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Laparoscopic revision of vertical banded gastroplasty to Roux-en-Y gastric bypass: An outcomes analysis
Abstracts: Plenary Session/Surgery for Obesity and Related Diseases / 1 (2005) 222–283
Purpose: The adjustable gastric band (AGB) is one of options for bariatric surgery. At least five models of AGB are available on the market, each with its own characteristics. The most known are the Lap-Band (Fodd and Drug Administration and CE approval), Swedish Adjustable Gastric Band (SAGB; CE approval, on Food and Drug Administration trial), Midband, Heliogast, and Softband (CE approval). Since December 1999, our group have implanted more then 1000 SAGB, Heliogast, and Midband bands (most of them SAGB). Our aim was to compare those three AGB types retrospectively in 100 consecutive cases after 50 initial cases with each of the bands. Methods: Between November 2001 and September 2002, the 100 consecutive patients undergoing SAGB, Heliogast, and Midband placement (after discharging the first 50 cases) had their files reviewed to raise data about casuistic, operative time, intraoperative complications, hospital discharge, complications, mortality, and revisional procedures. Results: No significant differences were found between sex, age, weight, initial weight and body mass index, operative time, intraoperative complications, and hospital discharge. The mortality rate was 0%. Differences occurred among the late complications, such as the rate of slippage for SAGB (0%), Heliogast (3%), and Midband (24%) and the rate of band intragastric migration for SAGB (1%), Heliogast (1%), and Midband (0%). No port complications were noted. The revisional procedure rate was 3% for SAGB, 6% for Heliogast, and 26% for Midband. Without significant differences among the bands, the body mass index decreased from 45.2 to 30.1 kg/m2. Conclusions: Among the AGBs analyzed, the Midband presented with a significantly greater rate of slippage, which led to a high rate of revisional surgery. PII: S1550-7289(05)00179-6
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LAPAROSCOPIC REVISION OF VERTICAL BANDED GASTROPLASTY TO ROUX-EN-Y GASTRIC BYPASS: AN OUTCOMES ANALYSIS Daniel J. Gagne´, M.D., David Goitein, M.D., Pavlos K. Papasavas, M.D., Nicole Hayden, P.A.-C., Julie Maurer, P.A.-C., Philip F. Caushaj, M.D., Western Pennsylvania Hospital, Clinical Campus Temple University School of Medicine, Pittsburgh, PA. Purpose: Although vertical banded gastroplasty (VBG) was endorsed by the 1991 National Institutes of Health Consensus Conference for the treatment of morbid obesity, it has largely been abandoned owing to the poor long-term results. We present our experience with laparoscopic revision of failed VBG to Roux-en-Y gastric bypass (RYGBP). Methods: Retrospective review of a prospectively collected database. Follow-up data were available in 100% of patients. Results: In a 3.5-year period, 25 laparoscopic revisions of previous open VBG to RYGBP were performed. Indications for revision were inadequate weight loss or weight gain in 23 patients and intractable vomiting in 2. Of the 25 patients, 23 (92%) were women. The mean age was 45 years (range 30 – 66), and the mean body mass index was 44.8 kg/m2 (range 30.5– 83). The mean follow-up was 17.6 months (range 1– 41). All procedures were completed laparoscopically. The mean operative time was 4.5
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hours (range 3–7.5), mean estimated blood loss was 90 mL, and mean length of hospital stay was 3 days (range 2–38). No mortalities occurred. Six patients (24%) experienced eight complications, including gastric remnant leak in 1, abscess in 2, gastrojejunostomy stricture in 3, internal hernia in 1, and prolonged ventilatory support in 1. The mean excess body weight loss was 42%, 49%, 47%, and 51% at 6, 12, 24, and 36 months, respectively. Diabetes resolved in 5 (100%) of 5 patients. Hypertension resolved in 5 (63%) of 8 patients. Conclusions: Laparoscopic revision of failed open VBG to RYGBP is a challenging but feasible procedure. It provides acceptable weight loss and reversal of weight-related comorbidities. PII: S1550-7289(05)00180-2 SESSION IX (10:30 A.M. – 12:30 P.M.) CONCURRENT WITH SESSION XIII OBESITY SURGERY AND COMORBID CONDITIONS
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PREVALENCE OF VITAMIN D DEPLETION AMONG MORBIDLY OBESE PATIENTS SEEKING GASTRIC BYPASS SURGERY Arthur M. Carlin, M.D., Ali M. Meslemani, M.D., Jeffrey A. Genaw, M.D., Shiri Levy, M.D., Arti Bhan, M.D., D. Sudhaker Rao, M.B., B.S., F.A.C.P., F.A.C.E., Henry Ford Hospital, Detroit, MI. Purpose: Abnormalities in calcium and vitamin D metabolism have been reported after bariatric surgery. The purpose of this study was to evaluate vitamin D nutritional status among morbidly obese patients before gastric bypass surgery. Methods: The information collected on 124 morbidly obese patients seeking gastric bypass surgery included age, sex, race, and body mass index. Serum samples were analyzed for calcium, alkaline phosphatase, intact parathormone, 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D. Results: The mean patient age was 43 years; 83% were women, and 74% were white. Serum calcium and alkaline phosphatase was normal in 96% and 91% of patients, respectively. Vitamin D depletion (25-hydroxyvitamin D ⱕ20 ng/mL) was identified in 53 patients (51%). Black patients had a significantly greater 25-hydroxyvitamin D deficit (13.6 ⫾ 5 ng/mL) compared with whites (23.3 ⫾ 8 ng/mL; p ⬍0.001). The serum 25-hydroxyvitamin D level was not dependent on age, sex, weight, or body mass index. A significant inverse correlation was found between intact parathormone and 25-hydroxyvitamin D (r ⫽ 0.71; p ⬍0.001). Elevated intact parathormone was observed in 40% of patients. Significant elevations in intact parathormone were noted with increasing weight (p ⫽ 0.003) and body mass index (p ⫽ 0.001). Conclusions: Before gastric bypass surgery, one half of the morbidly obese patients have vitamin D depletion despite normal calcium and alkaline phosphate levels. This vitamin D depletion is associated with secondary hyperparathyroidism. Morbidly obese black patients are at a significantly increased risk of vitamin D depletion. Studies evaluating the effects of gastric bypass on vitamin D metabolism must consider the patients’ preoperative status. PII: S1550-7289(05)00181-4
Purpose: The adjustable gastric band (AGB) is one of options for bariatric surgery. At least five models of AGB are available on the market, each with its own characteristics. The most known are the Lap-Band (Fodd and Drug Administration and CE approval), Swedish Adjustable Gastric Band (SAGB; CE approval, on Food and Drug Administration trial), Midband, Heliogast, and Softband (CE approval). Since December 1999, our group have implanted more then 1000 SAGB, Heliogast, and Midband bands (most of them SAGB). Our aim was to compare those three AGB types retrospectively in 100 consecutive cases after 50 initial cases with each of the bands. Methods: Between November 2001 and September 2002, the 100 consecutive patients undergoing SAGB, Heliogast, and Midband placement (after discharging the first 50 cases) had their files reviewed to raise data about casuistic, operative time, intraoperative complications, hospital discharge, complications, mortality, and revisional procedures. Results: No significant differences were found between sex, age, weight, initial weight and body mass index, operative time, intraoperative complications, and hospital discharge. The mortality rate was 0%. Differences occurred among the late complications, such as the rate of slippage for SAGB (0%), Heliogast (3%), and Midband (24%) and the rate of band intragastric migration for SAGB (1%), Heliogast (1%), and Midband (0%). No port complications were noted. The revisional procedure rate was 3% for SAGB, 6% for Heliogast, and 26% for Midband. Without significant differences among the bands, the body mass index decreased from 45.2 to 30.1 kg/m2. Conclusions: Among the AGBs analyzed, the Midband presented with a significantly greater rate of slippage, which led to a high rate of revisional surgery. PII: S1550-7289(05)00179-6
50.
LAPAROSCOPIC REVISION OF VERTICAL BANDED GASTROPLASTY TO ROUX-EN-Y GASTRIC BYPASS: AN OUTCOMES ANALYSIS Daniel J. Gagne´, M.D., David Goitein, M.D., Pavlos K. Papasavas, M.D., Nicole Hayden, P.A.-C., Julie Maurer, P.A.-C., Philip F. Caushaj, M.D., Western Pennsylvania Hospital, Clinical Campus Temple University School of Medicine, Pittsburgh, PA. Purpose: Although vertical banded gastroplasty (VBG) was endorsed by the 1991 National Institutes of Health Consensus Conference for the treatment of morbid obesity, it has largely been abandoned owing to the poor long-term results. We present our experience with laparoscopic revision of failed VBG to Roux-en-Y gastric bypass (RYGBP). Methods: Retrospective review of a prospectively collected database. Follow-up data were available in 100% of patients. Results: In a 3.5-year period, 25 laparoscopic revisions of previous open VBG to RYGBP were performed. Indications for revision were inadequate weight loss or weight gain in 23 patients and intractable vomiting in 2. Of the 25 patients, 23 (92%) were women. The mean age was 45 years (range 30 – 66), and the mean body mass index was 44.8 kg/m2 (range 30.5– 83). The mean follow-up was 17.6 months (range 1– 41). All procedures were completed laparoscopically. The mean operative time was 4.5
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hours (range 3–7.5), mean estimated blood loss was 90 mL, and mean length of hospital stay was 3 days (range 2–38). No mortalities occurred. Six patients (24%) experienced eight complications, including gastric remnant leak in 1, abscess in 2, gastrojejunostomy stricture in 3, internal hernia in 1, and prolonged ventilatory support in 1. The mean excess body weight loss was 42%, 49%, 47%, and 51% at 6, 12, 24, and 36 months, respectively. Diabetes resolved in 5 (100%) of 5 patients. Hypertension resolved in 5 (63%) of 8 patients. Conclusions: Laparoscopic revision of failed open VBG to RYGBP is a challenging but feasible procedure. It provides acceptable weight loss and reversal of weight-related comorbidities. PII: S1550-7289(05)00180-2 SESSION IX (10:30 A.M. – 12:30 P.M.) CONCURRENT WITH SESSION XIII OBESITY SURGERY AND COMORBID CONDITIONS
51.
PREVALENCE OF VITAMIN D DEPLETION AMONG MORBIDLY OBESE PATIENTS SEEKING GASTRIC BYPASS SURGERY Arthur M. Carlin, M.D., Ali M. Meslemani, M.D., Jeffrey A. Genaw, M.D., Shiri Levy, M.D., Arti Bhan, M.D., D. Sudhaker Rao, M.B., B.S., F.A.C.P., F.A.C.E., Henry Ford Hospital, Detroit, MI. Purpose: Abnormalities in calcium and vitamin D metabolism have been reported after bariatric surgery. The purpose of this study was to evaluate vitamin D nutritional status among morbidly obese patients before gastric bypass surgery. Methods: The information collected on 124 morbidly obese patients seeking gastric bypass surgery included age, sex, race, and body mass index. Serum samples were analyzed for calcium, alkaline phosphatase, intact parathormone, 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D. Results: The mean patient age was 43 years; 83% were women, and 74% were white. Serum calcium and alkaline phosphatase was normal in 96% and 91% of patients, respectively. Vitamin D depletion (25-hydroxyvitamin D ⱕ20 ng/mL) was identified in 53 patients (51%). Black patients had a significantly greater 25-hydroxyvitamin D deficit (13.6 ⫾ 5 ng/mL) compared with whites (23.3 ⫾ 8 ng/mL; p ⬍0.001). The serum 25-hydroxyvitamin D level was not dependent on age, sex, weight, or body mass index. A significant inverse correlation was found between intact parathormone and 25-hydroxyvitamin D (r ⫽ 0.71; p ⬍0.001). Elevated intact parathormone was observed in 40% of patients. Significant elevations in intact parathormone were noted with increasing weight (p ⫽ 0.003) and body mass index (p ⫽ 0.001). Conclusions: Before gastric bypass surgery, one half of the morbidly obese patients have vitamin D depletion despite normal calcium and alkaline phosphate levels. This vitamin D depletion is associated with secondary hyperparathyroidism. Morbidly obese black patients are at a significantly increased risk of vitamin D depletion. Studies evaluating the effects of gastric bypass on vitamin D metabolism must consider the patients’ preoperative status. PII: S1550-7289(05)00181-4