- Email: [email protected]
P10
Abstracts: Poster Session 2006 / 2 (2006) 310 –347
Conclusion: LRYGBP is a feasible operation following pancreas transplantation. This presents a technical challenge in locating the donor organ, preventing its injury, and in constructing the Roux limb. FK506 levels must be monitored to prevent perioperative toxicity. Also, the drug levels could be affected by significant weight loss and potential alteration in absorption of the drug. PII: S1550-7289(06)00350-9
P10.
LAPAROSCOPIC GASTRIC BYPASS IN PATIENTS OVER 65 YEARS OF AGE. Jorge L. Sosa, MD, Hector Pallavicini, MD, Hector Pombo, MD, Nancy Rubio, CST, Palmetto General Hospital, Hialeah, FL. Background: The Medicare Coverage Advisory Committee found insufficient evidence in patients over 65 years of age to recommend coverage for bariatric surgery, and requested additional data be developed and provided. In order to add to the data available in these patients we analyzed our results with laparoscopic gastric bypass in patients older than 65 years. Methods: We analyzed our prospective database collected on all gastric bypass patients for mortality, morbidity and results in patients older than 65 years. We determined in-hospital, 30 day and total mortality to date, as well as 30 day morbidity. We determined % excess weight loss, average drop in BMI, and resolution of co-morbidities. Results: There were 27 patients older than 65 years, the average age was 67.5 years (65-75). The pre-operative average BMI was 48 (36-59). Average follow-up was 16 months (6-31). In-hospital mortality was 0%. One patient died of pulmonary embolism at one month post op for a 30 day mortality of 4% (1/27). Total mortality to date is 4% (1/27). The average drop in BMI was 14 (6-28). Excess weight loss averaged 66.6% (22-100%). Resolution of co-morbidities: Diabetes 50%; Hypertension 47%; Sleep apnea 100%; Dyslipidemia 75%. A further 21% of diabetic patients were able to eliminate insulin use. Conclusion: In patients older than 65 years, laparoscopic gastric bypass has an acceptable risk/benefit ratio and should be offered to well selected, motivated patients. As the obesity epidemic affects our increasingly older population, it is a viable tool in the management of morbid obesity and its associated co-morbidities. PII: S1550-7289(06)00351-0
P11.
ARE OLDER BARIATRIC PATIENTS AT INCREASED RISK FOR MICRONUTRIENT DEFICIENCIES? RoseMarie Toussaint, MD, Robert T. Marema, MD, Cynthia K. Buffington, PhD, U.S. Bariatric, Ft. Lauderdale, FL. Background: The risk for deficiencies in B-complex vitamins, such as vitamin B12 and folic acid, decrease with advancing age. As gastric bypass (GBP) can lead to deficiencies in these vitamins, older gastric bypass patients have an increased risk for deficiencies in these and possibly other micronutrients. In our study, we have examined the association between age and postoperative micronutrients in GBP patients. Methods: The study population included 3 age groups (G) of post-surgical gastric bypass patients, G1 ⫽ ages 20-35 years,
313
G2 ⫽ 36-50, G3 ⫽ 51-75. All patients were similar with regard to body size, gender distribution, and time of post-surgical blood nutrient assessment. Nutrients measured included blood levels of B12, folic acid, ferritin, iron, and calcium. Results: Micronutrient levels of the older G3 patients were consistently and significantly (p⬍0.05) higher than those of the youngest G1 patients for vitamin B12, folic acid, and ferritin. Regression analyses show that age was positively, rather than inversely, correlated to vitamin B12 (p⫽0.03), folic acid (p⫽0.0006), ferritin (p⫽0.003) and iron (p⫽0.05). The higher micronutrients of the older vs. younger patients were not due to differences in weight loss, as % excess weight loss did not significantly differ between the age groups at the time samples were analyzed for micronutrients. However, the older bariatric patients were more compliant in taking their nutrient supplements than were patients of G1 (chi square ⬍ 0.05). Conclusion: Age is not a significant determinant of post-surgical vitamin and mineral deficiencies with GBP surgery, particularly for patients taking nutrient supplements. PII: S1550-7289(06)00352-2
P12.
GASTRIC BANDING FOR MORBIDLY OBESE ADOLESCENTS. Eliezer Avinoach, MD, Leonid Lansdberg, MD, Solly Mizrahi, MD, Surgery A, Soroka Medical Center, Ben Gurion University, Faculty of Health Sciences, Beer Sheva, Israel. Background: Although bariatric surgery is an effective treatment for morbid obesity there is relative little experience with the surgical treatment for the morbidly obese adolescent. This study describes our long-term clinical experience with the laparoscopic gastric banding in adolescents. Methods: During the last six years 116 morbidly obese patients had laparoscopic gastric banding. Their mean age was 16⫾1.4 (range - 9 to 18) years. Despite their young age, their mean height was 165⫾7 cm their mean weight was 119⫾15 kg with a mean BMI of 43⫾3. Fourteen patients (12%) were super-obese, BMI over 50. They had laparoscopic gastric banding performed through the pars flacida, with no gastro-gastric sutures. Mean operation time was 25 minutes and hospital stay did not exceed 24 hours. Results: Perioperative complication rate was ⬍ 1%. Late complications included band slippage in six (4.4%) patients who underwent laparoscopic reposition. Close follow-up is essential during the first year in order to inflate the band. Monthly inflation was performed and seven to eight milliliters was used to maintain weight reduction. Three to six years after surgery the mean BMI was 29⫾2.5 (32 patients).Two years after surgery the BMI was 28⫾3.2 (49 patients). The super-obese reduced their BMI to 32⫾4. There were no metabolic or nutritional disorders. Conclusion: We found that, despite their young age, obese adolescents had similar dimensions as obese adults. We conclude that gastric banding is well tolerated by young morbidly obese patients. It induces long-term significant weight reduction with a significant improvement in the quality of life. PII: S1550-7289(06)00353-4
Conclusion: LRYGBP is a feasible operation following pancreas transplantation. This presents a technical challenge in locating the donor organ, preventing its injury, and in constructing the Roux limb. FK506 levels must be monitored to prevent perioperative toxicity. Also, the drug levels could be affected by significant weight loss and potential alteration in absorption of the drug. PII: S1550-7289(06)00350-9
P10.
LAPAROSCOPIC GASTRIC BYPASS IN PATIENTS OVER 65 YEARS OF AGE. Jorge L. Sosa, MD, Hector Pallavicini, MD, Hector Pombo, MD, Nancy Rubio, CST, Palmetto General Hospital, Hialeah, FL. Background: The Medicare Coverage Advisory Committee found insufficient evidence in patients over 65 years of age to recommend coverage for bariatric surgery, and requested additional data be developed and provided. In order to add to the data available in these patients we analyzed our results with laparoscopic gastric bypass in patients older than 65 years. Methods: We analyzed our prospective database collected on all gastric bypass patients for mortality, morbidity and results in patients older than 65 years. We determined in-hospital, 30 day and total mortality to date, as well as 30 day morbidity. We determined % excess weight loss, average drop in BMI, and resolution of co-morbidities. Results: There were 27 patients older than 65 years, the average age was 67.5 years (65-75). The pre-operative average BMI was 48 (36-59). Average follow-up was 16 months (6-31). In-hospital mortality was 0%. One patient died of pulmonary embolism at one month post op for a 30 day mortality of 4% (1/27). Total mortality to date is 4% (1/27). The average drop in BMI was 14 (6-28). Excess weight loss averaged 66.6% (22-100%). Resolution of co-morbidities: Diabetes 50%; Hypertension 47%; Sleep apnea 100%; Dyslipidemia 75%. A further 21% of diabetic patients were able to eliminate insulin use. Conclusion: In patients older than 65 years, laparoscopic gastric bypass has an acceptable risk/benefit ratio and should be offered to well selected, motivated patients. As the obesity epidemic affects our increasingly older population, it is a viable tool in the management of morbid obesity and its associated co-morbidities. PII: S1550-7289(06)00351-0
P11.
ARE OLDER BARIATRIC PATIENTS AT INCREASED RISK FOR MICRONUTRIENT DEFICIENCIES? RoseMarie Toussaint, MD, Robert T. Marema, MD, Cynthia K. Buffington, PhD, U.S. Bariatric, Ft. Lauderdale, FL. Background: The risk for deficiencies in B-complex vitamins, such as vitamin B12 and folic acid, decrease with advancing age. As gastric bypass (GBP) can lead to deficiencies in these vitamins, older gastric bypass patients have an increased risk for deficiencies in these and possibly other micronutrients. In our study, we have examined the association between age and postoperative micronutrients in GBP patients. Methods: The study population included 3 age groups (G) of post-surgical gastric bypass patients, G1 ⫽ ages 20-35 years,
313
G2 ⫽ 36-50, G3 ⫽ 51-75. All patients were similar with regard to body size, gender distribution, and time of post-surgical blood nutrient assessment. Nutrients measured included blood levels of B12, folic acid, ferritin, iron, and calcium. Results: Micronutrient levels of the older G3 patients were consistently and significantly (p⬍0.05) higher than those of the youngest G1 patients for vitamin B12, folic acid, and ferritin. Regression analyses show that age was positively, rather than inversely, correlated to vitamin B12 (p⫽0.03), folic acid (p⫽0.0006), ferritin (p⫽0.003) and iron (p⫽0.05). The higher micronutrients of the older vs. younger patients were not due to differences in weight loss, as % excess weight loss did not significantly differ between the age groups at the time samples were analyzed for micronutrients. However, the older bariatric patients were more compliant in taking their nutrient supplements than were patients of G1 (chi square ⬍ 0.05). Conclusion: Age is not a significant determinant of post-surgical vitamin and mineral deficiencies with GBP surgery, particularly for patients taking nutrient supplements. PII: S1550-7289(06)00352-2
P12.
GASTRIC BANDING FOR MORBIDLY OBESE ADOLESCENTS. Eliezer Avinoach, MD, Leonid Lansdberg, MD, Solly Mizrahi, MD, Surgery A, Soroka Medical Center, Ben Gurion University, Faculty of Health Sciences, Beer Sheva, Israel. Background: Although bariatric surgery is an effective treatment for morbid obesity there is relative little experience with the surgical treatment for the morbidly obese adolescent. This study describes our long-term clinical experience with the laparoscopic gastric banding in adolescents. Methods: During the last six years 116 morbidly obese patients had laparoscopic gastric banding. Their mean age was 16⫾1.4 (range - 9 to 18) years. Despite their young age, their mean height was 165⫾7 cm their mean weight was 119⫾15 kg with a mean BMI of 43⫾3. Fourteen patients (12%) were super-obese, BMI over 50. They had laparoscopic gastric banding performed through the pars flacida, with no gastro-gastric sutures. Mean operation time was 25 minutes and hospital stay did not exceed 24 hours. Results: Perioperative complication rate was ⬍ 1%. Late complications included band slippage in six (4.4%) patients who underwent laparoscopic reposition. Close follow-up is essential during the first year in order to inflate the band. Monthly inflation was performed and seven to eight milliliters was used to maintain weight reduction. Three to six years after surgery the mean BMI was 29⫾2.5 (32 patients).Two years after surgery the BMI was 28⫾3.2 (49 patients). The super-obese reduced their BMI to 32⫾4. There were no metabolic or nutritional disorders. Conclusion: We found that, despite their young age, obese adolescents had similar dimensions as obese adults. We conclude that gastric banding is well tolerated by young morbidly obese patients. It induces long-term significant weight reduction with a significant improvement in the quality of life. PII: S1550-7289(06)00353-4