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P79: Preoperative consummatory behavior assessment survey does not predict postoperative weight loss following laparoscopic gastric bypass
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Abstracts: 2008 Poster Session 2 / Surgery for Obesity and Related Diseases 4 (2008) 312–357
Conclusion: The incidence of severe PONV in our patient population was relatively high but this was self-limited and rarely associated with a mechanical obstruction. Early prophylactic antiemetic therapy may be warranted in this group of patients. PII: S1550-7289(08)00250-5 P78.
EARLY JEJUNOJEJUNOSTOMY OBSTRUCTIONS FOLLOWING LAPAROSCOPIC GASTRIC BYPASS: CASE SERIES AND TREATMENT ALGORITHM Candice M. Jensen, MD; Talar Tejirian, MD; Catherine Lewis, MD; Amir Mehran, MD; Erik Dutson, MD; Surgery, UCLA, Los Angeles, CA, USA. Background: Early jejunojejunostomy obstruction (JJO) is a known and often over-looked complication of laparoscopic rouxen-Y gastric bypass (LRYGB). Our objective is to review our institution’s experience with JJO after LRYGB and to provide a management algorithm. Methods: Between 2003 and 2007, 1027patients underwent LRYGB at our institution. Data including patient demographics, co-morbidities, intraoperative data, peri- and post-operative complications and outcomes were prospectively recorded and retrospectively reviewed. Results: Early post-LRYGB JJO occurred in 10 (0.01%) patients. Compared with non-obstructed patients, there was no difference in comorbidities or intraoperative procedure. Average time to presentation of JJO was 14 days (range 5 - 30). Abdominal pain was present in all patients, and all underwent CT to confirm the diagnosis. Three patients (30%) required urgent operative intervention. Decision for operative intervention was based on more severe abdominal pain, persistent nausea and vomiting, and elevated WBC. All operative interventions were performed laparoscopically. In the nonoperative group, dietary noncompliance was the most common reason for JJO, followed by anastamotic edema. In contrast to the operative group, these patients demonstrated prompt resolution of abdominal pain, nausea and vomiting, and normalization of vital signs and laboratory values within 12 hours. Conclusion: Early jejunojejunostomy after LRYGB obstruction can be managed non-operatively in a select group of patients. However, bariatric surgeons must maintain a low threshold for surgical re-intervention in cases where rapid recovery is not seen. A treatment algorithm is proposed. PII: S1550-7289(08)00251-7 P79.
PREOPERATIVE CONSUMMATORY BEHAVIOR ASSESSMENT SURVEY DOES NOT PREDICT POSTOPERATIVE WEIGHT LOSS FOLLOWING LAPAROSCOPIC GASTRIC BYPASS David S. Tichansky, M.D.; Atul K. Madan, MD; Khurram A. Khan, MD; Whitney S. Orth, RD; University of Tennessee, Memphis, TN, USA. Background: Bariatric programs and surgeons continue to use tools to evaluate patients preoperatively in attempts to predict outcomes in terms of weight loss following laparoscopic Rouxen-Y gastric bypass (LRYGB). Many of these tools examine eating behaviors to determine if preoperative eating patterns or cravings
will influence patients’ compliance and their ability to lose weight. Herein, we study the effectiveness of a preoperative Consummatory Behavior Assessment Survey (CBAS) in predicting weight loss outcome after LRYGB. Methods: 103 consecutive patients were enrolled by completing the pre-operative CBAS survey. This 8 question survey queries feelings of hunger, cravings, fullness, appetite, portion control, and snacking over multiple weeks. Percent excess body weight loss at a minimum of one year and maximum of three years (EBWL) was analyzed against the score of each section of the questionnaire and the total score of the questionnaire using Pearson’s correlation coefficient test. Results: Complete questionnaire results and weight loss data were available on 99 patients. No single test question score, nor the total test score, had a statistical correlation with EBWL (p greater than 0.05). Conclusion: Preoperative consummatory behavior does not correlate with EBWL after LRYGB. Eating habits surveys should not be used as a tool to discriminate against patients who desire LRYGB. PII: S1550-7289(08)00252-9
P80.
RESOLUTION OF PLANTAR FASCIITIS AFTER WEIGHT LOSS SURGERY Patrick Gatmaitan, M.D.; Ramy H. Fouad, MD; Ali Elhorr, M.D.; Tracy Pitt, D.O.; Karen Cooper, MD; Stacy A. Brethauer, M.D.; Bipan Chand, M.D.; Philip R. Schauer, M.D.; Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA. Background: Plantar fasciitis (PF), an inflammatory condition of the plantar aponeurosis, is considered to be the most common cause of heel pain. A body mass index of ⬎30 kg/m 2 is strongly associated with this disorder. There is limited data on the effect of weight loss surgery on this condition. Methods: Our bariatric database was queried for patients with diagnosis of PF identified from January 2004 to November 2007. Chart review and telephone interviews were conducted with the following data obtained: patient demographics, type and effect of surgery, length of follow-up, PF duration and treatment modalities used. Results: 886 patients underwent bariatric surgery during the study period. 11 were found to have PF (1.24%). Mean age for this study group was 48.8 years (26-62 yrs) with a mean pre-operative BMI of 48.1 ⫾ 5.9 and all were females. All except one underwent laparoscopic Roux-en-Y gastric bypass. With a mean follow-up of 17.7 ⫾ 6.7 months, the average BMI was 34.7 (24.4-45.3) with excess weight loss of 51.6% ⫾ 19.7. Prior to bariatric surgery, PF had been present for 4.8 ⫾ 5.9 years. Pre-operatively, 100% took anti-inflammatory agents, 82% used orthotic devices, and 55% employed physical therapy. At the time of follow-up, none of the patients had experienced a postoperative episode of plantar fasciitis and all had discontinued their preoperative treatment. Conclusion: Plantar fasciitis is an uncommon condition among patients undergoing bariatric surgery. For those patients affected, though, this painful condition resolves after successful surgical weight loss. PII: S1550-7289(08)00253-0
Abstracts: 2008 Poster Session 2 / Surgery for Obesity and Related Diseases 4 (2008) 312–357
Conclusion: The incidence of severe PONV in our patient population was relatively high but this was self-limited and rarely associated with a mechanical obstruction. Early prophylactic antiemetic therapy may be warranted in this group of patients. PII: S1550-7289(08)00250-5 P78.
EARLY JEJUNOJEJUNOSTOMY OBSTRUCTIONS FOLLOWING LAPAROSCOPIC GASTRIC BYPASS: CASE SERIES AND TREATMENT ALGORITHM Candice M. Jensen, MD; Talar Tejirian, MD; Catherine Lewis, MD; Amir Mehran, MD; Erik Dutson, MD; Surgery, UCLA, Los Angeles, CA, USA. Background: Early jejunojejunostomy obstruction (JJO) is a known and often over-looked complication of laparoscopic rouxen-Y gastric bypass (LRYGB). Our objective is to review our institution’s experience with JJO after LRYGB and to provide a management algorithm. Methods: Between 2003 and 2007, 1027patients underwent LRYGB at our institution. Data including patient demographics, co-morbidities, intraoperative data, peri- and post-operative complications and outcomes were prospectively recorded and retrospectively reviewed. Results: Early post-LRYGB JJO occurred in 10 (0.01%) patients. Compared with non-obstructed patients, there was no difference in comorbidities or intraoperative procedure. Average time to presentation of JJO was 14 days (range 5 - 30). Abdominal pain was present in all patients, and all underwent CT to confirm the diagnosis. Three patients (30%) required urgent operative intervention. Decision for operative intervention was based on more severe abdominal pain, persistent nausea and vomiting, and elevated WBC. All operative interventions were performed laparoscopically. In the nonoperative group, dietary noncompliance was the most common reason for JJO, followed by anastamotic edema. In contrast to the operative group, these patients demonstrated prompt resolution of abdominal pain, nausea and vomiting, and normalization of vital signs and laboratory values within 12 hours. Conclusion: Early jejunojejunostomy after LRYGB obstruction can be managed non-operatively in a select group of patients. However, bariatric surgeons must maintain a low threshold for surgical re-intervention in cases where rapid recovery is not seen. A treatment algorithm is proposed. PII: S1550-7289(08)00251-7 P79.
PREOPERATIVE CONSUMMATORY BEHAVIOR ASSESSMENT SURVEY DOES NOT PREDICT POSTOPERATIVE WEIGHT LOSS FOLLOWING LAPAROSCOPIC GASTRIC BYPASS David S. Tichansky, M.D.; Atul K. Madan, MD; Khurram A. Khan, MD; Whitney S. Orth, RD; University of Tennessee, Memphis, TN, USA. Background: Bariatric programs and surgeons continue to use tools to evaluate patients preoperatively in attempts to predict outcomes in terms of weight loss following laparoscopic Rouxen-Y gastric bypass (LRYGB). Many of these tools examine eating behaviors to determine if preoperative eating patterns or cravings
will influence patients’ compliance and their ability to lose weight. Herein, we study the effectiveness of a preoperative Consummatory Behavior Assessment Survey (CBAS) in predicting weight loss outcome after LRYGB. Methods: 103 consecutive patients were enrolled by completing the pre-operative CBAS survey. This 8 question survey queries feelings of hunger, cravings, fullness, appetite, portion control, and snacking over multiple weeks. Percent excess body weight loss at a minimum of one year and maximum of three years (EBWL) was analyzed against the score of each section of the questionnaire and the total score of the questionnaire using Pearson’s correlation coefficient test. Results: Complete questionnaire results and weight loss data were available on 99 patients. No single test question score, nor the total test score, had a statistical correlation with EBWL (p greater than 0.05). Conclusion: Preoperative consummatory behavior does not correlate with EBWL after LRYGB. Eating habits surveys should not be used as a tool to discriminate against patients who desire LRYGB. PII: S1550-7289(08)00252-9
P80.
RESOLUTION OF PLANTAR FASCIITIS AFTER WEIGHT LOSS SURGERY Patrick Gatmaitan, M.D.; Ramy H. Fouad, MD; Ali Elhorr, M.D.; Tracy Pitt, D.O.; Karen Cooper, MD; Stacy A. Brethauer, M.D.; Bipan Chand, M.D.; Philip R. Schauer, M.D.; Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA. Background: Plantar fasciitis (PF), an inflammatory condition of the plantar aponeurosis, is considered to be the most common cause of heel pain. A body mass index of ⬎30 kg/m 2 is strongly associated with this disorder. There is limited data on the effect of weight loss surgery on this condition. Methods: Our bariatric database was queried for patients with diagnosis of PF identified from January 2004 to November 2007. Chart review and telephone interviews were conducted with the following data obtained: patient demographics, type and effect of surgery, length of follow-up, PF duration and treatment modalities used. Results: 886 patients underwent bariatric surgery during the study period. 11 were found to have PF (1.24%). Mean age for this study group was 48.8 years (26-62 yrs) with a mean pre-operative BMI of 48.1 ⫾ 5.9 and all were females. All except one underwent laparoscopic Roux-en-Y gastric bypass. With a mean follow-up of 17.7 ⫾ 6.7 months, the average BMI was 34.7 (24.4-45.3) with excess weight loss of 51.6% ⫾ 19.7. Prior to bariatric surgery, PF had been present for 4.8 ⫾ 5.9 years. Pre-operatively, 100% took anti-inflammatory agents, 82% used orthotic devices, and 55% employed physical therapy. At the time of follow-up, none of the patients had experienced a postoperative episode of plantar fasciitis and all had discontinued their preoperative treatment. Conclusion: Plantar fasciitis is an uncommon condition among patients undergoing bariatric surgery. For those patients affected, though, this painful condition resolves after successful surgical weight loss. PII: S1550-7289(08)00253-0