P86

328

Abstracts: 2007 Poster Session / Surgery for Obesity and Related Diseases 3 (2007) 299 –344

bariatric surgery. The VA population is predominately older males and has a higher incidence of obesity. We evaluated the preoperative comorbidity prevalence and 30 day complication rate in a VA bariatric surgery program. Methods: Retrospective analysis was performed on patients receiving bariatric surgery performed by three different surgeons between December 1, 1999 and October 17, 2006, at a VAHCS . BMI was measured. Patients were evaluated for preoperative comorbid conditions and 30 day postoperative complications including intraoperative injuries, postoperative infections, prolonged intubation ⬎48 hrs, respiratory distress, post- or intraoperative bleeding, renal failure, PE, leak and death. Data were analyzed in a retrospective fashion. Results: Results: 64 patients’ data were evaluated. 61 patients had a gastric bypass and 3 received a gastric band procedure. 51 patients were male (80%) Average age: 51y/o (range 33-66), average BMI :46 (range 36-74) . Comorbidities included: Type 2 diabetes 28 (44%); HTN 47(73%);OSA 44(69%);CAD 11(17%). Overall, 20 patients (31%) had 30 day complications:: wound infection 6(9%); readmit for dehydration 3 (4%); abscess 1(1.6%); PTX 1(1.6%) postop bleed: 2(3%); delayed opening 1 (1.6%); leak 4 (6%) – 2 requiring reoperation; PE 1 (16%); death 1 (1.6%) Conclusion: The VA bariatric surgery population comprises a high risk population with greater than average rates of Type 2 Diabetes, HTN, OSA and CAD. However bariatric surgery can be performed with acceptable complication rates. PII: S1550-7289(07)00327-9 P86.

CAN ADVANCED LAPAROSCOPIC FELLOWSHIP PROGRAMS BE ESTABLISHED WITHOUT COMPROMISING THE CENTER’S OUTCOMES? Shanu N Kothari, MD; William C Boyd, MD; Pamela J Lambert, RN; Michelle A Mathiason, MS Gundersen Lutheran Medical Center, La Crosse, WI Background: Advanced laparoscopic fellowships have been touted as ideal formats for laparoscopic gastric bypass (LGB) training. Impact of such fellowships on center outcomes remains unknown. We assess here our fellowship program’s impact on LGB outcomes. Methods: Fellowship-trained surgeon SNK established a multidisciplinary, minimally invasive bariatric surgery program. Initially, all LGBs were performed and assisted by the same surgeon and assistant and outcomes entered into a prospective database. Two years later, a fellowship was established. Pre- and postfellowship LGB outcomes were compared. Data were analyzed using chi-square. A p-value ⬍ 0.05 was considered statistically significant. Results: Pre- and post-fellowship group demographics were similar, as were their mean length of stay and percent excess weight loss. Mean operative time was significantly higher in the postfellowship group. Conclusion: An operative time increase was the only trainingrelated difference between the groups. An advanced laparoscopic fellowship program with LGB emphasis can be established without compromising center outcomes.

Measure Compared

Pre-Fellowship Post-Fellowship p-value nⴝ175 nⴝ175

Demographics Mean Age, years %Female Initial BMI Mean Operative Time, minutes Mean Length of Stay, days %Excess Weight Loss Complications Major Anastomotic leak DVT/PE Transfusion Intestinal Obstruction Mortality Minor Stomal Stenosis Marginal Ulcer Wound Infection Incisional Hernia

41.9 84 49.2 123 ⫾ 22

43.7 82 47.8 154 ⫾ 28

0.069 0.668 0.050 0.001

2.17 72.0

2.35 72.1

0.143 0.990

Pre-Fellowship nⴝ175

Post-Fellowship nⴝ175

p-value

1 0/0 9 6 0

1 0/0 5 6 0

0.999 0.275 0.999 -

1 3 2 2

1 4 4 1

0.999 0.999 0.685 0.999

PII: S1550-7289(07)00328-0 P87.

REVISIONAL BARIATRIC SURGERY. Olga N Tucker, MD; Iswanto Sucandy, MD; Tomas Escalante-Tattersfield, MD; Samuel Szomstein, MD; Raul J Rosenthal, MD Cleveland Clinic Florida, Weston, FL Background: Bariatric surgery is the fastest growing field in medicine. In parallel, the number of reoperations for complications and failure of previous weight loss surgery are increasing. Methods: A retrospective review of a prospectively maintained database of patients undergoing primary and revisional bariatric surgery was performed from January 2001 to October 2006. Results: 2,467 bariatric procedures were performed. Primary n⫽2,122; Roux-en-Y gastric bypass (RYGB) n⫽1,763, laparoscopic adjustable gastric banding (LAGB) n⫽244, and sleeve gastrectomy (SG) n⫽105. 345 revisions (excluding cholecystectomy) were performed in 266 patients; RYGB n⫽159, LAGB n⫽51, SG n⫽15, vertical banded gastroplasty (VBG) n⫽33, jejunoileal bypass (JIB) n⫽6, and distal RYGB n⫽1. In the RYGB group, 206 revisions were performed in 159 patients; 21 (13.2%) had initial RYGB elsewhere. 58 procedures were performed in 53 patients for acute complications: bleeding n⫽15, jejunojejunostomy-related n⫽19 (stenosis n⫽5, leak n⫽3, internal hernia n⫽2, bleed n⫽4, kinking n⫽5), gastrojejunostomy-related n⫽4 (stenosis n⫽2, leak n⫽2). 148 procedures were performed in 122 patients for chronic complications: intestinal obstruction n⫽41 in 37, gastrogastric fistula n⫽25, pouch dilation n⫽21, gastrojejunal anastomotic complications n⫽14. 7 revisions were performed in 6 patients after JIB, and 73 in 51 patients after LAGB (band removal n⫽46, conversion to RYGB n⫽9, conversion to SG n⫽11); 21.6% had LAGB elsewhere. 14 patients had SG after failed LAGB n⫽11, failed RYGB n⫽1, previous JIB n⫽2. 43 procedures were performed in 33 patients after VBG including LRYGB conversion in 31.