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P38
Abstracts: 2007 Poster Session / Surgery for Obesity and Related Diseases 3 (2007) 299 –344
Background: Infection is a well known risk following gastric bypass. Tight glycemic control using insulin drips has substantially reduced the risk of deep sternal wound infections in cardiac bypass surgery. We initiated an insulin drip protocol on our bariatric patients to decrease infection. Methods: A retrospective review was conducted of all gastric bypass cases performed at our institution between May 1, 2004 and September 30, 2006. All cases were done with a standard operative protocol and all received the same postoperative care. Beginning August 26, 2005, our institution started a glycemic control protocol in our bariatric patients. We compare complication rates before and after implementing the glycemic control protocol. Statistic analysis was performed using chi square test. Results: 198 patients underwent Roux-en-Y gastric bypass to treat morbid obesity during the study period. 97 patients had surgery before the glycemic control started and 101 had surgery after the protocol started. Results are as follows: Conclusion: Glycemic control with insulin drips significantly reduced overall complication rates. The majority of those complications eliminated are infection and ventral hernia formation. Complication
Pre-Insulin
Post-Insulin
P value
# Cases Infection Incisional Hernia Atelectasis Stenosis Ileus Hemorrhage Internal Hernia Intra-abdominal Abscess Bowel Obstruction DVT Respiratory Insufficiency Leak Total
97 19 6 4 4 3 2 1 1
101 2 1 2 10 0 6 2 0
⬍0.001 ⬍0.05 NS NS NS NS NS NS
1 1 0
1 0 1
0 42
1 26
NS NS NS NS ⬍0.001
PII: S1550-7289(07)00277-8 P37.
APPETITE REGULATION FOUR YEARS AFTER WEIGHT LOSS SURGERY - RESULTS FROM A RANDOMIZED CLINICAL TRIAL. Torsten Olbers, MD, PhD; Erik Fernstrom, MD; Sten Skogmar, MD; Anna Laurenius, RD; Hans Lonroth, MD, PhD; Jan Karlsson, PhD Sahlgrenska University Hospital, Gothenburg, Sweden Background: Weight loss surgical options, according to the current assumptions, act through either restriction of food intake or decreased uptake of calories from the bowel. The mechanism of action in gastric bypass has, by many, been regarded as restrictive since there is no evidence for calorie malabsorption. However, there are recent studies suggesting an increased physiological satiety signaling after gastric bypass. Methods: Twenty-eight subjects who four years previously were randomized to either gastric bypass (n⫽15) or vertical banded gastroplasty (VBG) (n⫽13) were interviewed. Using a blinded design, patients were interviewed regarding their appetite regula-
311
tion, feeding sensations and eating behavior. Special effort was put into defining the different sensations of hunger, craving, satiety, and restriction. Results: Gastric bypass patients reported less discomfort when eating and less feeling of restriction when eating compared to VBG patients. Perceived hunger was equal in the two groups while craving seemed to be less pronounced in gastric bypass subjects. The mean excess body weight loss was 79 and 69% respectively after gastric bypass and VBG. Conclusion: Patients who underwent gastric bypass experienced less discomfort and less feeling of restriction when eating, yet they lost more weight, compared to VBG patients. This strongly suggests that gastric bypass is not merely a restrictive weight loss surgical procedure but rather acts through altering the sensations of appetite. PII: S1550-7289(07)00278-X P38.
LONG-TERM RESULTS OF SCLEROTHERAPY FOR DILATED GASTROJEJUNOSTOMY AFTER GASTRIC BYPASS. Laurie Spaulding, MD Fletcher Allen Health Care and University of Vermont, Burlington, VT Background: One potential contributor to weight gain after gastric bypass has been dilation of the gastrojejunostomy. Endoscopic sclerotherapy of the gastrojejunostomy has been demonstrated to result in decrease in diameter of the gastrojejunostomy and provide weight loss or cessation of weight gain in 6 month follow-up. We now report the results 6 months to 5 years after sclerotherapy. Methods: Endoscopic sclerotherapy by single surgeon was performed on 118 gastric bypass patients from 2001 to 2006. The procedure was performed by endoscopic measurement of gastrojejunostomy. If greater than 10 mm in a patient with no evidence of staple line disruption, sclerotherapy was performed. Sodium morrhuate was injected in 1 cc increments circumferentially around in gastrojejunostomy in the muscular wall of the stomach. Percent excess weight loss was measured before and serially after this procedure for 6 months to 5 years after the procedure. Results: The procedure was performed on 118 patients over the study period. The mean pre-procedural diameter of the gastrojejunostomy was 15mm (range 11-24 mm). The mean increase in percent excess weight loss was 1.63% (range was decrease of 4.0% to increase of 8.6%). 73% of patients lost weight or stopped gaining weight. Conclusion: Endoscopic sclerotherapy provides weight loss or stabilizing of weight in most patients with a dilated gastrojejunostomy after gastric bypass. PII: S1550-7289(07)00279-1 P39.
LONG TERM OUTCOME OF LAPAROSCOPIC BARIATRIC SURGERY IN ELDERLY PATIENTS AT UNIVERSITY SETTING. Yong Kwon Lee, MD; Atif Iqbal, MD; Dimitrios Katsavelis, MS; Jon Thompson, MD; Corrigan McBride, MD University of Nebraska Medical Center, Omaha, NE
Background: Infection is a well known risk following gastric bypass. Tight glycemic control using insulin drips has substantially reduced the risk of deep sternal wound infections in cardiac bypass surgery. We initiated an insulin drip protocol on our bariatric patients to decrease infection. Methods: A retrospective review was conducted of all gastric bypass cases performed at our institution between May 1, 2004 and September 30, 2006. All cases were done with a standard operative protocol and all received the same postoperative care. Beginning August 26, 2005, our institution started a glycemic control protocol in our bariatric patients. We compare complication rates before and after implementing the glycemic control protocol. Statistic analysis was performed using chi square test. Results: 198 patients underwent Roux-en-Y gastric bypass to treat morbid obesity during the study period. 97 patients had surgery before the glycemic control started and 101 had surgery after the protocol started. Results are as follows: Conclusion: Glycemic control with insulin drips significantly reduced overall complication rates. The majority of those complications eliminated are infection and ventral hernia formation. Complication
Pre-Insulin
Post-Insulin
P value
# Cases Infection Incisional Hernia Atelectasis Stenosis Ileus Hemorrhage Internal Hernia Intra-abdominal Abscess Bowel Obstruction DVT Respiratory Insufficiency Leak Total
97 19 6 4 4 3 2 1 1
101 2 1 2 10 0 6 2 0
⬍0.001 ⬍0.05 NS NS NS NS NS NS
1 1 0
1 0 1
0 42
1 26
NS NS NS NS ⬍0.001
PII: S1550-7289(07)00277-8 P37.
APPETITE REGULATION FOUR YEARS AFTER WEIGHT LOSS SURGERY - RESULTS FROM A RANDOMIZED CLINICAL TRIAL. Torsten Olbers, MD, PhD; Erik Fernstrom, MD; Sten Skogmar, MD; Anna Laurenius, RD; Hans Lonroth, MD, PhD; Jan Karlsson, PhD Sahlgrenska University Hospital, Gothenburg, Sweden Background: Weight loss surgical options, according to the current assumptions, act through either restriction of food intake or decreased uptake of calories from the bowel. The mechanism of action in gastric bypass has, by many, been regarded as restrictive since there is no evidence for calorie malabsorption. However, there are recent studies suggesting an increased physiological satiety signaling after gastric bypass. Methods: Twenty-eight subjects who four years previously were randomized to either gastric bypass (n⫽15) or vertical banded gastroplasty (VBG) (n⫽13) were interviewed. Using a blinded design, patients were interviewed regarding their appetite regula-
311
tion, feeding sensations and eating behavior. Special effort was put into defining the different sensations of hunger, craving, satiety, and restriction. Results: Gastric bypass patients reported less discomfort when eating and less feeling of restriction when eating compared to VBG patients. Perceived hunger was equal in the two groups while craving seemed to be less pronounced in gastric bypass subjects. The mean excess body weight loss was 79 and 69% respectively after gastric bypass and VBG. Conclusion: Patients who underwent gastric bypass experienced less discomfort and less feeling of restriction when eating, yet they lost more weight, compared to VBG patients. This strongly suggests that gastric bypass is not merely a restrictive weight loss surgical procedure but rather acts through altering the sensations of appetite. PII: S1550-7289(07)00278-X P38.
LONG-TERM RESULTS OF SCLEROTHERAPY FOR DILATED GASTROJEJUNOSTOMY AFTER GASTRIC BYPASS. Laurie Spaulding, MD Fletcher Allen Health Care and University of Vermont, Burlington, VT Background: One potential contributor to weight gain after gastric bypass has been dilation of the gastrojejunostomy. Endoscopic sclerotherapy of the gastrojejunostomy has been demonstrated to result in decrease in diameter of the gastrojejunostomy and provide weight loss or cessation of weight gain in 6 month follow-up. We now report the results 6 months to 5 years after sclerotherapy. Methods: Endoscopic sclerotherapy by single surgeon was performed on 118 gastric bypass patients from 2001 to 2006. The procedure was performed by endoscopic measurement of gastrojejunostomy. If greater than 10 mm in a patient with no evidence of staple line disruption, sclerotherapy was performed. Sodium morrhuate was injected in 1 cc increments circumferentially around in gastrojejunostomy in the muscular wall of the stomach. Percent excess weight loss was measured before and serially after this procedure for 6 months to 5 years after the procedure. Results: The procedure was performed on 118 patients over the study period. The mean pre-procedural diameter of the gastrojejunostomy was 15mm (range 11-24 mm). The mean increase in percent excess weight loss was 1.63% (range was decrease of 4.0% to increase of 8.6%). 73% of patients lost weight or stopped gaining weight. Conclusion: Endoscopic sclerotherapy provides weight loss or stabilizing of weight in most patients with a dilated gastrojejunostomy after gastric bypass. PII: S1550-7289(07)00279-1 P39.
LONG TERM OUTCOME OF LAPAROSCOPIC BARIATRIC SURGERY IN ELDERLY PATIENTS AT UNIVERSITY SETTING. Yong Kwon Lee, MD; Atif Iqbal, MD; Dimitrios Katsavelis, MS; Jon Thompson, MD; Corrigan McBride, MD University of Nebraska Medical Center, Omaha, NE