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PL-131 Gastric plication: Our experience in 100 patients
350
Abstracts: Plenary Session 2011 / Surgery for Obesity and Related Diseases 7 (2011) 339 –354
PL-129
PL-130
IMMEDIATE AND EARLY EFFECTS OF MALABSORPTIVE AND RESTRICTIVE PROCEDURES ON FASTING GLUCOSE, INSULIN AND INSULIN RESISTANCE IN THE MORBIDLY OBESE DIABETIC PATIENTS Imran Alam, MD, FRCS1; Jeffery W. Stephens, PhD, MRCP2; Andrew Fielding, PhD3; Kier Lewis, MD, MRCP4; M. J. Lewis, PhD4; John N. Baxter, MD, FRCS, FACS1; 1 Department of Surgery, Morriston Hospital/Swansea University, Swansea, Wales, United Kingdom; 2Department of Diabetes and Endocrinology, Morriston Hospital/ Swansea University, Swansea, Wales, United Kingdom; 3Department of Biochemistry, Morriston Hospital/ Swansea University, Swansea, Wales, United Kingdom; 4School of Medicine, Swansea University, Swansea, Wales, United Kingdom
ROUX-EN-Y GASTRIC BYPASS (RYGB) IMPROVES MITOCHONDRIAL FUNCTION IN THE LIVER OF OBESE RATS VIA NRF2 Yanhua Peng, PhD1; Michel M. Murr, MD1; 1University of South Florida, Tampa, FL, United States
Background: Obesity surgery causes resolution/improvement of type 2 diabetes mellitus (T2DM). Our aim was to examine the effects of biliopancreatic diversion (BPD) and gastric banding (GB) on BMI, fasting insulin, glucose & leptin in morbidly obese diabetic subjects with T2DM. Methods: 13 morbidly obese patients (7 BPD, 6 GB) had serial measurements of fasting glucose & insulin at baseline, immediately following surgery (day 1-7), & at 1, 6 & 12 months. Homeostatic model assessment- insulin resistance (HOMA-1R) was calculated. Data were analyzed using paired t test (CI 95%). Results: In the BPD group, glucose levels normalized at day 3 (5.6⫾1 mmol/L), being statistically significant at 6 & 12 months (5⫾0.7, 4.4⫾0.5 mmol/L). Insulin levels improved from day 1, statistically significant at day 2 (19⫾9 mu/L), 5, 6 & 7 (14.2⫾7, 15.2⫾8 and 17.4⫾8 mu/L). All antidiabetic medications were stopped at the 4th postoperative day. In the GB group, no statistically significant changes were seen in the glucose levels. Statistically significant changes in the insulin were seen on day 1 & 2 (19⫾13, 13⫾6.5mu/L). HOMA-IR improved in both the groups 1.6⫾1.2** (BPD), 4.3⫾1.4*(GB). Pearson correlation between changes in BMI and leptin (r⫽0.972. p⫽0.005) was significant in the BPD group. Conclusion: BPD causes immediate remission of T2DM. Leptin may play an important role in early improvement of insulin resistance in fasting states following BPD. In the GB group, glucose homeostasis improved but the patients were still on (reduced) anti-diabetic medications suggesting that it may be mainly due to decreased intake and weight loss.
Effects of BPD and LGB on BMI, fasting insulin and and leptin BPD GROUP
Baseline 1months 6months 12 months
LGB GROUP
BMI (kg/m2)
Leptin (g/L)
Insulin (mu/L)
BMI (kg/m2)
Leptin (g/L)
Insulin (mu/L)
59 ⫾ 15 50 ⫾ 9** 45 ⫾ 9** 38 ⫾ 7**
49 ⫾ 26 40 ⫾ 29* 32 ⫾ 32** 8 ⫾ 19**
25.5 ⫾ 6.5 23.4 ⫾ 19 14 ⫾ 9.5** 7.8 ⫾ 5**
44 ⫾ 3 41 ⫾ 4** 37 ⫾ 3** 36 ⫾ 2**
38 ⫾ 17 29 ⫾ 11 31 ⫾ 7.7 28 ⫾ 17*
27.4 ⫾ 1 20.7 ⫾ 9 14 ⫾ 3.8* 15 ⫾5*
* Pⱕ0.05,
** Pⱕ0.01
Background: Obesity-related fatty liver disease is linked to mitochondrial dysfunction and oxidative stress. RYGB decreases both steatosis and oxidative stress in the liver. Nuclear erythroid 2-related factor 2 (Nrf2) is a transcription factor that regulates mitochondrial function and protects cells by activating antioxidants and detoxifying enzymes. Cytochrome C oxidase subunit II (COXII) is central to electron transfer in the mitochondrial respiratory chain. Objective: We hypothesized that RYGB activates Nrf2 and COXII in livers of obese rats. Methods: SD rats were fed high-fat diet; obese rats underwent either RYGB (n⫽20) or sham (n⫽20) operation. Tissues were harvested at 13 weeks post-operatively. Nuclear fraction and mitochondrial extracts were used for immunoblotting; Immuno-staining was done on liver sections for COXII, Nrf2 and macrophage markers ED2 and F4/80. Gels were quantified using densitometry; pⱕ0.05 was significant. Results: RYGB increased mitochondrial marker (COXII) expression in liver sections compared to obese sham control (3,330⫾56 vs. 2,056⫾37; p⬍0.001) Total (nuclear and cytoplasmic) Nrf2 expression decreased after RYGB (2,456⫾45 vs. 4,352⫾76, RYGB vs. Sham, p⬍0.001); however, RYGB increased the nuclear fraction of Nrf2 (2,341⫾46 vs. 1,352 ⫾35; RYGB vs. Sham p⬍0.001). Nrf2 protein co-localized with both Kupffer cells markers ED2 or F4/80. Conclusion: RYGB increases COXII that improves mitochondrial function and mitochondrial respiration. RYBG increased the nuclear translocation of Nrf2 that is involved in transcription of anti-oxidant and detoxifying enzymes. Taken together, these data suggest that RYGB is associated with improved mitochondrial function and improved anti-oxidant production. The role of Kupffer cells warrants further investigation.
SLEEVE GASTRECTOMY PL-131
GASTRIC PLICATION: OUR EXPERIENCE IN 100 PATIENTS Juan A. Lopez-Corvala, MD1; Fernando Guzman, MD1; Carmen Calleja, MD1; Cleysa Hermosillo, MD1; 1Bariatric Surgery, Hospital Angeles Tijuana, Tijuana, Mexico Background: The sleeve gastrectomy has shown good results in weight loss. However, it is not exempt of complications such as leaks and staple line hemorrhage. In 2009, we initiated a protocol with a new procedure which consists of plicating the stomach resulting in a smaller gastric lumen producing satiety. The results in excess weight loss (EWL) have been comparable to those in sleeve gastrectomy. Methods: From November 2009 to July 2010, 100 patients (74F, 26M) underwent laparoscopic gastric plication as surgical treat-
Abstracts: Plenary Session 2011 / Surgery for Obesity and Related Diseases 7 (2011) 339 –354
ment for obesity. In 5 of these patients, the gastric plication was performed as a revision procedure. Results: Mean initial body mass index (BMI) was 39.7 (30-61) kg/m2. The percentage of excess weight loss (%EWL) was 22.7% at one month, 43.1% at 3 months and 56.6% at 6 months. There were 2 complications:one patient with pulmonary embolism and another with disruption of the suture line with perforation of the fundus due to excess vomiting. Conclusion: After evaluating 100 patients, we can say this procedure is feasible. The results are comparable to those of the sleeve gastrectomy with fewer complications and a lower cost (no implants or staples are used). However, more studies are needed to determineits place in obesity surgery. PL-132
GASTROESOPHAGEAL REFLUX FOLLOWING SLEEVE GASTRECTOMY IN MORBIDLY OBESE PATIENTS Drew Howard, MD1; Angel Caban, MD1; Juan Cendan, MD2; Kfir Ben-David, MD1; 1Surgery, University of Florida College of Medicine, Gainesville, FL, United States; 2Medical Education, University of Central Florida, Orlando, FL, United States Background: Gastroesophageal reflux disease (GERD) is highly prevalent in morbidly obese patients, and having a high body mass index (BMI) is a risk factor for development of this co-morbidity. The effect of sleeve gastrectomy (SG) on GERD is poorly known. Methods: We studied the effect of the SG on GERD in patients with morbid obesity (MO). A retrospective review of 28 consecutive patients undergoing a sleeve gastrectomy for MO between September 2008 and September 2010 was performed. Results: 18 females and 10 males were identified with a mean age of 42 years (18-60). The mean weight and BMI was 166 kg and 55.5 kg/m2. The mean excess weight loss was 40% (17% to 83%) with a mean follow up time of 30 weeks (8 to 92). All patients had a pre and post operative UGI swallow study as part of their routine care. 18% were noted to have new onset of GERD on their postoperative UGI following their SG procedure. Using the GERD score questionnaire, all patients were contacted to evaluate their reflux symptoms. We had a 64% response rate with 22% of patients indicating new onset GERD symptoms despite being on daily PPI therapy. All respondents were extremely happy with their surgery and weight loss to date. Conclusion: SG may increase the prevalence of GERD despite satisfactory weight loss. Further studies evaluating esophageal manometry and ambulatory 24-h pH need to be done to better evaluate the effect of the sleeve gastrectomy on gastroesophageal reflux. PL-133
SUPEROBESE PATIENTS: EFFICACY OF LAPAROSCOPIC DUODENAL SWITCH AS SECOND STEP AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY Giovanni Dapri, MD, FACS1; Guy Bernard Cadiere, MD1; Jacques Himpens, MD1; 1Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Brussels, Belgium
351
Background: Morbidity and mortality after bariatric surgery in superobese patients allegedly can be reduced by performing surgery in two steps. The authors report a retrospective study gathered from a prospectively kept database for superobese patients (BMI⬎50kg/m2) submitted to laparoscopic duodenal switch (LDS) after laparoscopic sleeve gastrectomy (LSG). Methods: From October 2004 to June 2010, 31 patients benefited from LDS after LSG. Mean age was 45.8⫾10.1 (21-64) years. Mean interval time between the two procedures was 13.9⫾8.4 (6-37) months. At the time of LSG, mean weight and BMI was 168.8⫾35.4 (127-255) kg and 58.3⫾6.7 (50-74,5) kg/m2. At the time of LDS, mean weight, BMI and %EWL was 136.3⫾32.6 (92-220) kg, 47.1⫾7.2 (37,8-64,3) kg/m2, and 31.6⫾⫹12,2 (⫺11.7/⫾54,6) %. At the time of LSG, 26 patients suffered from 43 obesity comorbidities. Three of the latter (6.9%) had been resolved in 3 patients before the second step of LDS. Results: Mean operative time for LDS was 175.5⫾60.6 (75-285) min. No mortality was registered. Four patients presented early complications (1 anastomotic leak, 1 small bowel perforation, 1 renal insufficiency, 1 pneumonia). Mean hospital stay was 6.6⫾11.3 (3-35) days. All patients, with exception of 3, were followed-up for a mean time of 28.8⫾21.4 (4-71) months. During follow-up, mean weight, BMI, and %EWL (as compared to the pre-LSG weight) was 99.4⫾23.7 (62-150) kg, 3.,5⫾5.8 (24.946.3) kg/m2, and 54.8⫾16 (18.9-84.8) %. Twenty two obesity comorbidities (51.1%) were resolved in 14 patients. Three patients required surgery for late complications (1 ventral hernia, 1 anastomotic stenosis, 1 protein deficiency). Conclusion: Two step LDS in 31 superobese patients had no mortality and acceptable morbidity considering the high operative risk in this group. This procedure is efficient in term of weight loss and comorbidities resolution. PL-134
IS THERE “TOO OBESE FOR OBESITY SURGERY”? LAPAROSCOPIC BARIATRIC SURGERY IN BMI OF 70-125 KG/M2 Shai Meron Eldar; Helen Heneghan, MD; Stacy Brethauer, MD; Bipan Chand, MD; Tomasz Rogula, MD; Philip R. Schauer, PhD; Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, United States Background: Data on laparoscopic bariatric surgery in the extremely obese (BMI ⬎ 70 kg/m2) is limited. Anatomic limitations and severe co-morbidities pose unique risks for these patients. The aim of this study is to assess the safety and feasibility of laparoscopic bariatric surgery in obese patients with a BMI ⬎ 70 kg/m2. Methods: Prospectively collected data was retrospectively reviewed for patients with a BMI ⬎ 70 kg/m2 who underwent bariatric surgery at a single institution. Patient demographics, surgical procedure, BMI, %Excess weight loss (EWL), co-morbidities, length of follow-up, early (⬍30 days) and late (⬎30 days) complications, and length of hospital stay were measured. Results: Between 01/2004 and 09/2010, 49 patients with a mean pre-operative BMI of 80.7 kg/m2 (range 70-125) underwent 61 bariatric procedures. Twenty six sleeve gastrectomies, 11 gastric bypasses and 12 two stage procedures (sleeve gastrectomy followed by a gastric bypass) were performed. At a mean follow up of 17.4 months the mean BMI decreased to 60.9 kg/m2, representing 36% EWL. A
Abstracts: Plenary Session 2011 / Surgery for Obesity and Related Diseases 7 (2011) 339 –354
PL-129
PL-130
IMMEDIATE AND EARLY EFFECTS OF MALABSORPTIVE AND RESTRICTIVE PROCEDURES ON FASTING GLUCOSE, INSULIN AND INSULIN RESISTANCE IN THE MORBIDLY OBESE DIABETIC PATIENTS Imran Alam, MD, FRCS1; Jeffery W. Stephens, PhD, MRCP2; Andrew Fielding, PhD3; Kier Lewis, MD, MRCP4; M. J. Lewis, PhD4; John N. Baxter, MD, FRCS, FACS1; 1 Department of Surgery, Morriston Hospital/Swansea University, Swansea, Wales, United Kingdom; 2Department of Diabetes and Endocrinology, Morriston Hospital/ Swansea University, Swansea, Wales, United Kingdom; 3Department of Biochemistry, Morriston Hospital/ Swansea University, Swansea, Wales, United Kingdom; 4School of Medicine, Swansea University, Swansea, Wales, United Kingdom
ROUX-EN-Y GASTRIC BYPASS (RYGB) IMPROVES MITOCHONDRIAL FUNCTION IN THE LIVER OF OBESE RATS VIA NRF2 Yanhua Peng, PhD1; Michel M. Murr, MD1; 1University of South Florida, Tampa, FL, United States
Background: Obesity surgery causes resolution/improvement of type 2 diabetes mellitus (T2DM). Our aim was to examine the effects of biliopancreatic diversion (BPD) and gastric banding (GB) on BMI, fasting insulin, glucose & leptin in morbidly obese diabetic subjects with T2DM. Methods: 13 morbidly obese patients (7 BPD, 6 GB) had serial measurements of fasting glucose & insulin at baseline, immediately following surgery (day 1-7), & at 1, 6 & 12 months. Homeostatic model assessment- insulin resistance (HOMA-1R) was calculated. Data were analyzed using paired t test (CI 95%). Results: In the BPD group, glucose levels normalized at day 3 (5.6⫾1 mmol/L), being statistically significant at 6 & 12 months (5⫾0.7, 4.4⫾0.5 mmol/L). Insulin levels improved from day 1, statistically significant at day 2 (19⫾9 mu/L), 5, 6 & 7 (14.2⫾7, 15.2⫾8 and 17.4⫾8 mu/L). All antidiabetic medications were stopped at the 4th postoperative day. In the GB group, no statistically significant changes were seen in the glucose levels. Statistically significant changes in the insulin were seen on day 1 & 2 (19⫾13, 13⫾6.5mu/L). HOMA-IR improved in both the groups 1.6⫾1.2** (BPD), 4.3⫾1.4*(GB). Pearson correlation between changes in BMI and leptin (r⫽0.972. p⫽0.005) was significant in the BPD group. Conclusion: BPD causes immediate remission of T2DM. Leptin may play an important role in early improvement of insulin resistance in fasting states following BPD. In the GB group, glucose homeostasis improved but the patients were still on (reduced) anti-diabetic medications suggesting that it may be mainly due to decreased intake and weight loss.
Effects of BPD and LGB on BMI, fasting insulin and and leptin BPD GROUP
Baseline 1months 6months 12 months
LGB GROUP
BMI (kg/m2)
Leptin (g/L)
Insulin (mu/L)
BMI (kg/m2)
Leptin (g/L)
Insulin (mu/L)
59 ⫾ 15 50 ⫾ 9** 45 ⫾ 9** 38 ⫾ 7**
49 ⫾ 26 40 ⫾ 29* 32 ⫾ 32** 8 ⫾ 19**
25.5 ⫾ 6.5 23.4 ⫾ 19 14 ⫾ 9.5** 7.8 ⫾ 5**
44 ⫾ 3 41 ⫾ 4** 37 ⫾ 3** 36 ⫾ 2**
38 ⫾ 17 29 ⫾ 11 31 ⫾ 7.7 28 ⫾ 17*
27.4 ⫾ 1 20.7 ⫾ 9 14 ⫾ 3.8* 15 ⫾5*
* Pⱕ0.05,
** Pⱕ0.01
Background: Obesity-related fatty liver disease is linked to mitochondrial dysfunction and oxidative stress. RYGB decreases both steatosis and oxidative stress in the liver. Nuclear erythroid 2-related factor 2 (Nrf2) is a transcription factor that regulates mitochondrial function and protects cells by activating antioxidants and detoxifying enzymes. Cytochrome C oxidase subunit II (COXII) is central to electron transfer in the mitochondrial respiratory chain. Objective: We hypothesized that RYGB activates Nrf2 and COXII in livers of obese rats. Methods: SD rats were fed high-fat diet; obese rats underwent either RYGB (n⫽20) or sham (n⫽20) operation. Tissues were harvested at 13 weeks post-operatively. Nuclear fraction and mitochondrial extracts were used for immunoblotting; Immuno-staining was done on liver sections for COXII, Nrf2 and macrophage markers ED2 and F4/80. Gels were quantified using densitometry; pⱕ0.05 was significant. Results: RYGB increased mitochondrial marker (COXII) expression in liver sections compared to obese sham control (3,330⫾56 vs. 2,056⫾37; p⬍0.001) Total (nuclear and cytoplasmic) Nrf2 expression decreased after RYGB (2,456⫾45 vs. 4,352⫾76, RYGB vs. Sham, p⬍0.001); however, RYGB increased the nuclear fraction of Nrf2 (2,341⫾46 vs. 1,352 ⫾35; RYGB vs. Sham p⬍0.001). Nrf2 protein co-localized with both Kupffer cells markers ED2 or F4/80. Conclusion: RYGB increases COXII that improves mitochondrial function and mitochondrial respiration. RYBG increased the nuclear translocation of Nrf2 that is involved in transcription of anti-oxidant and detoxifying enzymes. Taken together, these data suggest that RYGB is associated with improved mitochondrial function and improved anti-oxidant production. The role of Kupffer cells warrants further investigation.
SLEEVE GASTRECTOMY PL-131
GASTRIC PLICATION: OUR EXPERIENCE IN 100 PATIENTS Juan A. Lopez-Corvala, MD1; Fernando Guzman, MD1; Carmen Calleja, MD1; Cleysa Hermosillo, MD1; 1Bariatric Surgery, Hospital Angeles Tijuana, Tijuana, Mexico Background: The sleeve gastrectomy has shown good results in weight loss. However, it is not exempt of complications such as leaks and staple line hemorrhage. In 2009, we initiated a protocol with a new procedure which consists of plicating the stomach resulting in a smaller gastric lumen producing satiety. The results in excess weight loss (EWL) have been comparable to those in sleeve gastrectomy. Methods: From November 2009 to July 2010, 100 patients (74F, 26M) underwent laparoscopic gastric plication as surgical treat-
Abstracts: Plenary Session 2011 / Surgery for Obesity and Related Diseases 7 (2011) 339 –354
ment for obesity. In 5 of these patients, the gastric plication was performed as a revision procedure. Results: Mean initial body mass index (BMI) was 39.7 (30-61) kg/m2. The percentage of excess weight loss (%EWL) was 22.7% at one month, 43.1% at 3 months and 56.6% at 6 months. There were 2 complications:one patient with pulmonary embolism and another with disruption of the suture line with perforation of the fundus due to excess vomiting. Conclusion: After evaluating 100 patients, we can say this procedure is feasible. The results are comparable to those of the sleeve gastrectomy with fewer complications and a lower cost (no implants or staples are used). However, more studies are needed to determineits place in obesity surgery. PL-132
GASTROESOPHAGEAL REFLUX FOLLOWING SLEEVE GASTRECTOMY IN MORBIDLY OBESE PATIENTS Drew Howard, MD1; Angel Caban, MD1; Juan Cendan, MD2; Kfir Ben-David, MD1; 1Surgery, University of Florida College of Medicine, Gainesville, FL, United States; 2Medical Education, University of Central Florida, Orlando, FL, United States Background: Gastroesophageal reflux disease (GERD) is highly prevalent in morbidly obese patients, and having a high body mass index (BMI) is a risk factor for development of this co-morbidity. The effect of sleeve gastrectomy (SG) on GERD is poorly known. Methods: We studied the effect of the SG on GERD in patients with morbid obesity (MO). A retrospective review of 28 consecutive patients undergoing a sleeve gastrectomy for MO between September 2008 and September 2010 was performed. Results: 18 females and 10 males were identified with a mean age of 42 years (18-60). The mean weight and BMI was 166 kg and 55.5 kg/m2. The mean excess weight loss was 40% (17% to 83%) with a mean follow up time of 30 weeks (8 to 92). All patients had a pre and post operative UGI swallow study as part of their routine care. 18% were noted to have new onset of GERD on their postoperative UGI following their SG procedure. Using the GERD score questionnaire, all patients were contacted to evaluate their reflux symptoms. We had a 64% response rate with 22% of patients indicating new onset GERD symptoms despite being on daily PPI therapy. All respondents were extremely happy with their surgery and weight loss to date. Conclusion: SG may increase the prevalence of GERD despite satisfactory weight loss. Further studies evaluating esophageal manometry and ambulatory 24-h pH need to be done to better evaluate the effect of the sleeve gastrectomy on gastroesophageal reflux. PL-133
SUPEROBESE PATIENTS: EFFICACY OF LAPAROSCOPIC DUODENAL SWITCH AS SECOND STEP AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY Giovanni Dapri, MD, FACS1; Guy Bernard Cadiere, MD1; Jacques Himpens, MD1; 1Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Brussels, Belgium
351
Background: Morbidity and mortality after bariatric surgery in superobese patients allegedly can be reduced by performing surgery in two steps. The authors report a retrospective study gathered from a prospectively kept database for superobese patients (BMI⬎50kg/m2) submitted to laparoscopic duodenal switch (LDS) after laparoscopic sleeve gastrectomy (LSG). Methods: From October 2004 to June 2010, 31 patients benefited from LDS after LSG. Mean age was 45.8⫾10.1 (21-64) years. Mean interval time between the two procedures was 13.9⫾8.4 (6-37) months. At the time of LSG, mean weight and BMI was 168.8⫾35.4 (127-255) kg and 58.3⫾6.7 (50-74,5) kg/m2. At the time of LDS, mean weight, BMI and %EWL was 136.3⫾32.6 (92-220) kg, 47.1⫾7.2 (37,8-64,3) kg/m2, and 31.6⫾⫹12,2 (⫺11.7/⫾54,6) %. At the time of LSG, 26 patients suffered from 43 obesity comorbidities. Three of the latter (6.9%) had been resolved in 3 patients before the second step of LDS. Results: Mean operative time for LDS was 175.5⫾60.6 (75-285) min. No mortality was registered. Four patients presented early complications (1 anastomotic leak, 1 small bowel perforation, 1 renal insufficiency, 1 pneumonia). Mean hospital stay was 6.6⫾11.3 (3-35) days. All patients, with exception of 3, were followed-up for a mean time of 28.8⫾21.4 (4-71) months. During follow-up, mean weight, BMI, and %EWL (as compared to the pre-LSG weight) was 99.4⫾23.7 (62-150) kg, 3.,5⫾5.8 (24.946.3) kg/m2, and 54.8⫾16 (18.9-84.8) %. Twenty two obesity comorbidities (51.1%) were resolved in 14 patients. Three patients required surgery for late complications (1 ventral hernia, 1 anastomotic stenosis, 1 protein deficiency). Conclusion: Two step LDS in 31 superobese patients had no mortality and acceptable morbidity considering the high operative risk in this group. This procedure is efficient in term of weight loss and comorbidities resolution. PL-134
IS THERE “TOO OBESE FOR OBESITY SURGERY”? LAPAROSCOPIC BARIATRIC SURGERY IN BMI OF 70-125 KG/M2 Shai Meron Eldar; Helen Heneghan, MD; Stacy Brethauer, MD; Bipan Chand, MD; Tomasz Rogula, MD; Philip R. Schauer, PhD; Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, United States Background: Data on laparoscopic bariatric surgery in the extremely obese (BMI ⬎ 70 kg/m2) is limited. Anatomic limitations and severe co-morbidities pose unique risks for these patients. The aim of this study is to assess the safety and feasibility of laparoscopic bariatric surgery in obese patients with a BMI ⬎ 70 kg/m2. Methods: Prospectively collected data was retrospectively reviewed for patients with a BMI ⬎ 70 kg/m2 who underwent bariatric surgery at a single institution. Patient demographics, surgical procedure, BMI, %Excess weight loss (EWL), co-morbidities, length of follow-up, early (⬍30 days) and late (⬎30 days) complications, and length of hospital stay were measured. Results: Between 01/2004 and 09/2010, 49 patients with a mean pre-operative BMI of 80.7 kg/m2 (range 70-125) underwent 61 bariatric procedures. Twenty six sleeve gastrectomies, 11 gastric bypasses and 12 two stage procedures (sleeve gastrectomy followed by a gastric bypass) were performed. At a mean follow up of 17.4 months the mean BMI decreased to 60.9 kg/m2, representing 36% EWL. A