- Email: [email protected]
P65
Abstracts: 2007 Poster Session / Surgery for Obesity and Related Diseases 3 (2007) 299 –344
Methods: The study protocol involves a total of 60 patients undergoing laparoscopic surgery for morbid obesity (with lap-band) at the center. Patients are entered into a repeated measures design, followed for 10 months after surgery, and have their body composition routinely examined once preoperatively, and every 3 months post- operatively using the bioimpendance analyzer “Biodynamics BIA 310e”. Results: Preliminary results indicate that although body loss is observed as expected, the % of fat loss is not ideal and the presence of mechanisms such as dehydration and BMR is substantial, most likely due to lack of education and compliance to medical and nutritional advice. Conclusion: The above findings are discussed in the context of the multidisciplinary assessments conducted at the center and the way they may inform about the antecedents of the above observations as well as about potential interventions for improved future outcomes. PII: S1550-7289(07)00305-X P64.
COMPARATIVE RESULTS OF THREE ADJUSTABLE GASTRIC BANDS FOR THE TREATMENT OF MORBID OBESITY. Dimitrios Stefanidis, MD, PhD; Ioannis Ioannou, MD Carolinas Medical Center, Charlotte, NC Background: Laparoscopic adjustable gastric banding is effective in inducing weight loss and is a less morbid procedure compared to gastric bypass. Consequently, a number of devices have been introduced into the market. The aim of this study was to compare outcomes and device related complications of three different adjustable bands placed for the treatment of morbid obesity. Methods: Retrospective review of a prospectively maintained database of all patients (n⫽306) undergoing laparoscopic adjustable gastric banding between June 2000 and June 2006 by one private practice bariatric surgeon. During the study period, three different adjustable gastric bands (Swedish Band n⫽201, LapBand n⫽55, AMI Soft Gastric Band n⫽50) were placed in a nonrandomized fashion using the pars flaccida technique. All patients underwent psychological and nutritional evaluation preoperatively. Patient demographics, % excess weight loss (%EWL) at follow up, morbidity and mortality as well as band related complications were prospectively recorded and compared. ANOVA and chi square test were used for statistical analysis; p⬍0.05 was considered significant. Results: 81% of patients were women; mean age was 35 ⫾ 10 years and preoperative BMI 43 ⫾ 6 kg/m2. No mortalities occurred. Comparative results for the three bands used are shown in the table. Conclusion: The three gastric bands used in this study appear to have different effectiveness in inducing weight loss and a different set of complications associated with their use. Bariatric surgeons need to be aware of such differences as they may affect the choice of device for weight loss. Further confirmatory study is needed.
N Patient age (yrs) Comorbidities (%) BMI (kg/m2) OR time (min) % EWL 1 yr
Swedish band
Lap band
AMI band
p-value
201 35 ⫾ 10 27 44 ⫾ 7 107 ⫾ 34 62 ⫾ 21
55 34 ⫾ 11 32 43 ⫾ 6 73 ⫾ 24 54 ⫾ 21
50 37 ⫾ 10 25 42 ⫾ 6 94 ⫾ 28 50 ⫾ 19
n.s. n.s. n.s. ⬍0.001 ⬍0.01
% EWL 2 yrs Complications Erosions Slippages Device failures Other
321
Swedish band
Lap band
AMI band
p-value
77 ⫾ 18 21% 12% 1% 1.5% 5%
Few data 15% 0% 7% 1.8% 5%
65 ⫾ 18 18% 0% 2% 12% 4%
n.s. n.s. ⬍0.01 ⬍0.03 ⬍0.01 n.s.
PII: S1550-7289(07)00306-1 P65.
QUALITY OF LIFE BEFORE AND AFTER GASTRIC BANDING IN A MULTIDISCIPLINARY INSTITUTION. Tony Brancatisano, B Appl Sc; Sara Wahlroos, B Med Sc; Roy Brancatisano, MB BS Institute of Weight Control, Sydney, NSW Australia Background: Quality of life (QOL) is an independent outcome measure for obesity surgery in addition to weight loss and improvement in co morbid illnesses. The aim of this study was to examine the impact of weight loss on QOL following gastric banding using the Swedish Adjustable Gastric Band (SAGB). Methods: QOL was evaluated using the Short Form 36 Health Survey (SF 36) and Beck Depression Inventory II (BDI-II) questionnaires. Forms were administered to 84 consecutive patients preoperatively undergoing laparoscopic gastric banding using the SAGB, and again 1 year postoperatively. Each patient was followed up by the multidisciplinary team which consisted of a surgeon, physician, dietician, psychologist and exercise consultant. The results of each category were compared to their individual pre and post score, and a paired t-test was used to calculate p values. Results: There were 71 females and 13 males. Following a median follow up of 13 months, mean (⫾ SD) body mass index (BMI) decreased from 44.5 ⫾ 9 kg/m2 to 36.7 ⫾ 9 kg/m2 (p⬍0.0001), with excess weight loss of 37.2 ⫾ 19%. This was associated with significant differences between the pre and post operative scores in all SF 36 subscales (Table 1). Also, the mean (⫾ SD) BDI-II score preoperatively was 16.9 ⫾ 12, and decreased significantly to 7.6 ⫾ 10 postoperatively (p⬍0.0001). Conclusion: Preoperative SF-36 and BDI-II scores indicate severe disability with the presence of mild to moderate depression in morbidly obese patients. Furthermore, modest weight loss following SAGB significantly improves QOL as well as depression to almost normal population values. PII: S1550-7289(07)00307-3 P66.
ABDOMINAL PAIN IS INDICATIVE OF GASTRIC NECROSIS WHEN TREATING GASTRIC PROLAPSE ASSOCIATED WITH LAPAROSCOPIC ADJUSTABLE GASTRIC BAND. Jeff W Allen, MD University of Louisville, Louisville, KY Background: Gastric prolapse is the most common intra-abdominal complication following laparoscopic adjustable gastric band (LAGB). It is due to a migration of the fundus of the stomach up through the device. Symptoms include heartburn, dysphagia, and vomiting. Usually gastric prolapse is treated with elective or
Methods: The study protocol involves a total of 60 patients undergoing laparoscopic surgery for morbid obesity (with lap-band) at the center. Patients are entered into a repeated measures design, followed for 10 months after surgery, and have their body composition routinely examined once preoperatively, and every 3 months post- operatively using the bioimpendance analyzer “Biodynamics BIA 310e”. Results: Preliminary results indicate that although body loss is observed as expected, the % of fat loss is not ideal and the presence of mechanisms such as dehydration and BMR is substantial, most likely due to lack of education and compliance to medical and nutritional advice. Conclusion: The above findings are discussed in the context of the multidisciplinary assessments conducted at the center and the way they may inform about the antecedents of the above observations as well as about potential interventions for improved future outcomes. PII: S1550-7289(07)00305-X P64.
COMPARATIVE RESULTS OF THREE ADJUSTABLE GASTRIC BANDS FOR THE TREATMENT OF MORBID OBESITY. Dimitrios Stefanidis, MD, PhD; Ioannis Ioannou, MD Carolinas Medical Center, Charlotte, NC Background: Laparoscopic adjustable gastric banding is effective in inducing weight loss and is a less morbid procedure compared to gastric bypass. Consequently, a number of devices have been introduced into the market. The aim of this study was to compare outcomes and device related complications of three different adjustable bands placed for the treatment of morbid obesity. Methods: Retrospective review of a prospectively maintained database of all patients (n⫽306) undergoing laparoscopic adjustable gastric banding between June 2000 and June 2006 by one private practice bariatric surgeon. During the study period, three different adjustable gastric bands (Swedish Band n⫽201, LapBand n⫽55, AMI Soft Gastric Band n⫽50) were placed in a nonrandomized fashion using the pars flaccida technique. All patients underwent psychological and nutritional evaluation preoperatively. Patient demographics, % excess weight loss (%EWL) at follow up, morbidity and mortality as well as band related complications were prospectively recorded and compared. ANOVA and chi square test were used for statistical analysis; p⬍0.05 was considered significant. Results: 81% of patients were women; mean age was 35 ⫾ 10 years and preoperative BMI 43 ⫾ 6 kg/m2. No mortalities occurred. Comparative results for the three bands used are shown in the table. Conclusion: The three gastric bands used in this study appear to have different effectiveness in inducing weight loss and a different set of complications associated with their use. Bariatric surgeons need to be aware of such differences as they may affect the choice of device for weight loss. Further confirmatory study is needed.
N Patient age (yrs) Comorbidities (%) BMI (kg/m2) OR time (min) % EWL 1 yr
Swedish band
Lap band
AMI band
p-value
201 35 ⫾ 10 27 44 ⫾ 7 107 ⫾ 34 62 ⫾ 21
55 34 ⫾ 11 32 43 ⫾ 6 73 ⫾ 24 54 ⫾ 21
50 37 ⫾ 10 25 42 ⫾ 6 94 ⫾ 28 50 ⫾ 19
n.s. n.s. n.s. ⬍0.001 ⬍0.01
% EWL 2 yrs Complications Erosions Slippages Device failures Other
321
Swedish band
Lap band
AMI band
p-value
77 ⫾ 18 21% 12% 1% 1.5% 5%
Few data 15% 0% 7% 1.8% 5%
65 ⫾ 18 18% 0% 2% 12% 4%
n.s. n.s. ⬍0.01 ⬍0.03 ⬍0.01 n.s.
PII: S1550-7289(07)00306-1 P65.
QUALITY OF LIFE BEFORE AND AFTER GASTRIC BANDING IN A MULTIDISCIPLINARY INSTITUTION. Tony Brancatisano, B Appl Sc; Sara Wahlroos, B Med Sc; Roy Brancatisano, MB BS Institute of Weight Control, Sydney, NSW Australia Background: Quality of life (QOL) is an independent outcome measure for obesity surgery in addition to weight loss and improvement in co morbid illnesses. The aim of this study was to examine the impact of weight loss on QOL following gastric banding using the Swedish Adjustable Gastric Band (SAGB). Methods: QOL was evaluated using the Short Form 36 Health Survey (SF 36) and Beck Depression Inventory II (BDI-II) questionnaires. Forms were administered to 84 consecutive patients preoperatively undergoing laparoscopic gastric banding using the SAGB, and again 1 year postoperatively. Each patient was followed up by the multidisciplinary team which consisted of a surgeon, physician, dietician, psychologist and exercise consultant. The results of each category were compared to their individual pre and post score, and a paired t-test was used to calculate p values. Results: There were 71 females and 13 males. Following a median follow up of 13 months, mean (⫾ SD) body mass index (BMI) decreased from 44.5 ⫾ 9 kg/m2 to 36.7 ⫾ 9 kg/m2 (p⬍0.0001), with excess weight loss of 37.2 ⫾ 19%. This was associated with significant differences between the pre and post operative scores in all SF 36 subscales (Table 1). Also, the mean (⫾ SD) BDI-II score preoperatively was 16.9 ⫾ 12, and decreased significantly to 7.6 ⫾ 10 postoperatively (p⬍0.0001). Conclusion: Preoperative SF-36 and BDI-II scores indicate severe disability with the presence of mild to moderate depression in morbidly obese patients. Furthermore, modest weight loss following SAGB significantly improves QOL as well as depression to almost normal population values. PII: S1550-7289(07)00307-3 P66.
ABDOMINAL PAIN IS INDICATIVE OF GASTRIC NECROSIS WHEN TREATING GASTRIC PROLAPSE ASSOCIATED WITH LAPAROSCOPIC ADJUSTABLE GASTRIC BAND. Jeff W Allen, MD University of Louisville, Louisville, KY Background: Gastric prolapse is the most common intra-abdominal complication following laparoscopic adjustable gastric band (LAGB). It is due to a migration of the fundus of the stomach up through the device. Symptoms include heartburn, dysphagia, and vomiting. Usually gastric prolapse is treated with elective or