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P40
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Abstracts: 2007 Poster Session / Surgery for Obesity and Related Diseases 3 (2007) 299 –344
Background: Morbid obesity has been described as a continuing epidemic affecting a growing portion of our population. Age ⱖ 55 years is considered a relative contraindication for bariatric surgery. The aim of the present study is to report long term outcome of laparoscopic gastric bypass in elderly patients at a University setting. Methods: This is a retrospective study in a university setting with IRB approval. Between 2001 and 2006, 74 elderly patients ⱖ 55 years underwent laparoscopic gastric bypass. Data were collected using patient charts, and radiographic reports. Variables included were age, sex, follow up time (FT), post-operative complications in less than 30 days (PCL30), and post-operative complications in more than 30 days (PCM30). Results: Current follow-up mean (⫾ SD) available on 74 patients (9 male and 65 female) was 27.7 (⫾13.5) months. Age was 60 (⫾4.5). PCL30 reported was 9.5% (abscess n ⫽ 3; DVT n ⫽ 1; dehiscence n ⫽ 1; respiratory failure n ⫽ 5; leak n ⫽ 3), while PCM30 was 20.3% (hernia n ⫽ 2; stenosis n ⫽ 4; ulcer ⫽ 12). Conclusion: Laparoscopic gastric bypass in elderly patients can be performed safely with low rates of complications including abscess, DVT and leak. Our long-term outcomes show a low rate of complications comparable to the short-term data available in the literature. PII: S1550-7289(07)00280-8 P40.
THE ROLE OF EARLY ROUTINE UPPER GASTROINTESTINAL CONTRAST STUDIES AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS. Iswanto Sucandy, MD; Olga Tucker, MD; Samuel Szomstein, MD; Raul J Rosenthal, MD Cleveland Clinic Florida, Weston, FL Background: Routine performance of upper gastrointestinal contrast studies (UGI) after laparoscopic Roux-en-Y gastric bypass (LRYGB) is controversial. At our center, a routine UGI is performed on postoperative day (POD) 1 after LRYGB. Methods: A retrospective review of a prospectively maintained database was performed from January 2004 to October 2006 on all patients undergoing primary LRYGB. Results: 995 patients underwent LRYGB; mean age: 43 (range 17-81) years, mean BMI: 49 (range 37–90) kg/m2, M:F 1:3. POD 1 UGI demonstrated pathology in n⫽6; gastrojejunal anastomotic (GJA) stenosis in 4 (complete n⫽2, incomplete n⫽2), jejunojejunostomy anastomotic (JJA) stenosis in 2, suspected pouch staple line leak in 1. The pouch staple line leak was unconfirmed on abdominal CT and the patient remained well (false positive rate 0.1%). Of the 2 patients with complete GJA obstruction, repeat UGI 4 days later was normal suggesting anastomotic edema. Only 1 patient required intervention; a percutaneous gastrostomy was inserted in the remnant in 1 patient with JJA stenosis, which was complicated by gastric wall leak requiring laparotomy. A further 8 patients with a negative POD1 UGI were diagnosed with a GI complication at a mean of 3.5 (range 2-6) days after surgery; GJA leak n⫽1, JJA stenosis n⫽7. Surgical intervention was required in all 8; conversion n⫽2, laparotomy n⫽3, laparoscopy n⫽3. Conclusion: POD1 UGI after LRYGB had a negative predictive value of 99%, a false positive rate of 0.1%, and a false negative value of 0.8%. It accurately assessed anastomotic patency and
early leaks. However, a negative study may not diagnose evolving complications, therefore continued careful clinical evaluation is essential. PII: S1550-7289(07)00281-X P41.
USEFULNESS OF LIQUID DIET PRIOR TO LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS. Molly F Wangsgaard, MS, RD; Jennifer G Ginnings, RN; Christian R Ketel, MSN, NPC; Alfonso Torquati, MSCI, MD; William O Richards, MD, FACS Vanderbilt University Medical Center, Nashville, TN Background: This study assesses the weight loss resulting from a high protein, liquid diet prior to laparoscopic Roux-en-Y Gastric Bypass (RYGB) surgery, as well as the impact on operating time and incidence of macroscopic fatty liver disease. Methods: During the pre-operative nutrition assessment, 80 RYGB patients (19 male, 61 female) were instructed to follow a liquid diet for 4-11 days (7.6⫾1.3 days) prior to surgery. The liquid diet consisted of six, skim milk-based drinks per day (approximately 930 kcal, 75 g protein) plus ⬎ 48 oz very low calorie (ⱕ 5 kcal/8 oz) liquids. Body weights were obtained at the assessment (within six weeks of surgery) and the day of surgery. Results: The prescribed liquid diet resulted in 4.5⫾1.2 kg weight loss over 7.6⫾1.3 days, which was a loss 3.0⫾0.02% of excess weight. Compliance of the diet was stressed but not monitored; and therefore, some noncompliance was anticipated. Seven (9%) of the patients did not lose weight prior to surgery. After the implementation of the preoperative weight loss program, the average operating time decreased 15.5⫾6.9 minutes (p⬍0.05) and the rate of concurrent liver biopsy for fatty liver diseases decreased from 21% to 13% (p⬍0.05). Conclusion: The majority of RYGB patient candidates can lose weight on an 8-day liquid diet, which results in shorter operating times and decreased incidence of macroscopic fatty liver disease. PII: S1550-7289(07)00282-1 P42.
SIMPLIFIED GASTRIC BYPASS APPROACH TO MORBID OBESITY – 2500 CASES. Almino Ramos, MD; Manoel Galvao Neto, MD; Manoela Galvao, MD; Andrey Carlo, MD; Edwin Campos, MD; Marcus Lima, MD; Abel Murakami, MD; Marcelo Falcao, MD Gastro Obeso Center, Sao Paulo, Brazil Background: The gastric bypass is considered the golden standard in the treatment of morbid obesity. It is considered one of the most complex procedures in laparoscopy. So, any maneuver, or approaches who can improve its feasibility are welcome. AIM: Evaluate initial results of Simplified Gastric Bypass (SGB) approach Methods: From December of 2001 to November of 2005, 2500 SGB patients records were analyzed in a retrospective manner, 1080 of them were vertical banded gastroplasty and 1420 were non-banded gastroplasty; 1633 were female, age range from 13 a 65y (M⫽ 38,5y), weight range from 85 a 240 Kg (M⫽ 137 Kg) and BMI were between 36 a 69 Kg/m2 (M⫽ 45,8 Kg/m2). The Simplified technique (to be presented) is based in doing all of the
Abstracts: 2007 Poster Session / Surgery for Obesity and Related Diseases 3 (2007) 299 –344
Background: Morbid obesity has been described as a continuing epidemic affecting a growing portion of our population. Age ⱖ 55 years is considered a relative contraindication for bariatric surgery. The aim of the present study is to report long term outcome of laparoscopic gastric bypass in elderly patients at a University setting. Methods: This is a retrospective study in a university setting with IRB approval. Between 2001 and 2006, 74 elderly patients ⱖ 55 years underwent laparoscopic gastric bypass. Data were collected using patient charts, and radiographic reports. Variables included were age, sex, follow up time (FT), post-operative complications in less than 30 days (PCL30), and post-operative complications in more than 30 days (PCM30). Results: Current follow-up mean (⫾ SD) available on 74 patients (9 male and 65 female) was 27.7 (⫾13.5) months. Age was 60 (⫾4.5). PCL30 reported was 9.5% (abscess n ⫽ 3; DVT n ⫽ 1; dehiscence n ⫽ 1; respiratory failure n ⫽ 5; leak n ⫽ 3), while PCM30 was 20.3% (hernia n ⫽ 2; stenosis n ⫽ 4; ulcer ⫽ 12). Conclusion: Laparoscopic gastric bypass in elderly patients can be performed safely with low rates of complications including abscess, DVT and leak. Our long-term outcomes show a low rate of complications comparable to the short-term data available in the literature. PII: S1550-7289(07)00280-8 P40.
THE ROLE OF EARLY ROUTINE UPPER GASTROINTESTINAL CONTRAST STUDIES AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS. Iswanto Sucandy, MD; Olga Tucker, MD; Samuel Szomstein, MD; Raul J Rosenthal, MD Cleveland Clinic Florida, Weston, FL Background: Routine performance of upper gastrointestinal contrast studies (UGI) after laparoscopic Roux-en-Y gastric bypass (LRYGB) is controversial. At our center, a routine UGI is performed on postoperative day (POD) 1 after LRYGB. Methods: A retrospective review of a prospectively maintained database was performed from January 2004 to October 2006 on all patients undergoing primary LRYGB. Results: 995 patients underwent LRYGB; mean age: 43 (range 17-81) years, mean BMI: 49 (range 37–90) kg/m2, M:F 1:3. POD 1 UGI demonstrated pathology in n⫽6; gastrojejunal anastomotic (GJA) stenosis in 4 (complete n⫽2, incomplete n⫽2), jejunojejunostomy anastomotic (JJA) stenosis in 2, suspected pouch staple line leak in 1. The pouch staple line leak was unconfirmed on abdominal CT and the patient remained well (false positive rate 0.1%). Of the 2 patients with complete GJA obstruction, repeat UGI 4 days later was normal suggesting anastomotic edema. Only 1 patient required intervention; a percutaneous gastrostomy was inserted in the remnant in 1 patient with JJA stenosis, which was complicated by gastric wall leak requiring laparotomy. A further 8 patients with a negative POD1 UGI were diagnosed with a GI complication at a mean of 3.5 (range 2-6) days after surgery; GJA leak n⫽1, JJA stenosis n⫽7. Surgical intervention was required in all 8; conversion n⫽2, laparotomy n⫽3, laparoscopy n⫽3. Conclusion: POD1 UGI after LRYGB had a negative predictive value of 99%, a false positive rate of 0.1%, and a false negative value of 0.8%. It accurately assessed anastomotic patency and
early leaks. However, a negative study may not diagnose evolving complications, therefore continued careful clinical evaluation is essential. PII: S1550-7289(07)00281-X P41.
USEFULNESS OF LIQUID DIET PRIOR TO LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS. Molly F Wangsgaard, MS, RD; Jennifer G Ginnings, RN; Christian R Ketel, MSN, NPC; Alfonso Torquati, MSCI, MD; William O Richards, MD, FACS Vanderbilt University Medical Center, Nashville, TN Background: This study assesses the weight loss resulting from a high protein, liquid diet prior to laparoscopic Roux-en-Y Gastric Bypass (RYGB) surgery, as well as the impact on operating time and incidence of macroscopic fatty liver disease. Methods: During the pre-operative nutrition assessment, 80 RYGB patients (19 male, 61 female) were instructed to follow a liquid diet for 4-11 days (7.6⫾1.3 days) prior to surgery. The liquid diet consisted of six, skim milk-based drinks per day (approximately 930 kcal, 75 g protein) plus ⬎ 48 oz very low calorie (ⱕ 5 kcal/8 oz) liquids. Body weights were obtained at the assessment (within six weeks of surgery) and the day of surgery. Results: The prescribed liquid diet resulted in 4.5⫾1.2 kg weight loss over 7.6⫾1.3 days, which was a loss 3.0⫾0.02% of excess weight. Compliance of the diet was stressed but not monitored; and therefore, some noncompliance was anticipated. Seven (9%) of the patients did not lose weight prior to surgery. After the implementation of the preoperative weight loss program, the average operating time decreased 15.5⫾6.9 minutes (p⬍0.05) and the rate of concurrent liver biopsy for fatty liver diseases decreased from 21% to 13% (p⬍0.05). Conclusion: The majority of RYGB patient candidates can lose weight on an 8-day liquid diet, which results in shorter operating times and decreased incidence of macroscopic fatty liver disease. PII: S1550-7289(07)00282-1 P42.
SIMPLIFIED GASTRIC BYPASS APPROACH TO MORBID OBESITY – 2500 CASES. Almino Ramos, MD; Manoel Galvao Neto, MD; Manoela Galvao, MD; Andrey Carlo, MD; Edwin Campos, MD; Marcus Lima, MD; Abel Murakami, MD; Marcelo Falcao, MD Gastro Obeso Center, Sao Paulo, Brazil Background: The gastric bypass is considered the golden standard in the treatment of morbid obesity. It is considered one of the most complex procedures in laparoscopy. So, any maneuver, or approaches who can improve its feasibility are welcome. AIM: Evaluate initial results of Simplified Gastric Bypass (SGB) approach Methods: From December of 2001 to November of 2005, 2500 SGB patients records were analyzed in a retrospective manner, 1080 of them were vertical banded gastroplasty and 1420 were non-banded gastroplasty; 1633 were female, age range from 13 a 65y (M⫽ 38,5y), weight range from 85 a 240 Kg (M⫽ 137 Kg) and BMI were between 36 a 69 Kg/m2 (M⫽ 45,8 Kg/m2). The Simplified technique (to be presented) is based in doing all of the