- Email: [email protected]
Laparoscopic Total Gastrectomy for the Treatment of Post-Sleeve Chronic Unhealing Fistula
Vol. 225, No. 4S2, October 2017
Scientific Forum: 2017 Clinical Congress
e3
length of stay (LOS) and 30-day readmission rates was assessed and compared with 820 non-ROUP patients with an unrestricted opioid use. ROUP and non-ROUP patients participated in our FTP and received opioids in the operating room and recovery room, intravenous acetaminophen until discharge, and local infiltration of bupivacaine. ROUP patients were discouraged using opioids after admission to the surgical floor until discharge, and were not prescribed opioids after discharge. Non-ROUP patients were placed on patient-controlled anesthesia and received an opioid prescription after discharge.
(n¼22) presented a preoperative eGFR of 47.868.26 mL/min/ 1.73m2, and 62.4016.43mL/min/1.73m2 at 12 months followup (p<0.001). Of the 105 patients with CKD stage2, 67.61% (n¼71) were type 2 diabetics and 60% (n¼63) had a diagnosis of hypertension.
RESULTS: Revisional LRYGB were more frequent among ROUP patients (8/54, 14.8%, vs (36/820, 4.4%, p¼.003). Twenty-one (38.9%) ROUP patients received no opioids during inpatient stay and only 1/54 (1.85%) ROUP patient received a postdischarge narcotic prescription. ROUP and non-ROUP mean LOS (1.18 vs 1.35, p¼.11) days and readmission rates (3/54, 5.5% vs 33/820, 4%, p¼.48) were not statistically significant. ROUP readmissions were unrelated to pain management.
Laparoscopic Total Gastrectomy for the Treatment of Post-Sleeve Chronic Unhealing Fistula Almino Ramos, MD, Eduardo LS Bastos, Manoel P Galvao, Manoela G Ramos, Josemberg M Campos Gastro Obeso Center Institute, Sao Paulo, Brazil
CONCLUSIONS: Despite a higher percentage of revisional LRYGB, ROUP is feasible without compromising successful implementation of a 1-day fast-track protocol after LRYGB. Laparoscopic Sleeve Gastrectomy Improves Glomerular Filtration Rate in Morbidly Obese Patients with Impaired Kidney Function Raul J Rosenthal, MD, FACS, FASMBS, David R Funes, MD, David G Blanco, MD, Emanuele Lo Menzo, MD, PhD, FACS, Samuel Szomstein, MD, FACS Cleveland Clinic Florida, Weston, FL INTRODUCTION: Obesity is detrimental to the kidney function, independently from its associated comorbidities. The objective of this is study is to describe the induced changes in kidney function after laparoscopic sleeve gastrectomy (LSG). METHODS: We retrospectively reviewed all patients who underwent LSG from 2012 to 2015. We assessed kidney function using the Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) equation preoperatively and at 12 months follow-up. R version 3.3.1 statistical software was used to apply a paired t-test to determine statistical significance. RESULTS: Of the 1,330 patients reviewed, 18.79% (n¼250) met the criteria for CKD-EPI glomerular filtration rate (GFR) calculation. Forty-two percent (n¼105) of patients had a CKD stage2. There was a predominantly female distribution of 63.8% (n¼67), and Caucasian 88.57% (n¼93). The mean age was 62.549.7 years. The excess BMI loss was 60.58%, with a preoperative BMI of 42.346.46 kg/m2 and BMI at 12 months of 32.426.04 kg/m2 (p<0.0001). The preoperative estimated GFR (eGFR) was 69.2118.19 mL/min/1.73m2 and 77.4720.91 mL/min/1.73m2 at 12 months follow-up (p<0.0001). Patients with Stage 2 CKD 75.23% (n¼79) presented a preoperative eGFR of 78.118.6 mL/min/1.73m2, and of 85.0312.70 mL/min/1.73m2 at 12 months follow-up (p0.001). Patients with Stage 3A/3B 20.95%
CONCLUSIONS: There is a clear improvement of the GFR in morbidly obese patients with chronic kidney disease after LSG. Prospective studies are needed to further understand this improvement.
INTRODUCTION: Sleeve gastrectomy (SG) has become a safe and common primary bariatric surgery. Occurrence of leaks is very rare but can lead to chronic evolution besides reoperative and endoscopic management. Post-sleeve chronic fistulas are one of the most feared complications and represent a true challenge for the surgeons. After the failure of more conservative treatments, including surgical and endoscopic approaches, laparoscopic total gastrectomy (LTG) appears an alternative treatment. The aim of this study was to evaluate outcomes of patients who underwent LTG for the treatment of post-sleeve chronic fistula. METHODS: We retrospectively reviewed data from patients after LTG due to post-sleeve chronic fistula who had failed all attempts after a combination of conservative, endoscopic, and/or surgical approach. RESULTS: Charts from 20 patients who underwent LTG from January 2008 to December 2016 were revised. Mean time from SG to LTG ranged from 6 months to 38 months (mean 18 months). All patients had undergone several previous treatment attempts, including endoscopic techniques (fibrin glue, stents, clips, pneumatic dilation, and prosthesis) and surgical procedures for abscess drainage and closure of the leak attempts. Surgical time ranged from 4 hours to 7 hours with a mean hospital stay of 6 days. There were no conversions to open surgery. Complications occurred in 4 patients (20%) with 1 revision due to an intestinal occlusion. There were no anastomotic leaks or deaths. CONCLUSIONS: LTG was feasible in the management of postsleeve chronic recalcitrant fistula with a minor complications and high rate of resolution. Neutrophil-To-Lymphocyte Ratio as a Useful Tool to Predict 30-Day Outcomes in Bariatric Surgery Raul J Rosenthal, MD, FACS, FASMBS, Alexandra Ferre, MD, Rafael R Vecchio, MD, Emanuele Lo Menzo, MD, PhD, FACS, Samuel Szomstein, MD, FACS Cleveland Clinic Florida, Weston, FL
Scientific Forum: 2017 Clinical Congress
e3
length of stay (LOS) and 30-day readmission rates was assessed and compared with 820 non-ROUP patients with an unrestricted opioid use. ROUP and non-ROUP patients participated in our FTP and received opioids in the operating room and recovery room, intravenous acetaminophen until discharge, and local infiltration of bupivacaine. ROUP patients were discouraged using opioids after admission to the surgical floor until discharge, and were not prescribed opioids after discharge. Non-ROUP patients were placed on patient-controlled anesthesia and received an opioid prescription after discharge.
(n¼22) presented a preoperative eGFR of 47.868.26 mL/min/ 1.73m2, and 62.4016.43mL/min/1.73m2 at 12 months followup (p<0.001). Of the 105 patients with CKD stage2, 67.61% (n¼71) were type 2 diabetics and 60% (n¼63) had a diagnosis of hypertension.
RESULTS: Revisional LRYGB were more frequent among ROUP patients (8/54, 14.8%, vs (36/820, 4.4%, p¼.003). Twenty-one (38.9%) ROUP patients received no opioids during inpatient stay and only 1/54 (1.85%) ROUP patient received a postdischarge narcotic prescription. ROUP and non-ROUP mean LOS (1.18 vs 1.35, p¼.11) days and readmission rates (3/54, 5.5% vs 33/820, 4%, p¼.48) were not statistically significant. ROUP readmissions were unrelated to pain management.
Laparoscopic Total Gastrectomy for the Treatment of Post-Sleeve Chronic Unhealing Fistula Almino Ramos, MD, Eduardo LS Bastos, Manoel P Galvao, Manoela G Ramos, Josemberg M Campos Gastro Obeso Center Institute, Sao Paulo, Brazil
CONCLUSIONS: Despite a higher percentage of revisional LRYGB, ROUP is feasible without compromising successful implementation of a 1-day fast-track protocol after LRYGB. Laparoscopic Sleeve Gastrectomy Improves Glomerular Filtration Rate in Morbidly Obese Patients with Impaired Kidney Function Raul J Rosenthal, MD, FACS, FASMBS, David R Funes, MD, David G Blanco, MD, Emanuele Lo Menzo, MD, PhD, FACS, Samuel Szomstein, MD, FACS Cleveland Clinic Florida, Weston, FL INTRODUCTION: Obesity is detrimental to the kidney function, independently from its associated comorbidities. The objective of this is study is to describe the induced changes in kidney function after laparoscopic sleeve gastrectomy (LSG). METHODS: We retrospectively reviewed all patients who underwent LSG from 2012 to 2015. We assessed kidney function using the Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) equation preoperatively and at 12 months follow-up. R version 3.3.1 statistical software was used to apply a paired t-test to determine statistical significance. RESULTS: Of the 1,330 patients reviewed, 18.79% (n¼250) met the criteria for CKD-EPI glomerular filtration rate (GFR) calculation. Forty-two percent (n¼105) of patients had a CKD stage2. There was a predominantly female distribution of 63.8% (n¼67), and Caucasian 88.57% (n¼93). The mean age was 62.549.7 years. The excess BMI loss was 60.58%, with a preoperative BMI of 42.346.46 kg/m2 and BMI at 12 months of 32.426.04 kg/m2 (p<0.0001). The preoperative estimated GFR (eGFR) was 69.2118.19 mL/min/1.73m2 and 77.4720.91 mL/min/1.73m2 at 12 months follow-up (p<0.0001). Patients with Stage 2 CKD 75.23% (n¼79) presented a preoperative eGFR of 78.118.6 mL/min/1.73m2, and of 85.0312.70 mL/min/1.73m2 at 12 months follow-up (p0.001). Patients with Stage 3A/3B 20.95%
CONCLUSIONS: There is a clear improvement of the GFR in morbidly obese patients with chronic kidney disease after LSG. Prospective studies are needed to further understand this improvement.
INTRODUCTION: Sleeve gastrectomy (SG) has become a safe and common primary bariatric surgery. Occurrence of leaks is very rare but can lead to chronic evolution besides reoperative and endoscopic management. Post-sleeve chronic fistulas are one of the most feared complications and represent a true challenge for the surgeons. After the failure of more conservative treatments, including surgical and endoscopic approaches, laparoscopic total gastrectomy (LTG) appears an alternative treatment. The aim of this study was to evaluate outcomes of patients who underwent LTG for the treatment of post-sleeve chronic fistula. METHODS: We retrospectively reviewed data from patients after LTG due to post-sleeve chronic fistula who had failed all attempts after a combination of conservative, endoscopic, and/or surgical approach. RESULTS: Charts from 20 patients who underwent LTG from January 2008 to December 2016 were revised. Mean time from SG to LTG ranged from 6 months to 38 months (mean 18 months). All patients had undergone several previous treatment attempts, including endoscopic techniques (fibrin glue, stents, clips, pneumatic dilation, and prosthesis) and surgical procedures for abscess drainage and closure of the leak attempts. Surgical time ranged from 4 hours to 7 hours with a mean hospital stay of 6 days. There were no conversions to open surgery. Complications occurred in 4 patients (20%) with 1 revision due to an intestinal occlusion. There were no anastomotic leaks or deaths. CONCLUSIONS: LTG was feasible in the management of postsleeve chronic recalcitrant fistula with a minor complications and high rate of resolution. Neutrophil-To-Lymphocyte Ratio as a Useful Tool to Predict 30-Day Outcomes in Bariatric Surgery Raul J Rosenthal, MD, FACS, FASMBS, Alexandra Ferre, MD, Rafael R Vecchio, MD, Emanuele Lo Menzo, MD, PhD, FACS, Samuel Szomstein, MD, FACS Cleveland Clinic Florida, Weston, FL