- Email: [email protected]
P69: Reverse vertical gastroalloplasty: A new restrictive technique for morbid obesity
Abstracts: 2008 Poster Session 2 / Surgery for Obesity and Related Diseases 4 (2008) 312–357
339
P70.
GASTRIC BYPASS PROVIDES LONG-TERM IMPROVEMENT IN CARDIAC RISK FACTORS Gavitt Woodard, BA; John Downey, BS; Joseph Peraza, BS; John Morton, MD, MPH; Surgery, Stanford University, Stanford, CA, USA.
Nuclear gastric emptying study after revisional surgery. PII: S1550-7289(08)00241-4
P69.
REVERSE VERTICAL GASTROALLOPLASTY: A NEW RESTRICTIVE TECHNIQUE FOR MORBID OBESITY Andrea Rizzi, Medical Doctor; Fabio Corsi, MD; Annalisa Verga; Maria Milanesi, MD; Elson Gjoni, MD; Diego Foschi, PhD, MD; Department of Medical Sciences L.Sacco, University of Milan, Milan, Italy. Background: Laparoscopic gastric banding has been indicated as reference restrictive technique for morbidly obese patients becaming easier and safer than vertical banded gastroplasty (VBG). We describe the preliminary results of a modified VBG, intended to simplify the surgical technique. Methods: 8 patients (M⫽4, F⫽4), mean weight 135.5 ⫾ 18 (SD), Kg, BMI 46 ⫾ 5.8 (SD)gave their informed consent to the operation. Technique: the operation was performed with 5 trocars; the gastro-gastro anastomosis was performed in the lower antrum after opening the gastro colic ligament; a long gastroplasty was performed along the lesser curvature with complete partition of the stomach to the cardias. The polypropylene mesh ring (1.5 x 5.5 cm.) was sutured at the basis of the gastric pouch constructed along the greater curvature, to avoid/reduce the passage of food into the main gastric cavity. The volume of the gastric pouch was estimated in 150 cc. The mean time of operation was 150 ⫾ 37 min. Postoperative course: there were no significant complications and the patients were discharged after a regular length of stay. Results: The short-term results were compared with 9 patients who had the standard Mac Lean VBG. There were no significant differences in weight and BMI reduction 1 month (BW -12.3⫾2.3 Vs -11.6⫾3.28, BMI -3.79 ⫾ 0.95 Vs -3.51⫾0.83) and 3 months (BW: -24.6 ⫾ 9.40 Vs -16.62⫾10.39,BMI -9.09⫾0.8 Vs -6.98⫾2.98) after the operation. One patient had a re-operation for perforated gastric ulcer. Conclusion: Modified reverse long VBG is a safe restrictive operation, better than the traditional VBG for the easier technique and better than sleeve gastrectomy for its full reversibility. PII: S1550-7289(08)00242-6
Background: Biochemical cardiac risk factors (BCRF) have demonstrated strong prediction for cardiovascular events. Improvement in BCRFs after Roux-en-Y gastric bypass surgery (RYGB) has been demonstrated at one year; however longer term results have not been reported. We hypothesize that there is sustained, long-term improvement in BCRF following RYGB. Methods: At a single academic institution (2004-2007), we measured BCRF in gastric bypass patients preoperatively and at 24 months (n⫽72) and 36 months (n⫽18) postoperatively. These risk factors included high-density lipoprotein (HDL) cholesterol, lowdensity lipoprotein (LDL) cholesterol, triglycerides (Trig), and high-sensitivity C-reactive protein (CRP). Variables were compared by Students T-test analysis. Correlations between weight loss and cardiac risk factor improvement were measured by Spearman coefficients with P⬍.05 as significant. Results: All BCRFs improved following RYGB surgery at all time points. There was significant improvement in HDL from preoperative to 24 and 36 months (45, 59, 51, p⬍.0001), LDL (111, 95, 79, p⬍.0003), Trig (138, 79, 72, p⬍.0001), and hs-CRP (8.05, 1.0, 1.0, p⬍.0001). Percent excess weight loss did not correlate significantly to improvement of LDL or Trig, but did correlate with improvements in HDL and CRP with Spearman coefficients of .00554 (p⬍.0110) and .20914 (p⬍.0076) respectively. Conclusion: The improvement in BCRFs seen at one year after RYGB is durable at two and three years. Both HDL and CRP improvements correlated to weight loss which may reflect their link to exercise. These findings may allow for serologic surrogate markers for exercise further refining post-operative care. PII: S1550-7289(08)00243-8
P71.
IS THERE CONSENSUS FOR POSTOPERATIVE PRACTICE PATTERNS? A SURVEY OF ASMBS SURGEONS Sharla Owens; John Downey, BS; Tara Ramachandra, BA; Joseph Peraza, BS; Gavitt Woodard, BA; John Morton, MD, MPH; Surgery, Stanford University, Stanford, CA, USA. Background: The only effective and enduring treatment for morbid obesity is bariatric surgery. However, questions remain regarding optimal postoperative management. Methods: 1200 surveys were sent to practicing bariatric surgeons as identified by the American Society of Metabolic and Bariatric Surgery with a 40% response rate. Results: 57% of respondents have been in practice ⬎10 years with 84% dedicating ⬎50% of their practice to bariatric surgery and 60% center of excellence affiliation. Bariatric procedures performed were gastric bypass (68%) and gastric banding (32%). 84% claimed ⬎70% 1 year follow-up with 72% stating they see their patients ⬎5 times post-op. Comorbidity surveillance ranged from 98% for diabetes to 65% for depression. Post-op medical manage-
339
P70.
GASTRIC BYPASS PROVIDES LONG-TERM IMPROVEMENT IN CARDIAC RISK FACTORS Gavitt Woodard, BA; John Downey, BS; Joseph Peraza, BS; John Morton, MD, MPH; Surgery, Stanford University, Stanford, CA, USA.
Nuclear gastric emptying study after revisional surgery. PII: S1550-7289(08)00241-4
P69.
REVERSE VERTICAL GASTROALLOPLASTY: A NEW RESTRICTIVE TECHNIQUE FOR MORBID OBESITY Andrea Rizzi, Medical Doctor; Fabio Corsi, MD; Annalisa Verga; Maria Milanesi, MD; Elson Gjoni, MD; Diego Foschi, PhD, MD; Department of Medical Sciences L.Sacco, University of Milan, Milan, Italy. Background: Laparoscopic gastric banding has been indicated as reference restrictive technique for morbidly obese patients becaming easier and safer than vertical banded gastroplasty (VBG). We describe the preliminary results of a modified VBG, intended to simplify the surgical technique. Methods: 8 patients (M⫽4, F⫽4), mean weight 135.5 ⫾ 18 (SD), Kg, BMI 46 ⫾ 5.8 (SD)gave their informed consent to the operation. Technique: the operation was performed with 5 trocars; the gastro-gastro anastomosis was performed in the lower antrum after opening the gastro colic ligament; a long gastroplasty was performed along the lesser curvature with complete partition of the stomach to the cardias. The polypropylene mesh ring (1.5 x 5.5 cm.) was sutured at the basis of the gastric pouch constructed along the greater curvature, to avoid/reduce the passage of food into the main gastric cavity. The volume of the gastric pouch was estimated in 150 cc. The mean time of operation was 150 ⫾ 37 min. Postoperative course: there were no significant complications and the patients were discharged after a regular length of stay. Results: The short-term results were compared with 9 patients who had the standard Mac Lean VBG. There were no significant differences in weight and BMI reduction 1 month (BW -12.3⫾2.3 Vs -11.6⫾3.28, BMI -3.79 ⫾ 0.95 Vs -3.51⫾0.83) and 3 months (BW: -24.6 ⫾ 9.40 Vs -16.62⫾10.39,BMI -9.09⫾0.8 Vs -6.98⫾2.98) after the operation. One patient had a re-operation for perforated gastric ulcer. Conclusion: Modified reverse long VBG is a safe restrictive operation, better than the traditional VBG for the easier technique and better than sleeve gastrectomy for its full reversibility. PII: S1550-7289(08)00242-6
Background: Biochemical cardiac risk factors (BCRF) have demonstrated strong prediction for cardiovascular events. Improvement in BCRFs after Roux-en-Y gastric bypass surgery (RYGB) has been demonstrated at one year; however longer term results have not been reported. We hypothesize that there is sustained, long-term improvement in BCRF following RYGB. Methods: At a single academic institution (2004-2007), we measured BCRF in gastric bypass patients preoperatively and at 24 months (n⫽72) and 36 months (n⫽18) postoperatively. These risk factors included high-density lipoprotein (HDL) cholesterol, lowdensity lipoprotein (LDL) cholesterol, triglycerides (Trig), and high-sensitivity C-reactive protein (CRP). Variables were compared by Students T-test analysis. Correlations between weight loss and cardiac risk factor improvement were measured by Spearman coefficients with P⬍.05 as significant. Results: All BCRFs improved following RYGB surgery at all time points. There was significant improvement in HDL from preoperative to 24 and 36 months (45, 59, 51, p⬍.0001), LDL (111, 95, 79, p⬍.0003), Trig (138, 79, 72, p⬍.0001), and hs-CRP (8.05, 1.0, 1.0, p⬍.0001). Percent excess weight loss did not correlate significantly to improvement of LDL or Trig, but did correlate with improvements in HDL and CRP with Spearman coefficients of .00554 (p⬍.0110) and .20914 (p⬍.0076) respectively. Conclusion: The improvement in BCRFs seen at one year after RYGB is durable at two and three years. Both HDL and CRP improvements correlated to weight loss which may reflect their link to exercise. These findings may allow for serologic surrogate markers for exercise further refining post-operative care. PII: S1550-7289(08)00243-8
P71.
IS THERE CONSENSUS FOR POSTOPERATIVE PRACTICE PATTERNS? A SURVEY OF ASMBS SURGEONS Sharla Owens; John Downey, BS; Tara Ramachandra, BA; Joseph Peraza, BS; Gavitt Woodard, BA; John Morton, MD, MPH; Surgery, Stanford University, Stanford, CA, USA. Background: The only effective and enduring treatment for morbid obesity is bariatric surgery. However, questions remain regarding optimal postoperative management. Methods: 1200 surveys were sent to practicing bariatric surgeons as identified by the American Society of Metabolic and Bariatric Surgery with a 40% response rate. Results: 57% of respondents have been in practice ⬎10 years with 84% dedicating ⬎50% of their practice to bariatric surgery and 60% center of excellence affiliation. Bariatric procedures performed were gastric bypass (68%) and gastric banding (32%). 84% claimed ⬎70% 1 year follow-up with 72% stating they see their patients ⬎5 times post-op. Comorbidity surveillance ranged from 98% for diabetes to 65% for depression. Post-op medical manage-