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Reoperation Following Roux-en-Y Gastric Bypass for Morbid Obesity
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ASMBS E-Poster Abstracts / Surgery for Obesity and Related Diseases 13 (2017) S66–S226
reversals, seven gastric bypass revisions, and 20 emergent surgeries. The most common indication for gastric bypass reversal was intractable marginal ulcer, and the most common indication for gastric bypass revision surgery was gastrogastric fistulae. Of the 20 patients receiving emergent surgeries, there were 12 small bowel obstructions, 5 gastric leaks, and 3 internal bleeding. There were no mortalities following reoperation for gastric bypass surgery. Conclusions: Reoperation after gastric bypass surgery is a technically feasible and safe procedure, which is recommended be performed by experienced surgeons in order to minimize surgical complications and achieve good surgical outcomes.
A5225
FAILED SLEEVE GASTRECTOMY TO OUTPATIENT REVISION D-LOOP: AN IDEA WHOSE TIME HAS COME Amit Surve1; Hinali Zaveri1; Daniel Cottam1; Thomas Umbach2; Matthew Apel2; Legrand Belnap1; Christina Richards1; Walter Medlin1; Austin Cottam1; 1Bariatric Medicine Institute, Salt Lake City UT; 2Blossom Bariatrics Introduction: Sleeve gastrectomy (SG) is a common bariatric procedure and has gained popularity as a standalone surgery. Weight recidivism following SG is one of the most common
indications for revision. When considering revision, the SG can be converted to different types of revision procedures like Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with or without duodenal switch (BPD/BPD-DS), single anastomosis duodenal switch (SADS), and many more. Most of these revision procedures are performed in the inpatient setting. We have converted 8 patients with failed primary SG to revision D-loop (300-cm loop duodeno-ileostomy) in an ambulatory setting. Objective To assess the safety and short-term efficacy of the patients who underwent a revision D-loop following failed SG in an ambulatory setting. Setting Private practice, United States. Methods: Between Nov 2016 and Apr 2017, a total of 26 patients underwent revision D-loop following failed SG at two independent surgical centers. Of 26 patients, 8 patients who underwent laparoscopic revision D-loop by two surgeons in an ambulatory setting were included in this retrospective study of the prospectively collected bariatric database. Results: The patients experienced mean EWL of 15.3% over an average of 4 years (range: 1-7) with their primary SG surgery. The most common indication was weight recidivism. At the time of revision, the mean age and body mass index (BMI) was 40.8 ± 10.6 years and 4.2 ± 6.2 kg/m2, respectively. The mean operating time, total operating room time, emergence from general anesthesia time, and phase 2 time was 1 hour and 42 mins ± 46.7 mins, 1 hour and 52 mins ± 5.6 mins, 2 hours and 13 mins ± 22.4 mins, and 5 hours and 4 mins ± 20.5 mins, respectively. The mean length of stay (admission to discharge) was 8 hours and 2 mins ± 1 hour and 18 mins. There was no unplanned return to surgery with 24 hours, overnight hospitalization, transfer from an outpatient-to-inpatient setting, readmission or reoperation within 30 days of the intervention, and death. None of our patients experienced a short- or longterm complication. The patients experienced mean EWL of 28.2% (95%CI: 21.2, 35.1) at 4 months following revision D-loop. Conclusion: Revision D-loop following failed SG is a safe procedure even if it is performed in an ambulatory setting. Although our early outcomes are encouraging, further studies are needed to provide definitive conclusions regarding the short, midand long-term weight loss outcomes.
A5226
LAPAROSCOPIC LIMB DISTALIZATION FOR FAILED ROUX-EN-Y GASTRIC BYPASS Michael Goldberg1; Emily Woodworth2; Calleigh Reardon3; Malcolm Robinson1; Ali Tavakkoli1; Ashley Vernon1; Eric Sheu1; Scott Shikora1; 1Brigham and Women's Hospital, Boston MA; 2 Brigham and Women's Hospital, Weston MA; 3Brigham and Women's Hospital, Newton Massachusetts Introduction: There are several surgical options for patients who fail to lose sufficient weight or have significant weight regain after roux-en-y gastric bypass (RYGB); however, these techniques are not well studied and provide inconsistent results. We aim to describe our experience with RYGB limb distalization, in which patients undergo creation of a new enteroenterostomy, extending
ASMBS E-Poster Abstracts / Surgery for Obesity and Related Diseases 13 (2017) S66–S226
reversals, seven gastric bypass revisions, and 20 emergent surgeries. The most common indication for gastric bypass reversal was intractable marginal ulcer, and the most common indication for gastric bypass revision surgery was gastrogastric fistulae. Of the 20 patients receiving emergent surgeries, there were 12 small bowel obstructions, 5 gastric leaks, and 3 internal bleeding. There were no mortalities following reoperation for gastric bypass surgery. Conclusions: Reoperation after gastric bypass surgery is a technically feasible and safe procedure, which is recommended be performed by experienced surgeons in order to minimize surgical complications and achieve good surgical outcomes.
A5225
FAILED SLEEVE GASTRECTOMY TO OUTPATIENT REVISION D-LOOP: AN IDEA WHOSE TIME HAS COME Amit Surve1; Hinali Zaveri1; Daniel Cottam1; Thomas Umbach2; Matthew Apel2; Legrand Belnap1; Christina Richards1; Walter Medlin1; Austin Cottam1; 1Bariatric Medicine Institute, Salt Lake City UT; 2Blossom Bariatrics Introduction: Sleeve gastrectomy (SG) is a common bariatric procedure and has gained popularity as a standalone surgery. Weight recidivism following SG is one of the most common
indications for revision. When considering revision, the SG can be converted to different types of revision procedures like Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with or without duodenal switch (BPD/BPD-DS), single anastomosis duodenal switch (SADS), and many more. Most of these revision procedures are performed in the inpatient setting. We have converted 8 patients with failed primary SG to revision D-loop (300-cm loop duodeno-ileostomy) in an ambulatory setting. Objective To assess the safety and short-term efficacy of the patients who underwent a revision D-loop following failed SG in an ambulatory setting. Setting Private practice, United States. Methods: Between Nov 2016 and Apr 2017, a total of 26 patients underwent revision D-loop following failed SG at two independent surgical centers. Of 26 patients, 8 patients who underwent laparoscopic revision D-loop by two surgeons in an ambulatory setting were included in this retrospective study of the prospectively collected bariatric database. Results: The patients experienced mean EWL of 15.3% over an average of 4 years (range: 1-7) with their primary SG surgery. The most common indication was weight recidivism. At the time of revision, the mean age and body mass index (BMI) was 40.8 ± 10.6 years and 4.2 ± 6.2 kg/m2, respectively. The mean operating time, total operating room time, emergence from general anesthesia time, and phase 2 time was 1 hour and 42 mins ± 46.7 mins, 1 hour and 52 mins ± 5.6 mins, 2 hours and 13 mins ± 22.4 mins, and 5 hours and 4 mins ± 20.5 mins, respectively. The mean length of stay (admission to discharge) was 8 hours and 2 mins ± 1 hour and 18 mins. There was no unplanned return to surgery with 24 hours, overnight hospitalization, transfer from an outpatient-to-inpatient setting, readmission or reoperation within 30 days of the intervention, and death. None of our patients experienced a short- or longterm complication. The patients experienced mean EWL of 28.2% (95%CI: 21.2, 35.1) at 4 months following revision D-loop. Conclusion: Revision D-loop following failed SG is a safe procedure even if it is performed in an ambulatory setting. Although our early outcomes are encouraging, further studies are needed to provide definitive conclusions regarding the short, midand long-term weight loss outcomes.
A5226
LAPAROSCOPIC LIMB DISTALIZATION FOR FAILED ROUX-EN-Y GASTRIC BYPASS Michael Goldberg1; Emily Woodworth2; Calleigh Reardon3; Malcolm Robinson1; Ali Tavakkoli1; Ashley Vernon1; Eric Sheu1; Scott Shikora1; 1Brigham and Women's Hospital, Boston MA; 2 Brigham and Women's Hospital, Weston MA; 3Brigham and Women's Hospital, Newton Massachusetts Introduction: There are several surgical options for patients who fail to lose sufficient weight or have significant weight regain after roux-en-y gastric bypass (RYGB); however, these techniques are not well studied and provide inconsistent results. We aim to describe our experience with RYGB limb distalization, in which patients undergo creation of a new enteroenterostomy, extending