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P-73: Diabetes mellitus and insulin resolution after laparoscopic Roux-en-Y gastric bypass
Abstracts: 2009 Poster Session / Surgery for Obesity and Related Diseases 5 (2009) S24 –S57
Background: An implantable device that intermittently blocks intra-abdominal vagal trunks has been shown to cause significant excess weight loss (EWL) in obese subjects. The aim of this analysis was to assess the effect of VBLOC therapy on glycemic control in obese subjects with type 2 diabetes mellitus (T2DM). Methods: Subjects were implanted at 5 centers in an open-label study. No dietary or behavioral consultation was used in order to isolate the effects of VBLOC therapy. Effects on HbA1c were evaluated at 1, 3 and 6 mo. Results: To date, 6 subjects (4 females, age 46⫾5 yrs, BMI 42⫾2 kg/m2; mean ⫾ SE) have completed 6 mo follow-up. Mean EWLs were 9⫾2%, 11⫾2% and 12⫾1% at 1, 3 and 6 mo, respectively (P⬍0.05). HbA1c reductions were 1.4⫾0.4% (P⬍0.05), 1.3⫾0.3% (P⬍0.01) and 1.7⫾0.6% (P⬍0.05) at 1, 3 and 6 mo, respectively from a baseline of 8.7⫾0.9%. Four subjects were treated with hypoglycemic agents at baseline: therapy was reduced in 1. In all subjects, improvements in HbA1c were achieved and maintained. VBLOC therapy was well tolerated. Conclusion: VBLOC therapy was associated with weight loss and sustained improvements in HbA1c in obese subjects with T2DM. P-73.
DIABETES MELLITUS AND INSULIN RESOLUTION AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS Tallal Zeni, MD1; Seema Kapur, MD2; Tamara R. Lark, BA1; Paula Magid, AAS1; 1St. Mary Mercy Hospital, Livonia, MI, USA; 2St. Joseph Mercy Hospital, Ann Arbor, MI, USA. Background: Laparoscopic Roux-en-y gastric bypass (LRYGB) has been shown to be effective in resolving and improving diabetes mellitus (DM) in many studies. This study investigates resolution and reduction of insulin use in patients undergoing LRYGB. Methods: A retrospective review of 257 consecutive patients undergoing LRYGB from October 2005 until July 2008 was done. Results: Seventy patients (27.2%) who underwent LRYGB had DM. The mean Body Mass Index (BMI) was 48.1 kg/m2 (range 38-67.3), mean age was 49 (range 26-65), and 80% were female. Twenty-five (35.7%) patients were on insulin. The mean insulin dosage was 101 units (range 18-277). Overall, 53 patients (75.7%) resolved their DM. In patients who did not require insulin preoperatively all but one patient (97.7%) had resolution of their DM. In patients who were insulin dependent preoperatively, eleven (44%) no longer required insulin although two still required one of their preoperative oral medications. In the remaining 14 patients (56%) whose DM improved the mean insulin dosage decreased from 99 ⫹/- 48 units to 26 ⫹/- 18 units postoperatively (p⬍0.01). EBMIL% among this group of diabetic patients at 3, 6, and 12 months was 41%, 55%, and 67%, respectively. Conclusion: DM is resolved in nearly all non insulin dependent diabetic patients after LRYGB. More than 40% of insulin dependent diabetics may no longer require insulin after LRYGB. Of those that still do require insulin there is a nearly 75% reduction in insulin dosage postoperatively.
S49
P-74.
LAPAROSCOPIC REVISIONAL BARIATRIC SURGERY WITH THE USE OF A LAPAROSCOPIC ADJUSTABLE GASTRIC BAND (LAGB) OVER A PRIMARY ROUX-ENY BYPASS (RYGB) David L. Schumacher, MD; Melissa Rawlins, PA-C; Jerod Grogg, PA-C; General Surgery, Boonshoft School of Medicine, Wright State University, Kettering, OH, USA. Background: Twenty percent of successful Roux-en-Y Gastric Bypass (RYGB) patients experience weight regain in the post-operative period. Concomitant reestablishment of co-morbidities occurs with significant weight regain. Pouch size, stoma size and limb length are variables that have been surgically altered with limited success. The addition of an adjustable gastric band to an existing RYGB may be a useful technique to reestablish weight loss. Methods: Patients with prior successful RYGB with weight regain were examined and evaluated by our bariatric team. After EGD, UGI and assessment, seven patients were offered band over bypass. Our retrospective analysis involves the seven patients (6 female, 1 male) over a two year time frame. Charts were evaluated for prior weight loss, weight loss after placement of LAGB, change in BMI and %EWL recorded through interval follow up visits. Complications, surgical time, and LOS were noted. Results: All patients were followed on an interval basis with onehundred percent compliance. Six primary cases were done open. All band placements were laparoscopic. The average time between bypass and band, age, amount of weight regained, and weights were documented. Mean Body Mass Index (BMI) at the time of revision was 47 kg/m2. The average %EWL was 43 % and average change in BMI was 12 kg/m2. No complications were recorded. Conclusion: The placement of band over bypass reestablishes weight loss in patients selected and followed in a weight loss program with proper education and adequate instruction. The laparoscopic placement of band over bypass is a viable option for patients with weight regain. P-75.
122 CONSECUTIVE LAPAROSCOPIC REVISIONAL BARIATRIC SURGICAL PROCEDURES IN A U.S. CENTER Gordon G. Wisbach, MD; Philip Okafor, MD; Solis C. Miriam, MD; Heidi L. Fitzgerald, MD; Ashley Vernon, MD; Haley Hathaway, BABS; Kerri Clancy, MD; David B. Lautz, MD; Surgery, Brigham and Women’s Hospital, Boston, MA, USA. Background: Commensurate with the growing number of patients undergoing bariatric surgical procedures is the resulting increase in patients who will subsequently require a revisional procedure. The laparoscopic approach is now our initial approach for all revisional procedures. We sought to evaluate our experience to date with a laparoscopic approach to revisional bariatric surgery. Methods: Using an institutional prospective database, a retrospective review of all consecutive patients from January 2001 to October 2008, who underwent laparoscopic bariatric surgical revisions was performed. Patient demographics, indications for revision, 30-day morbidity, and percent excess body weight loss results (EBWL) following the revision were determined for each group.
Background: An implantable device that intermittently blocks intra-abdominal vagal trunks has been shown to cause significant excess weight loss (EWL) in obese subjects. The aim of this analysis was to assess the effect of VBLOC therapy on glycemic control in obese subjects with type 2 diabetes mellitus (T2DM). Methods: Subjects were implanted at 5 centers in an open-label study. No dietary or behavioral consultation was used in order to isolate the effects of VBLOC therapy. Effects on HbA1c were evaluated at 1, 3 and 6 mo. Results: To date, 6 subjects (4 females, age 46⫾5 yrs, BMI 42⫾2 kg/m2; mean ⫾ SE) have completed 6 mo follow-up. Mean EWLs were 9⫾2%, 11⫾2% and 12⫾1% at 1, 3 and 6 mo, respectively (P⬍0.05). HbA1c reductions were 1.4⫾0.4% (P⬍0.05), 1.3⫾0.3% (P⬍0.01) and 1.7⫾0.6% (P⬍0.05) at 1, 3 and 6 mo, respectively from a baseline of 8.7⫾0.9%. Four subjects were treated with hypoglycemic agents at baseline: therapy was reduced in 1. In all subjects, improvements in HbA1c were achieved and maintained. VBLOC therapy was well tolerated. Conclusion: VBLOC therapy was associated with weight loss and sustained improvements in HbA1c in obese subjects with T2DM. P-73.
DIABETES MELLITUS AND INSULIN RESOLUTION AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS Tallal Zeni, MD1; Seema Kapur, MD2; Tamara R. Lark, BA1; Paula Magid, AAS1; 1St. Mary Mercy Hospital, Livonia, MI, USA; 2St. Joseph Mercy Hospital, Ann Arbor, MI, USA. Background: Laparoscopic Roux-en-y gastric bypass (LRYGB) has been shown to be effective in resolving and improving diabetes mellitus (DM) in many studies. This study investigates resolution and reduction of insulin use in patients undergoing LRYGB. Methods: A retrospective review of 257 consecutive patients undergoing LRYGB from October 2005 until July 2008 was done. Results: Seventy patients (27.2%) who underwent LRYGB had DM. The mean Body Mass Index (BMI) was 48.1 kg/m2 (range 38-67.3), mean age was 49 (range 26-65), and 80% were female. Twenty-five (35.7%) patients were on insulin. The mean insulin dosage was 101 units (range 18-277). Overall, 53 patients (75.7%) resolved their DM. In patients who did not require insulin preoperatively all but one patient (97.7%) had resolution of their DM. In patients who were insulin dependent preoperatively, eleven (44%) no longer required insulin although two still required one of their preoperative oral medications. In the remaining 14 patients (56%) whose DM improved the mean insulin dosage decreased from 99 ⫹/- 48 units to 26 ⫹/- 18 units postoperatively (p⬍0.01). EBMIL% among this group of diabetic patients at 3, 6, and 12 months was 41%, 55%, and 67%, respectively. Conclusion: DM is resolved in nearly all non insulin dependent diabetic patients after LRYGB. More than 40% of insulin dependent diabetics may no longer require insulin after LRYGB. Of those that still do require insulin there is a nearly 75% reduction in insulin dosage postoperatively.
S49
P-74.
LAPAROSCOPIC REVISIONAL BARIATRIC SURGERY WITH THE USE OF A LAPAROSCOPIC ADJUSTABLE GASTRIC BAND (LAGB) OVER A PRIMARY ROUX-ENY BYPASS (RYGB) David L. Schumacher, MD; Melissa Rawlins, PA-C; Jerod Grogg, PA-C; General Surgery, Boonshoft School of Medicine, Wright State University, Kettering, OH, USA. Background: Twenty percent of successful Roux-en-Y Gastric Bypass (RYGB) patients experience weight regain in the post-operative period. Concomitant reestablishment of co-morbidities occurs with significant weight regain. Pouch size, stoma size and limb length are variables that have been surgically altered with limited success. The addition of an adjustable gastric band to an existing RYGB may be a useful technique to reestablish weight loss. Methods: Patients with prior successful RYGB with weight regain were examined and evaluated by our bariatric team. After EGD, UGI and assessment, seven patients were offered band over bypass. Our retrospective analysis involves the seven patients (6 female, 1 male) over a two year time frame. Charts were evaluated for prior weight loss, weight loss after placement of LAGB, change in BMI and %EWL recorded through interval follow up visits. Complications, surgical time, and LOS were noted. Results: All patients were followed on an interval basis with onehundred percent compliance. Six primary cases were done open. All band placements were laparoscopic. The average time between bypass and band, age, amount of weight regained, and weights were documented. Mean Body Mass Index (BMI) at the time of revision was 47 kg/m2. The average %EWL was 43 % and average change in BMI was 12 kg/m2. No complications were recorded. Conclusion: The placement of band over bypass reestablishes weight loss in patients selected and followed in a weight loss program with proper education and adequate instruction. The laparoscopic placement of band over bypass is a viable option for patients with weight regain. P-75.
122 CONSECUTIVE LAPAROSCOPIC REVISIONAL BARIATRIC SURGICAL PROCEDURES IN A U.S. CENTER Gordon G. Wisbach, MD; Philip Okafor, MD; Solis C. Miriam, MD; Heidi L. Fitzgerald, MD; Ashley Vernon, MD; Haley Hathaway, BABS; Kerri Clancy, MD; David B. Lautz, MD; Surgery, Brigham and Women’s Hospital, Boston, MA, USA. Background: Commensurate with the growing number of patients undergoing bariatric surgical procedures is the resulting increase in patients who will subsequently require a revisional procedure. The laparoscopic approach is now our initial approach for all revisional procedures. We sought to evaluate our experience to date with a laparoscopic approach to revisional bariatric surgery. Methods: Using an institutional prospective database, a retrospective review of all consecutive patients from January 2001 to October 2008, who underwent laparoscopic bariatric surgical revisions was performed. Patient demographics, indications for revision, 30-day morbidity, and percent excess body weight loss results (EBWL) following the revision were determined for each group.