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Selective laparoscopic cholecystectomy during laparoscopic Roux-en-Y gastric bypass
Abstracts: Students/Residents/Fellows Session/Surgery for Obesity and Related Diseases / 1 (2005) 291–294
ticipated in our institution’s medically supervised weight management program before surgery. Results: Preoperatively, 30 patients (Group A) lost an average of 4% excess body weight (EBW) and 43 patients (Group B) did not lose weight or gained an average of 6% EBW over an average period of 3.3 months. There were no differences between the two groups in starting BMI, number of comorbidities, or the last preoperative BMI. Group A had less intraoperative blood loss (106 vs. 72 mL, p ⫽ 0.01). No differences were seen between Group A and Group B with respect to operative times (180 vs. 179 min, p ⫽ NS), intraoperative complications/conversions (3.3% vs. 14%, p ⫽ 0.2), need for additional trocars (6.7% vs. 4.7%, p ⫽ NS), or anastamotic leaks/obstructions (3.3% vs. 7%, p ⫽ NS). Conclusions: Minimal acute preoperative weight loss is associated with less blood loss and appears to reduce intraoperative complications and conversions in laparoscopic gastric bypass. A larger series with a greater reduction in EBW is necessary determine the maximal benefits of acute preoperative weight loss. PII: S1550-7289(05)00321-7
SRF7.
IS GALLBLADDER ULTRASOUND NECESSARY IN PATIENTS UNDERGOING LAPAROSCOPIC ROUX-ENY GASTRIC BYPASS? Federico A. Ceppa, M.D., Pavlos K. Papasavas, M.D., Daniel J. Gagne´, M.D., Cornelia Savopoulou, M.D., Philip F. Caushaj, M.D., Temple University Clinical Campus at the Western Pennsylvania Hospital, Pittsburgh, PA. Purpose: Bariatric surgeons perform either routine cholecystectomy at the time of laparoscopic Roux-en-Y gastric bypass (LRYGBP), selectively in patients with positive ultrasound (US) or not at all. We reviewed our experience with biliary disease in patients undergoing LRYGBP. Methods: From July 1999 to October 2004, 647 patients underwent LRYGBP in our institution. Data on preoperative US were available in 557 patients. Preoperative US was routinely obtained early in our series and selectively thereafter in patients with suspected symptomatic biliary disease. Cholecystectomy, at the time of LRYGBP, was performed in symptomatic patients with positive US. Results: Three of 21 patients with no preoperative US presented with common bile duct pathology that was treated with laparoscopic transgastric ERCP and sphincterotomy (n ⫽ 2) or common bile duct exploration (n ⫽ 1). GROUPS
NUMBER Lap Chole Lap Chole Lap Chole % Lap Chole Mean prior to with After after follow-up LRYGBP LRYGBP LYRGBP LYRGBP (months)
Preop Chole US Positive Symptomatic US Positive Asymptomatic US Negative Asymptomatic No Preop US TOTAL
133 18
133 0
0 18
0 0
0% 0%
15
0
0
1
6.6%
10.7
64
0
0
3
4.7%
15.1
6.4%
10.5
327 557
0 133(24%)
0 18(3.2%)
21 25(4.5%)
Conclusions: Omission of preoperative US is associated with an acceptable rate of postoperative biliary disease, which can be treated laparoscopically safely. PII: S1550-7289(05)00322-9
293
SRF8.
SELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY DURING LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS Alexander Perez, M.D., Lauren Seymour, P.A.-C., Jay Kuhn, M.D., Imtiaz A. Munshi, M.D., Department of Surgery, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA. Purpose: It has been proposed that laparoscopic cholecystectomy (LC) be done routinely during laparoscopic Roux-en-Y gastric bypass (LRGB). It is believed there is a high incidence of gallbladder disease despite negative clinical or radiographic preoperative findings. However, it has been shown that gallbladder removal prolongs operative times as well as the hospital length of stay. We performed an interim analysis of our experience to evaluate these concepts. Methods: Retrospective review of prospective data over 1 year, on all consecutive LRGB and LRGB/LC cases performed by the same surgeon using the same technique. Patients with clinical or radiographic evidence biliary disease and/or intraoperative finding of inflammation had LC after LRGB. Pathologic findings were reviewed after each case. Statistics used include Student’s t test and chi-square test. Data are expressed as mean ⫾ SD. Results: One patient required conversion of LC to open cholecystectomy due to the inability to define the anatomy adequately. One asymptomatic patient with ultrasonographic evidence of cholelithiasis was found to have a pT2 adenocarcinoma. Conclusions: While our data cannot support routine LC with LRGB, a select subset of patients can have LC performed safely without increasing the hospital length of stay, but this does increase the OR time. PII: S1550-7289(05)00323-0
SRF9.
BANDS VERSUS BYPASSES: RANDOMIZATION AND PATIENTS’ CHOICES AND PERCEPTIONS Craig A. Ternovits, M.D., David S. Tichansky, M.D., Atul K. Madan, M.D., University of Tennessee Health Science Center, Memphis, TN. Purpose: The laparoscopic gastric bypass and laparoscopic adjustable gastric band have become two increasingly popular procedures. Little is understood about patient motivational factors and reasons for procedure selection. This investigation explored patient choices and perceptions concerning laparoscopic gastric bypass and laparoscopic adjustable banding. Methods: A survey was given to patients who had undergone laparoscopic gastric bypass and laparoscopic adjustable gastric banding. The survey was designed to ascertain what reasons the patients relied on to choose banding versus bypass, as well as their perception on how they had done from their surgery. Results: There were 101 patients who filled out the survey. 22 patients had undergone laparoscopic placement of the adjustable band, and 79 for the laparoscopic gastric bypass. Overall, 21% of patients would be willing to be involved in a prospective randomized study with respect to bariatric procedure choice. While 6 of 22 (32%) band patients stated that they would be willing to undergo randomization of their bariatric procedure, only 12 of 79 (18%) bypass patients would be willing to be randomized.
ticipated in our institution’s medically supervised weight management program before surgery. Results: Preoperatively, 30 patients (Group A) lost an average of 4% excess body weight (EBW) and 43 patients (Group B) did not lose weight or gained an average of 6% EBW over an average period of 3.3 months. There were no differences between the two groups in starting BMI, number of comorbidities, or the last preoperative BMI. Group A had less intraoperative blood loss (106 vs. 72 mL, p ⫽ 0.01). No differences were seen between Group A and Group B with respect to operative times (180 vs. 179 min, p ⫽ NS), intraoperative complications/conversions (3.3% vs. 14%, p ⫽ 0.2), need for additional trocars (6.7% vs. 4.7%, p ⫽ NS), or anastamotic leaks/obstructions (3.3% vs. 7%, p ⫽ NS). Conclusions: Minimal acute preoperative weight loss is associated with less blood loss and appears to reduce intraoperative complications and conversions in laparoscopic gastric bypass. A larger series with a greater reduction in EBW is necessary determine the maximal benefits of acute preoperative weight loss. PII: S1550-7289(05)00321-7
SRF7.
IS GALLBLADDER ULTRASOUND NECESSARY IN PATIENTS UNDERGOING LAPAROSCOPIC ROUX-ENY GASTRIC BYPASS? Federico A. Ceppa, M.D., Pavlos K. Papasavas, M.D., Daniel J. Gagne´, M.D., Cornelia Savopoulou, M.D., Philip F. Caushaj, M.D., Temple University Clinical Campus at the Western Pennsylvania Hospital, Pittsburgh, PA. Purpose: Bariatric surgeons perform either routine cholecystectomy at the time of laparoscopic Roux-en-Y gastric bypass (LRYGBP), selectively in patients with positive ultrasound (US) or not at all. We reviewed our experience with biliary disease in patients undergoing LRYGBP. Methods: From July 1999 to October 2004, 647 patients underwent LRYGBP in our institution. Data on preoperative US were available in 557 patients. Preoperative US was routinely obtained early in our series and selectively thereafter in patients with suspected symptomatic biliary disease. Cholecystectomy, at the time of LRYGBP, was performed in symptomatic patients with positive US. Results: Three of 21 patients with no preoperative US presented with common bile duct pathology that was treated with laparoscopic transgastric ERCP and sphincterotomy (n ⫽ 2) or common bile duct exploration (n ⫽ 1). GROUPS
NUMBER Lap Chole Lap Chole Lap Chole % Lap Chole Mean prior to with After after follow-up LRYGBP LRYGBP LYRGBP LYRGBP (months)
Preop Chole US Positive Symptomatic US Positive Asymptomatic US Negative Asymptomatic No Preop US TOTAL
133 18
133 0
0 18
0 0
0% 0%
15
0
0
1
6.6%
10.7
64
0
0
3
4.7%
15.1
6.4%
10.5
327 557
0 133(24%)
0 18(3.2%)
21 25(4.5%)
Conclusions: Omission of preoperative US is associated with an acceptable rate of postoperative biliary disease, which can be treated laparoscopically safely. PII: S1550-7289(05)00322-9
293
SRF8.
SELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY DURING LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS Alexander Perez, M.D., Lauren Seymour, P.A.-C., Jay Kuhn, M.D., Imtiaz A. Munshi, M.D., Department of Surgery, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA. Purpose: It has been proposed that laparoscopic cholecystectomy (LC) be done routinely during laparoscopic Roux-en-Y gastric bypass (LRGB). It is believed there is a high incidence of gallbladder disease despite negative clinical or radiographic preoperative findings. However, it has been shown that gallbladder removal prolongs operative times as well as the hospital length of stay. We performed an interim analysis of our experience to evaluate these concepts. Methods: Retrospective review of prospective data over 1 year, on all consecutive LRGB and LRGB/LC cases performed by the same surgeon using the same technique. Patients with clinical or radiographic evidence biliary disease and/or intraoperative finding of inflammation had LC after LRGB. Pathologic findings were reviewed after each case. Statistics used include Student’s t test and chi-square test. Data are expressed as mean ⫾ SD. Results: One patient required conversion of LC to open cholecystectomy due to the inability to define the anatomy adequately. One asymptomatic patient with ultrasonographic evidence of cholelithiasis was found to have a pT2 adenocarcinoma. Conclusions: While our data cannot support routine LC with LRGB, a select subset of patients can have LC performed safely without increasing the hospital length of stay, but this does increase the OR time. PII: S1550-7289(05)00323-0
SRF9.
BANDS VERSUS BYPASSES: RANDOMIZATION AND PATIENTS’ CHOICES AND PERCEPTIONS Craig A. Ternovits, M.D., David S. Tichansky, M.D., Atul K. Madan, M.D., University of Tennessee Health Science Center, Memphis, TN. Purpose: The laparoscopic gastric bypass and laparoscopic adjustable gastric band have become two increasingly popular procedures. Little is understood about patient motivational factors and reasons for procedure selection. This investigation explored patient choices and perceptions concerning laparoscopic gastric bypass and laparoscopic adjustable banding. Methods: A survey was given to patients who had undergone laparoscopic gastric bypass and laparoscopic adjustable gastric banding. The survey was designed to ascertain what reasons the patients relied on to choose banding versus bypass, as well as their perception on how they had done from their surgery. Results: There were 101 patients who filled out the survey. 22 patients had undergone laparoscopic placement of the adjustable band, and 79 for the laparoscopic gastric bypass. Overall, 21% of patients would be willing to be involved in a prospective randomized study with respect to bariatric procedure choice. While 6 of 22 (32%) band patients stated that they would be willing to undergo randomization of their bariatric procedure, only 12 of 79 (18%) bypass patients would be willing to be randomized.