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P-86: Prevalence of nutritional deficiencies after laparoscopic sleeve gastrectomy as a final step in morbidly obese patients
Abstracts: 2009 Poster Session / Surgery for Obesity and Related Diseases 5 (2009) S24 –S57
Background: Sleeve gastrectomy (SG) is becoming popular as a standalone procedure for the treatment of morbid obesity & related diseases. This study presents the outcome of SG with regards to weight loss and improvement in co-morbidities and quality of life (QOL) at the end of 3 years after surgery. Methods: Retrospective study of 23 patients M:F ⫽ 8:15) of morbid obesity (Mean BMI ⫽ 49 ⫾ 11kg / m2) with type 2 Diabetes operated for SG during the period 2004 to 2005 is performed with regards to percent excess weight loss ( %EWL), changes in co-morbidity status & QOL at the end of 3 years. BAROS score has been calculated. Results: % EWL at 36 months was 74.6%. 16 / 23 Pts demonstrated significant improvement in all co-morbidities and the rest (7/23) showed at least one major co-morbidity improvement. All (23/23) referred improvement in their QOL but , not equally in all parameters of the questionnaire. BAROS total outcome score was good in 4/23 (17.4%), very good 4/23 (17.4%), and excellent 15/23 (65.2%). Conclusion: SG has demonstrated to be highly effective in improving weight loss, co-morbidities and also the QOL. P-85.
LAPROSCOPIC SLEEVE GASTRECTOMY AS A WEIGHT LOSS OPTION IN THE ELDERLY HIGH-RISK SEVERELY OBESE PATIENT Fady Moustarah, MD; Joseph Talarico, MD; Allen Mikhail, MD; Shaneeta Johnson; Abdulrazak F. Alchakaki, MD; Jill Zink, MD; Vasanth Stalin, MD; Matthew Kroh, MD; Rogula Tomasz, MD, PhD; Bipan Chand, MD; Stacy A. Brethauer, MD; Philip Schauer, MD; Bariatric and Metabolic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. Background: Laparoscopic sleeve gastrectomy (LSG) is increasing in popularity as a therapeutic option for the obese, high risk patient. There is scarce data, however, describing LSG in the elderly population (age ⬎60). We evaluated our LSG experience in this cohort. Methods: Single institution administrative databases were examined to identify patients ⱖ 60 years of age who underwent a LSG. Relevant outcome information was obtained from retrospective review of patients’ charts using electronic medical records. Patients ⱖ1 year out from the date of surgery were evaluated. Results: Between April 2005 and August 2008, 42 patients had a LSG; 22 patients were ⱖ 1 year since surgery. The mean preoperative age, weight, and Body Mass Index (BMI) were 65 yrs, 132 kg, and 52 kg/m2 (n⫽22), respectively. The mean %EWL at 12 months was 40.8% ⫾ 13.5%, 95%CI:[37.7, 43.7]. At 6 months from operation, the mean drop in BMI was 9.5⫾3.0 kg/m2 (n⫽14) as compared to the 12 months decrease of 11.9⫾3.1 kg/m2 (n⫽9)(p⫽0.001). Mean 6 and 12 month BMI values were 40.7⫾5.5 kg/m2 and 38.2⫾5.8 kg/m2, respectively, for patients with both measurements (n⫽9); and these were both statistically different from preoperative values (p⬍ 0.0001). The most common indication for LSG was severe obesity in a high risk patient with multiple comorbidities (mean⫽ 5 comorbidities). Average OR time was 169 minutes; mean hospitalization was 6 days. There were 2 late mortalities (⬎3 months from operation). No other
S53
major complications were seen. In patients with preoperative HbA1c levels ⬎6% (n⫽12), HbA1c improved from a preoperative mean of 7.5%⫾1.3% to 6.1%⫾0.9% 6 months after surgery (p⫽0.04). Conclusion: LSG can result in shortened OR time, significant weight loss, and improvement in comorbidities on 1 year followup. LSG also appears to be an acceptable strategy for weight loss in the elderly high-risk patient population. P-86.
PREVALENCE OF NUTRITIONAL DEFICIENCIES AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY AS A FINAL STEP IN MORBIDLY OBESE PATIENTS Wasef Abu-Jaish, MD; Alexander Ramirez, MD; Sheetal Patel, MD; Emeka Acholonu, MD; Jeremy Gallego Eckstein, MD; Samuel Szomstein, MD; Raul Rosenthal, MD; Batriatric and Metabolic Surgery, Cleveland Clinic Florida, Weston, FL, USA. Background: Laparoscopic sleeve gastrectomy has been recently advocated as a final step in the treatment of morbid obesity. Reports of long-term complications and nutritional deficiencies are yet to be determined. The aim of this study was to evaluate the prevalence of nutritional deficiencies after sleeve gastrectomy. Methods: This was a retrospective study of a prospectively collected database that underwent IRB approval and was conducted following HIPAA guidelines. Between August 2005 and July 2008 the charts of all patients that underwent laparoscopic sleeve gastrectomy were reviewed for nutritional deficiencies and surgical complications. Results: 218 patients were included in this analysis. Follow-up was conducted at 3 months, 6 months, 12 months and on a yearly basis after. The average preoperative Body Mass Index (BMI) was 50.5 (33-58) kg/m2, the average age was 46.2 years (20-65), sex distribution was: F⫽ 151/218, M⫽ 67/218. All patients were subjected to a routine postoperative oral multivitamin supplementation. Both thiamine (“vitamin B1”) and folate deficiency were identified in one patient each (0.4%). Vitamin D was deficient in 13 (5.9%) patients. All patients were asymptomatic and had an incidental diagnosis. No other medical or surgical complications were identified in this patient population after three years follow up. Conclusion: Though rare and not significant, nutritional deficiencies can occur in morbidly obese patients undergoing sleeve gastrectomy. Laparoscopic sleeve gastrectomy has a significantly lower incidence of long-term complications when compared to other well established bariatric procedures. P-87.
POST OPERATIVE VITAMINS AND NUTRITIONAL ASSESSMENT 1 YEAR AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY Ramy H. Fouad, MD; Allen Mikhail, MD; Patrick Gatmaitan, MD; Philip Schauer, MD; Stacy A. Brethauer, MD; Matthew Kroh, MD; Bipan Chand, MD; Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA.
Background: Sleeve gastrectomy (SG) is becoming popular as a standalone procedure for the treatment of morbid obesity & related diseases. This study presents the outcome of SG with regards to weight loss and improvement in co-morbidities and quality of life (QOL) at the end of 3 years after surgery. Methods: Retrospective study of 23 patients M:F ⫽ 8:15) of morbid obesity (Mean BMI ⫽ 49 ⫾ 11kg / m2) with type 2 Diabetes operated for SG during the period 2004 to 2005 is performed with regards to percent excess weight loss ( %EWL), changes in co-morbidity status & QOL at the end of 3 years. BAROS score has been calculated. Results: % EWL at 36 months was 74.6%. 16 / 23 Pts demonstrated significant improvement in all co-morbidities and the rest (7/23) showed at least one major co-morbidity improvement. All (23/23) referred improvement in their QOL but , not equally in all parameters of the questionnaire. BAROS total outcome score was good in 4/23 (17.4%), very good 4/23 (17.4%), and excellent 15/23 (65.2%). Conclusion: SG has demonstrated to be highly effective in improving weight loss, co-morbidities and also the QOL. P-85.
LAPROSCOPIC SLEEVE GASTRECTOMY AS A WEIGHT LOSS OPTION IN THE ELDERLY HIGH-RISK SEVERELY OBESE PATIENT Fady Moustarah, MD; Joseph Talarico, MD; Allen Mikhail, MD; Shaneeta Johnson; Abdulrazak F. Alchakaki, MD; Jill Zink, MD; Vasanth Stalin, MD; Matthew Kroh, MD; Rogula Tomasz, MD, PhD; Bipan Chand, MD; Stacy A. Brethauer, MD; Philip Schauer, MD; Bariatric and Metabolic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. Background: Laparoscopic sleeve gastrectomy (LSG) is increasing in popularity as a therapeutic option for the obese, high risk patient. There is scarce data, however, describing LSG in the elderly population (age ⬎60). We evaluated our LSG experience in this cohort. Methods: Single institution administrative databases were examined to identify patients ⱖ 60 years of age who underwent a LSG. Relevant outcome information was obtained from retrospective review of patients’ charts using electronic medical records. Patients ⱖ1 year out from the date of surgery were evaluated. Results: Between April 2005 and August 2008, 42 patients had a LSG; 22 patients were ⱖ 1 year since surgery. The mean preoperative age, weight, and Body Mass Index (BMI) were 65 yrs, 132 kg, and 52 kg/m2 (n⫽22), respectively. The mean %EWL at 12 months was 40.8% ⫾ 13.5%, 95%CI:[37.7, 43.7]. At 6 months from operation, the mean drop in BMI was 9.5⫾3.0 kg/m2 (n⫽14) as compared to the 12 months decrease of 11.9⫾3.1 kg/m2 (n⫽9)(p⫽0.001). Mean 6 and 12 month BMI values were 40.7⫾5.5 kg/m2 and 38.2⫾5.8 kg/m2, respectively, for patients with both measurements (n⫽9); and these were both statistically different from preoperative values (p⬍ 0.0001). The most common indication for LSG was severe obesity in a high risk patient with multiple comorbidities (mean⫽ 5 comorbidities). Average OR time was 169 minutes; mean hospitalization was 6 days. There were 2 late mortalities (⬎3 months from operation). No other
S53
major complications were seen. In patients with preoperative HbA1c levels ⬎6% (n⫽12), HbA1c improved from a preoperative mean of 7.5%⫾1.3% to 6.1%⫾0.9% 6 months after surgery (p⫽0.04). Conclusion: LSG can result in shortened OR time, significant weight loss, and improvement in comorbidities on 1 year followup. LSG also appears to be an acceptable strategy for weight loss in the elderly high-risk patient population. P-86.
PREVALENCE OF NUTRITIONAL DEFICIENCIES AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY AS A FINAL STEP IN MORBIDLY OBESE PATIENTS Wasef Abu-Jaish, MD; Alexander Ramirez, MD; Sheetal Patel, MD; Emeka Acholonu, MD; Jeremy Gallego Eckstein, MD; Samuel Szomstein, MD; Raul Rosenthal, MD; Batriatric and Metabolic Surgery, Cleveland Clinic Florida, Weston, FL, USA. Background: Laparoscopic sleeve gastrectomy has been recently advocated as a final step in the treatment of morbid obesity. Reports of long-term complications and nutritional deficiencies are yet to be determined. The aim of this study was to evaluate the prevalence of nutritional deficiencies after sleeve gastrectomy. Methods: This was a retrospective study of a prospectively collected database that underwent IRB approval and was conducted following HIPAA guidelines. Between August 2005 and July 2008 the charts of all patients that underwent laparoscopic sleeve gastrectomy were reviewed for nutritional deficiencies and surgical complications. Results: 218 patients were included in this analysis. Follow-up was conducted at 3 months, 6 months, 12 months and on a yearly basis after. The average preoperative Body Mass Index (BMI) was 50.5 (33-58) kg/m2, the average age was 46.2 years (20-65), sex distribution was: F⫽ 151/218, M⫽ 67/218. All patients were subjected to a routine postoperative oral multivitamin supplementation. Both thiamine (“vitamin B1”) and folate deficiency were identified in one patient each (0.4%). Vitamin D was deficient in 13 (5.9%) patients. All patients were asymptomatic and had an incidental diagnosis. No other medical or surgical complications were identified in this patient population after three years follow up. Conclusion: Though rare and not significant, nutritional deficiencies can occur in morbidly obese patients undergoing sleeve gastrectomy. Laparoscopic sleeve gastrectomy has a significantly lower incidence of long-term complications when compared to other well established bariatric procedures. P-87.
POST OPERATIVE VITAMINS AND NUTRITIONAL ASSESSMENT 1 YEAR AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY Ramy H. Fouad, MD; Allen Mikhail, MD; Patrick Gatmaitan, MD; Philip Schauer, MD; Stacy A. Brethauer, MD; Matthew Kroh, MD; Bipan Chand, MD; Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA.