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Nutritional status is preserved after adolescent gastric bypass
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Abstracts: Plenary Session/Surgery for Obesity and Related Diseases / 1 (2005) 222–283
Results: A total of 604 consecutive patients were brought to the operating room. 600 were successfully banded. This comprised a population with a mean age of 44 and initial BMI of 46.6. Mean excess weight loss of 21%, 27%, 34%, 39%, 39% and 44% was achieved at 3, 6, 9, 12, 18 and 24 months, respectively. A single death from medical causes after discharge resulted in a 30 day mortality of 0.17%. An overall complication rate of 9.0% was noted. Conclusions: Laparoscopic adjustable gastric banding utilizing the Lap-Band device provides a successful and safe means to obtain surgical weight loss for patients in the United States. Close follow-up and regular adjustments are necessary to achieve weight loss. Meaningful outcomes can be achieved by the dedicated surgeon when supported by a multidisciplinary team. PII: S1550-7289(05)00268-6
P81.
DOES A PATIENT CONTRACT IMPROVE FOLLOW-UP WITH BARIATRIC PATIENTS? Thomas P. McIntyre, M.D., Benjamin E. Schneider, M.D., Angela K. Walsh, R.N., Daniel B. Jones, M.D., Beth Israel Deaconess Medical Center, Boston, MA. Purpose: Postoperative follow-up for bariatric patients is essential to avoid complications and maximize the benefits of obesity surgery. Recent experience at our bariatric center revealed extremely low compliance with follow-up appointments. The purpose of our study was to institute a preoperative patient contract and evaluate its effect on compliance with follow-up appointments. Methods: During the past 4 months a patient contract has been incorporated into our preoperative clinical pathway. The contract emphasizes keeping all follow-up appointments and rescheduling missed appointments. Contracts were signed by both patients and a member of the bariatric team, given to patients and placed in the chart. We retrospectively reviewed the compliance with follow-up for patients who signed the contract and for patients that were not offered the contract during the study interval. Analysis was performed using a chi-square test (p ⬍0.05) 250. Results: Review of patient records over the past 4 months revealed 10 patients that signed patient contracts and 33 patients that did not. The compliance with early postoperative care among the contracted patients was 100% (all 10 patients made all appointments). Compliance with the patients without contracts was 79% (26 of 33 patients made all appointments; p ⫽ NS). Conclusions: A patient contract explicitly states the importance of follow-up after weight loss surgery, fosters discussion, and furthers patient understanding of their health. Nevertheless, other methods of reinforcing the importance of follow-up are essential to achieve ideal compliance. The data here suggest that a patient contract improves early postoperative compliance. The long-term value of the contract remains to be determined. PII: S1550-7289(05)00269-8
P82.
NUTRITIONAL STATUS IS PRESERVED AFTER ADOLESCENT GASTRIC BYPASS Steve Allen, M.D., Victor Garcia, M.D., Shelley Kirk, Ph.D., Louise Lawson, Ph.D., Stephen Daniels, M.D., Ph.D., Thomas Inge, M.D., Ph.D., Cincinnati Children’s Hospital Medical Center, Cincinnati, OH. Purpose: Clinically severe obesity is increasingly threatening the health of adolescents. Roux-en-Y gastric bypass (RYGBP) has been effectively used to treat morbidly obese adults and adolescents. However, it is unclear whether adolescent GBP patients may be more prone to micronutrient deficiencies due inadequate vitamin and mineral compliance. The purpose of this study was to determine nutritional consequences of adolescents who underwent RYGBP. Methods: A retrospective analysis of all adolescents (n ⫽ 17) who were beyond 1 year from RYGBP was performed. Change in BMI, serum albumin, total lymphocyte count, hemoglobin, iron, ferritin, thiamine, folate and vitamin B12 were measured at baseline, 6, and 12 months postoperatively. Data were evaluated by one way ANOVA and Mann-Whitney rank sum test to assess significance of changes. Results: Mean BMI fell by 38% from 57.5 ⫾ 10 kg/m2 to 36.2 ⫾ 8 kg/m2 (p ⬍0.05). All nutritional measures were normal preoperatively and no significant changes were observed postoperatively, except for thiamine. Mean serum thiamine values increased twofold from 7.7 to 14.9 nM at 12 months (p ⫽ 0.021). Conclusions: Morbidly obese adolescents are increasingly undergoing bariatric procedures. Although RYGBP does present nutritional risks, our early 1 year data suggest that careful nutritional management results in satisfactory outcomes despite markedly negative caloric balance overall. PII: S1550-7289(05)00270-4 HERNIAS
P83.
RISK FACTORS FOR DEVELOPMENT OF INCISIONAL HERNIA AFTER ROUX-EN-Y GASTRIC BYPASS SURGERY I. Michael Letman, M.D., Michael Horowitz, M.D., Vivek Patil, M.D., Mitchell Chorost, M.D., Lenox Hill Hospital, New York, NY. Purpose: Roux-en-Y gastric bypass (RYGB) has become the most common operation for morbid obesity. Incisional hernias are a complication of any abdominal surgery with an incidence of about 1%. Patients with obesity are at increased risk. Methods: Patients undergoing RYGB over 4 years were reviewed to evaluate the risk factors for incisional hernia. 344 adults (58 male, 286 female) using ASBS and NIH criteria who underwent RYGB were studied. Patients with asthma and a history of steroid use were all off steroids for at least 6 months before surgery. Lesser curvature RYGB was performed through a 10 –14 cm upper abdominal incision. The linea alba was closed using running 1-0 polydiaxone sulfate (PDS) sutures. The mean follow-up was 2 years.
Abstracts: Plenary Session/Surgery for Obesity and Related Diseases / 1 (2005) 222–283
Results: A total of 604 consecutive patients were brought to the operating room. 600 were successfully banded. This comprised a population with a mean age of 44 and initial BMI of 46.6. Mean excess weight loss of 21%, 27%, 34%, 39%, 39% and 44% was achieved at 3, 6, 9, 12, 18 and 24 months, respectively. A single death from medical causes after discharge resulted in a 30 day mortality of 0.17%. An overall complication rate of 9.0% was noted. Conclusions: Laparoscopic adjustable gastric banding utilizing the Lap-Band device provides a successful and safe means to obtain surgical weight loss for patients in the United States. Close follow-up and regular adjustments are necessary to achieve weight loss. Meaningful outcomes can be achieved by the dedicated surgeon when supported by a multidisciplinary team. PII: S1550-7289(05)00268-6
P81.
DOES A PATIENT CONTRACT IMPROVE FOLLOW-UP WITH BARIATRIC PATIENTS? Thomas P. McIntyre, M.D., Benjamin E. Schneider, M.D., Angela K. Walsh, R.N., Daniel B. Jones, M.D., Beth Israel Deaconess Medical Center, Boston, MA. Purpose: Postoperative follow-up for bariatric patients is essential to avoid complications and maximize the benefits of obesity surgery. Recent experience at our bariatric center revealed extremely low compliance with follow-up appointments. The purpose of our study was to institute a preoperative patient contract and evaluate its effect on compliance with follow-up appointments. Methods: During the past 4 months a patient contract has been incorporated into our preoperative clinical pathway. The contract emphasizes keeping all follow-up appointments and rescheduling missed appointments. Contracts were signed by both patients and a member of the bariatric team, given to patients and placed in the chart. We retrospectively reviewed the compliance with follow-up for patients who signed the contract and for patients that were not offered the contract during the study interval. Analysis was performed using a chi-square test (p ⬍0.05) 250. Results: Review of patient records over the past 4 months revealed 10 patients that signed patient contracts and 33 patients that did not. The compliance with early postoperative care among the contracted patients was 100% (all 10 patients made all appointments). Compliance with the patients without contracts was 79% (26 of 33 patients made all appointments; p ⫽ NS). Conclusions: A patient contract explicitly states the importance of follow-up after weight loss surgery, fosters discussion, and furthers patient understanding of their health. Nevertheless, other methods of reinforcing the importance of follow-up are essential to achieve ideal compliance. The data here suggest that a patient contract improves early postoperative compliance. The long-term value of the contract remains to be determined. PII: S1550-7289(05)00269-8
P82.
NUTRITIONAL STATUS IS PRESERVED AFTER ADOLESCENT GASTRIC BYPASS Steve Allen, M.D., Victor Garcia, M.D., Shelley Kirk, Ph.D., Louise Lawson, Ph.D., Stephen Daniels, M.D., Ph.D., Thomas Inge, M.D., Ph.D., Cincinnati Children’s Hospital Medical Center, Cincinnati, OH. Purpose: Clinically severe obesity is increasingly threatening the health of adolescents. Roux-en-Y gastric bypass (RYGBP) has been effectively used to treat morbidly obese adults and adolescents. However, it is unclear whether adolescent GBP patients may be more prone to micronutrient deficiencies due inadequate vitamin and mineral compliance. The purpose of this study was to determine nutritional consequences of adolescents who underwent RYGBP. Methods: A retrospective analysis of all adolescents (n ⫽ 17) who were beyond 1 year from RYGBP was performed. Change in BMI, serum albumin, total lymphocyte count, hemoglobin, iron, ferritin, thiamine, folate and vitamin B12 were measured at baseline, 6, and 12 months postoperatively. Data were evaluated by one way ANOVA and Mann-Whitney rank sum test to assess significance of changes. Results: Mean BMI fell by 38% from 57.5 ⫾ 10 kg/m2 to 36.2 ⫾ 8 kg/m2 (p ⬍0.05). All nutritional measures were normal preoperatively and no significant changes were observed postoperatively, except for thiamine. Mean serum thiamine values increased twofold from 7.7 to 14.9 nM at 12 months (p ⫽ 0.021). Conclusions: Morbidly obese adolescents are increasingly undergoing bariatric procedures. Although RYGBP does present nutritional risks, our early 1 year data suggest that careful nutritional management results in satisfactory outcomes despite markedly negative caloric balance overall. PII: S1550-7289(05)00270-4 HERNIAS
P83.
RISK FACTORS FOR DEVELOPMENT OF INCISIONAL HERNIA AFTER ROUX-EN-Y GASTRIC BYPASS SURGERY I. Michael Letman, M.D., Michael Horowitz, M.D., Vivek Patil, M.D., Mitchell Chorost, M.D., Lenox Hill Hospital, New York, NY. Purpose: Roux-en-Y gastric bypass (RYGB) has become the most common operation for morbid obesity. Incisional hernias are a complication of any abdominal surgery with an incidence of about 1%. Patients with obesity are at increased risk. Methods: Patients undergoing RYGB over 4 years were reviewed to evaluate the risk factors for incisional hernia. 344 adults (58 male, 286 female) using ASBS and NIH criteria who underwent RYGB were studied. Patients with asthma and a history of steroid use were all off steroids for at least 6 months before surgery. Lesser curvature RYGB was performed through a 10 –14 cm upper abdominal incision. The linea alba was closed using running 1-0 polydiaxone sulfate (PDS) sutures. The mean follow-up was 2 years.