Combination pre-operative chemoradiation (Preop CRT) and low anterior resection with cultural anastomosis (LAR CAA) in the treatment of rectal cancer enables sphincter preservation in many patients who would otherwise require abdominoperineal resection and permanent colostomy. However, the effect of Preop CRT on the long-term bowel function of patients so treated has not been well studied. Methods: Patients who underwent LAR CAA between 1/1111990 and 12/31/1996 were identified from a prospective database. Inclusion criteria were histology confirmed rectal adenocarcinoma with no evidence of metastatic disease at operation, LAR with straight CAA053cm from the anal verge and negative resection margins. Operative and clinical data were obtained from a prospective database. Patients were interviewed using a standardized questionnaire, which queried bowel movement (BM) frequency, incontinence, BM habits, satisfaction with function, and overall health. Statistics: Response data were analyzed using Fischer's Exact Test (2-Tail), and a significant difference was defined as (p= <0.05) Results: 75 patients were identified and 56 were available and completed the questionnaire. Of the 56, one patient who required permanent diversion and five others who received postoperative radiation were excluded from the analysis. In the total group analyzed (n=50), 23 patients had PCRT and 27 did not. Median follow-up was 57 months (range 26 to 105) Analysis of patient self-assessed responses to the survey revealed that significantly more Preop CRT treated patients reported < I BM! 24 hours compared to their non-radiated counterparts, but otherwise no differences between the groups were identified, Conclusion: Use of Preop CRT was associated with a significantly increased distribution of patients reporting less than one BM!24 hours, but no other differences in patient-reported measures of anorectal function were observed. Moreover, the small, statistically appreciated difference in BM frequency did not impact on patient-reported satisfaction between the groups. We conclude that Preop CRT is not a major negative determinant of long-term bowel function following LAR CAA for rectal cancer 8MI 24 hours
Continence
8M Urgency
Cluster 8M
Pad use
Med use
Overall Satisfaction
Overall Health
P=O.03
(NS)
(NS)
(NS)
(NS)
(NS)
(NS)
(NS)