P72

Abstracts: Poster Session 2006 / 2 (2006) 310 –347

Methods: Retrospective review of the incisional hernia rate in 400 consecutive open RYGBP patients performed through an upper midline incision with running suture closure. Results: With a mean follow-up of 12.8 months, 14% of the patients developed an incisional hernia. Incisional hernia was present and repaired primarily without the use of mesh at the time of RYGBP in 4% of the patients. These patients had a significantly higher incidence of recurrent incisional hernia after RYGBP (33% vs. 14%, p⬍0.05). Patients who developed postoperative wound infection after RYGBP had a significantly higher incidence of incisional hernia (27% vs. 13%, p⬍0.05). There was a significant difference in the frequency of incisional hernia between the two surgeons performing the RYGBP (18% vs. 11%, p⬍0.05). Body Mass Index (BMI) of the patient did not correlate with the incidence of incisional hernia (13% for BMI ⬎ 50 vs. 16% for BMI ⬍ 50, p⫽0.39). After the first 317 RYGBP, the fascial closure suture was switched from a long acting absorbable suture to a non-absorbable suture. This seems to have decreased the incisional hernia rate but longer follow-up is needed to confirm this. Conclusion: The incidence of incisional hernia after RYGBP is high. Wound infection, preoperative incisional hernia, and surgeon technique all significantly affect the incidence of postoperative incisional hernia. The type of fascial closure suture may also play a role in the development of incisional hernia. PII: S1550-7289(06)00413-8

P72.

INDICATIONS FOR LAPAROSCOPIC SLEEVE GASTRECTOMY (LSG). Aniceto Baltasar, MD, Rafael Bou, MD, Marcelo Bengochea, MD, Carlos Serra, Alcoy Hospital, Alcoy, Spain. Background: LSG (Laparoscopic Sleeve Gastrectomy) was developed as a first stage of the more complex DS (Duodenal Switch) operation in the SO (super-obese) patients. More than 80% of the stomach is removed at the greater curvature and a gastric tube based on the lesser curvature is made. A 12 mm NG tube is used as a stent to size the gastric tube. The remaining gastric pouch is less than 50 cc. in capacity. Methods: 38 MO (morbidly obese) patients had the LSG with 4 trocars of 5 mm, one 10 mm trocar for the camera and a working 12 mm. trocar. The stapled suture line was reinforced with a continuous polypropylene suture to prevent bleeding and leaks. The indications were weight loss but the patients operated belonged to several different clinical settings: I) SO – 7 patients, with BMI ⬎60 (61-74) as a first stage; II) severe medical conditions 10 patients were 6 cirrhotic (discovered at the time of surgery), one with Crohn’s disease and right hemicolectomy, a HIV⫹ patient, a patient with Ardystil syndrome (pulmonary-poison condition) and a patient with severe diarrhea on whom the DS was contraindicated; III) Low BMI (35-43) - 20 patients with at least a major co-morbidity and IV) Lap-band removal - 1 patient with a lap-band had a near normal BMI at the time conversion. Results: All weight loss are expressed in %EBMIL (%Excess BMI loss). A patient with a 74-BMI died as result of bleeding at the trocar site (⬍400 cc) but required a laparotomy and developed MOF, mortality 2.3%. Type I patients: Mean 61 (57-62) at 8-35 months. Only

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one 61-BMI patient, so far, required the second stage operation when her BMI was 49 and she has a BMI of 35 at 9 months. Type II patients: Cirrhotic patients had 76 % EBMIL at 5 months, Crohn’s: 66%, AIDS: 42% at 5 month, Ardystil syndrome: 82%. Type III patients: 68.5% at 3-27 months One patient bled at the trocar site and required re-Lap exploration and control; and Type IV patient had a BMI of 28 and she is now BMI 27. All these are early results. MO adolescent patients may be another good indication for the LSG. No secondary-effects occurred. Conclusion: LSG can become a good operation in 4 different MO settings and as an excellent alternative to gastric banding patients with low BMI, since no foreign material is used and no adjustments required. PII: S1550-7289(06)00414-X

P73.

TWO STAGE DUODENAL SWITCH INTESTINAL BYPASS VS SLEEVE GASTRECTOMY. Simon Biron, MD, Picard Marceau, MD, Stefane Lebel, MD, Odette Lescelleur, MD, Christine Simard, MD, Laval Hospital, Quebec, Canada. Background: In rare circumstances, to lower the operative risk of a duodenal switch (DS), it may be helpful to limit the procedure to decrease its operative risk. Which part of the operation should be done first? In 892 consecutive DS, this situation was met on 20 occasions (2.2%). Methods: Charts were reviewed to analyze circumstances when it was decided to do the intestinal bypass alone (IB) in 16 patients and do a sleeve gastrectomy alone (SG) in 4 patients. Results were compared after 23 ⫾ 17 (range: 3-65) months in terms of weight loss, improvement in co-morbidities and side effects. Results: IB patients were heavier, older and sicker. After an initial similar weight loss for both groups, SG patients started to regain weight, so that within 3 years, 3 out 4 SG patients had regained 21.4, 12 and 22 kg respectively. While among IB patients only 2 out of 16 had regained 2 and 7 kg respectively. Improvement in co-morbidities was greater for IB patients; side effects were limited to one patient with diarrhea. There were no clinical signs of peptic ulcer and medication consisted in vitamins and ulcer prevention. Conclusion: In DS both the intestinal switch and the sleeve gastrectomy produce the same early weight loss. However after 3 years, 3 out of 4 SG patients did not maintain their weight loss. Considering the greater efficiency of intestinal switch vs gastrectomy on both long-term weight loss and improved co-morbidities, where only part of the DS is chosen, preference should be given to intestinal switch. IB

Diabetes Dyslipidemia HTA APNEA

SG

n

Cured

Improved

12 9

6 8

6 1

15 11

2 4

5 5

Unchanged

8 2

n

Cured

1 1

1

2 2

Improved

Unchanged 1

1 1

1 1

PII: S1550-7289(06)00415-1