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P-112 Resolution of diabetes and peroperative complications: Outcome after single loop gastric bypass, roux-en-y gastric bypass and biliopancreatic diversion in our experience
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Abstracts: Poster Session 2011 / Surgery for Obesity and Related Diseases 7 (2011) 372– 416
weight prior to entering a surgical weight loss program may be more successful achieving weight loss at 12 months following surgery. Demographic factors associated with ⬎ 30% EWL following adolescent LAGB Demographic Measure
p value
Gender Ethnicity Family income Insurance Family obesity Family with wls* Wt loss ⬎5lb
ns ns ns ns ⬍.05 ns ⬍.005
* weight loss surgery.
METABOLIC SURGERY FOR DIABETES P-111
DOES TIGHTER HEMOGLOBIN A1C REGULATION PREDICT SHORTER LENGTH OF STAY AND LOWER RATES OF RE-OPERATION AND READMISSION AFTER BARIATRIC SURGERY? Leslie M. Schuh, PhD1; Brenda Cacucci, MD1; David Diaz, MD1; Christopher Evanson, MD1; John Huse, MD1; Margaret Inman, MD1; Douglas Kaderabek, MD1; 1St. Vincent Carmel Bariatric Center of Excellence, Carmel, IN, United States Background: Elevated levels of glycosylated hemoglobin A1c (HbA1c) may have an impact on recovery after bariatric surgery. The present, retrospective chart review examined HbA1c levels pre-surgery to determine whether tighter glucose control was associated with better outcomes after bariatric surgery. Methods: Patients having bariatric surgery at the St. Vincent Carmel Bariatric Center of Excellence from March 1, 2004 until Sept. 22, 2009 were eligible for these analyses. 2,754 patients had HbA1c levels measured before surgery. 541 patients had high HbA1c levels (defined as ⱖ8.0%). Of the remaining 2,213 patients with lower HbA1c levels, 542 were randomly selected for analysis. Categorical and continuous analyses examined the effects of presurgery HbA1c on length of stay, reoperation, 30-day readmission, and death. Results: HbA1c levels ranged from 6.0 to 13.6%. Mean length of stay was 2.8 days (range 1-26, means of 2.8 for high and 2.7 for low HbA1c patients, p⫽.32). Sixteen of 1083 patients required reoperation (10 with high and 6 with low HbA1c, p⫽.31). A total of 207 of 1,083 patients were readmitted (102 with high and 105 with low HbA1c, p⫽.83). Five of 1,083 patients died (3 with high and 2 with low HbA1c, p⫽.65). Similarly, the continuous analysis showed no significant effect of HbA1c levels on outcomes (p⫽.91, .32, and .20 for length of stay, re-operation, and readmission, respectively). Conclusion: Although tight glucose control has been shown to improve outcomes in a variety of surgeries, the present study found
no relation between pre-surgery HbA1c and several key outcome measures following bariatric surgery.
P-112
RESOLUTION OF DIABETES AND PEROPERATIVE COMPLICATIONS: OUTCOME AFTER SINGLE LOOP GASTRIC BYPASS, ROUX-EN-Y GASTRIC BYPASS AND BILIOPANCREATIC DIVERSION IN OUR EXPERIENCE Tacchino Roberto, MD1, Greco Francesco, MD1; 1policlinico agostino gemelli, Rome, Italy Background: Efficacy of single loop gastric bypass in the treatment of diabetes in morbid obese patients has been poorly investigated. Methods: Between January 2005 and December 2008, 109 patients underwent SLGB, 134 Roux-en-Y gastric bypass (RYGB) and 244 biliopancreatic diversion (BPD) for treatment morbid obesity. Data were collected prospectively in order to evaluate peroperative outcome and resolution of diabetes at 2, 6 and 12 months follow-up. In the SLGB group 33 patients had serum glucose higher than 110 mg/dL with a mean BMI 45.7 kg/m2 and an average serum glucose level 157.8. In the RYGB group 49 patients had serum glucose higher than 110 mg/dL with a mean BMI 45 kg/m2 and an average serum glucose level of 150. In the BPD group, 77 patients had serum glucose higher than 110 mg/dL; with a mean BMI of 51.32 kg/m2 and an average serum glucose level of 146. Results: There was no mortality. Major adverse event were recorded in 8 patients in all groups (rate 1.6%) and in 4/154 (2.6% rate) of all diabetics patients. All intervention showed great effectiveness in treating diabetes: at 12 months PO resolution of diabetes was accomplished in 100% of patients in the SLGB group and in the RYGB group while it approximate 95% in BPD group. Conclusion: The SLGB shows an excellent rate of resolution of diabetes, excellent weight loss and may be considered easier to perform compared with BPD and RYGB. Eventually it can be performed with a single-incision technique providing a faster recovery and a virtually scar-less surgery.
P-113
INCRETIN EFFECT IS MARKEDLY ENHANCED AFTER SLEEVE GASTRECTOMY IN TYPE 2 DIABETES PATIENTS Wei J. Lee, PhD1, Chih-Yen Chen, PhD2, Shu-Chu Chen1, Yi-Chih Lee1, Jung-Chien Chen, MD1, Kong-Han Ser, MD1, Yen-How Su, MD1; 1Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan, Taoyuan, Taiwan; 2Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Background: Type II diabetes mellitus (T2DM) patients are known to have defect in incretin effect and are markedly enhanced after gastric bypass surgery. However, data after sleeve gastrectomy in T2DM patients with BMI ⬍ 35 kg/m2 is lacking.
Abstracts: Poster Session 2011 / Surgery for Obesity and Related Diseases 7 (2011) 372– 416
weight prior to entering a surgical weight loss program may be more successful achieving weight loss at 12 months following surgery. Demographic factors associated with ⬎ 30% EWL following adolescent LAGB Demographic Measure
p value
Gender Ethnicity Family income Insurance Family obesity Family with wls* Wt loss ⬎5lb
ns ns ns ns ⬍.05 ns ⬍.005
* weight loss surgery.
METABOLIC SURGERY FOR DIABETES P-111
DOES TIGHTER HEMOGLOBIN A1C REGULATION PREDICT SHORTER LENGTH OF STAY AND LOWER RATES OF RE-OPERATION AND READMISSION AFTER BARIATRIC SURGERY? Leslie M. Schuh, PhD1; Brenda Cacucci, MD1; David Diaz, MD1; Christopher Evanson, MD1; John Huse, MD1; Margaret Inman, MD1; Douglas Kaderabek, MD1; 1St. Vincent Carmel Bariatric Center of Excellence, Carmel, IN, United States Background: Elevated levels of glycosylated hemoglobin A1c (HbA1c) may have an impact on recovery after bariatric surgery. The present, retrospective chart review examined HbA1c levels pre-surgery to determine whether tighter glucose control was associated with better outcomes after bariatric surgery. Methods: Patients having bariatric surgery at the St. Vincent Carmel Bariatric Center of Excellence from March 1, 2004 until Sept. 22, 2009 were eligible for these analyses. 2,754 patients had HbA1c levels measured before surgery. 541 patients had high HbA1c levels (defined as ⱖ8.0%). Of the remaining 2,213 patients with lower HbA1c levels, 542 were randomly selected for analysis. Categorical and continuous analyses examined the effects of presurgery HbA1c on length of stay, reoperation, 30-day readmission, and death. Results: HbA1c levels ranged from 6.0 to 13.6%. Mean length of stay was 2.8 days (range 1-26, means of 2.8 for high and 2.7 for low HbA1c patients, p⫽.32). Sixteen of 1083 patients required reoperation (10 with high and 6 with low HbA1c, p⫽.31). A total of 207 of 1,083 patients were readmitted (102 with high and 105 with low HbA1c, p⫽.83). Five of 1,083 patients died (3 with high and 2 with low HbA1c, p⫽.65). Similarly, the continuous analysis showed no significant effect of HbA1c levels on outcomes (p⫽.91, .32, and .20 for length of stay, re-operation, and readmission, respectively). Conclusion: Although tight glucose control has been shown to improve outcomes in a variety of surgeries, the present study found
no relation between pre-surgery HbA1c and several key outcome measures following bariatric surgery.
P-112
RESOLUTION OF DIABETES AND PEROPERATIVE COMPLICATIONS: OUTCOME AFTER SINGLE LOOP GASTRIC BYPASS, ROUX-EN-Y GASTRIC BYPASS AND BILIOPANCREATIC DIVERSION IN OUR EXPERIENCE Tacchino Roberto, MD1, Greco Francesco, MD1; 1policlinico agostino gemelli, Rome, Italy Background: Efficacy of single loop gastric bypass in the treatment of diabetes in morbid obese patients has been poorly investigated. Methods: Between January 2005 and December 2008, 109 patients underwent SLGB, 134 Roux-en-Y gastric bypass (RYGB) and 244 biliopancreatic diversion (BPD) for treatment morbid obesity. Data were collected prospectively in order to evaluate peroperative outcome and resolution of diabetes at 2, 6 and 12 months follow-up. In the SLGB group 33 patients had serum glucose higher than 110 mg/dL with a mean BMI 45.7 kg/m2 and an average serum glucose level 157.8. In the RYGB group 49 patients had serum glucose higher than 110 mg/dL with a mean BMI 45 kg/m2 and an average serum glucose level of 150. In the BPD group, 77 patients had serum glucose higher than 110 mg/dL; with a mean BMI of 51.32 kg/m2 and an average serum glucose level of 146. Results: There was no mortality. Major adverse event were recorded in 8 patients in all groups (rate 1.6%) and in 4/154 (2.6% rate) of all diabetics patients. All intervention showed great effectiveness in treating diabetes: at 12 months PO resolution of diabetes was accomplished in 100% of patients in the SLGB group and in the RYGB group while it approximate 95% in BPD group. Conclusion: The SLGB shows an excellent rate of resolution of diabetes, excellent weight loss and may be considered easier to perform compared with BPD and RYGB. Eventually it can be performed with a single-incision technique providing a faster recovery and a virtually scar-less surgery.
P-113
INCRETIN EFFECT IS MARKEDLY ENHANCED AFTER SLEEVE GASTRECTOMY IN TYPE 2 DIABETES PATIENTS Wei J. Lee, PhD1, Chih-Yen Chen, PhD2, Shu-Chu Chen1, Yi-Chih Lee1, Jung-Chien Chen, MD1, Kong-Han Ser, MD1, Yen-How Su, MD1; 1Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan, Taoyuan, Taiwan; 2Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Background: Type II diabetes mellitus (T2DM) patients are known to have defect in incretin effect and are markedly enhanced after gastric bypass surgery. However, data after sleeve gastrectomy in T2DM patients with BMI ⬍ 35 kg/m2 is lacking.