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Su1564 Thromboembolic Events After Laparoscopic Adjustable Gastric Band: Identification of High-Risk Factors
Su1563
Procedural Terminology code for LAGB. Univariate comparison and regression analysis of demographics and comorbidities of patients with and without TE were performed to determine independent risk factors for the development of TE. Results: During the study period, 16,015 patients underwent LGB, of whom 19 (0.12%) developed a TE (10 (0.062%) developed a pulmonary embolus, 11 (0.069%) developed a deep-vein thrombosis, and 2 developed both) within 30 days of surgery. Eighty percent of the pulmonary embolisms and ninety-one percent of the deep venous thromboses were diagnosed after discharge. On regression analysis several patient characteristics, medical comorbidities and postoperative complications were independently associated with increased risk of TE. (Table) Conclusion: The 30-day incidence of thromboembolic events after LAGB in ACS-NSQIP hospitals is exceedingly low, although the majority of these events occur following discharge. Certain patients are at higher risk for TE, and may represent a cohort that could benefit from extended post-operative prophylaxis.
Evaluation and Treatment of Gastric Stimulator Failure Nancy Salloum, Micah R. Walker, Patrick A. Williams, Yana Nikitina, Thomas S. Helling, Thomas L. Abell, Christopher J. Lahr, James Griffith Introduction: Some patients who undergo gastric electrical stimulation (GES) for gastroparesis (GP) develop recurrent symptoms i.e.: vomiting, nausea, early satiety, bloating, and abdominal pain despite an initial good result, replete with a functioning stimulator and unbroken leads. This study evaluates treatment for these patients, which includes temporary stimulation at a new gastric location and if symptoms are relieved this is followed by implantation of new leads and stimulator. We expect symptom scores to significantly decrease in the control group; we hypothesize that the symptom scores will also show a significant decrease in the replacement group. Patients: 15 patients with recurrent symptoms after placement of GES have undergone surgical insertions of a new gastric electrical stimulation (GES) system. Of the 15 replacement surgeries, 10 (67%) were female, 5 were male (33%) (mean age of all: 45), and 3 (20%) had diabetes-induced gastroparesis; the remainder (80%) were either idiopathic, post-surgical, or sarcoidosis-induced. Of 87 patients without recurrent symptoms after placement of GES who have not needed a replacement, 15 were selected as the control arm, matched by the three variables of investigator-derived independent outcome score (IDIOMS), baseline symptom scores before initial GES implantation, and etiology of disease (i.e. diabetic or idiopathic). Methods: Each patient met specific indications to receive GES replacement surgery. All patients had a preoperative diagnosis of either diabetic or idiopathic, drug-refractory, or post-surgical gastroparesis, and disordered gastric emptying with significant weight change. Patients with failed GES were evaluated over a 1-2 week period with insertion of a temporary endoscopic gastric stimulator. Patients with a positive response to temporary stimulation undergo GES replacement surgery. Common gastroparesis symptoms were evaluated before and after gastric pacemaker replacement using the Likert score system 0-4. These symptoms include vomiting, nausea, epigastric pain, early satiety and bloating. Results: See Tables 1 and 2. Total score of symptoms improved for 12 out of the 15 (80%) patients that underwent the GES replacement surgery. The frequency, amplitude, freq/ amplitude ratio (FAR), and gastric emptying times (GET) are displayed to reinforce physiological similarity between the two groups. Conclusion: Trial gastric mucosal electrical stimulation followed by implantation of new leads and stimulator successfully salvages the majority of patients whose gastric electrical stimulator is no longer relieving symptoms. Table 1 - Comparison of Mean Pre-Op and Mean Post-Op Symptom Scores
Significant Independent Risk Factors After LAGB Su1565 Changes in Quality of Life Before Roux-en-Y Gastric Bypass for Morbidity Obesity and After a Short and Long Term Follow-up Rafael M. Laurino Neto, Fernando A. Herbella
SSAT Abstracts
Introduction: Roux-en-Y gastric bypass is considered an effective therapy for weight loss although weight regain may be observed in a long-term follow-up. It is unclear if quality of life is sustained in a long-term follow-up when weight regain occurs. Methods: Three groups were studied: Group A - 50 patients (88% females, age 51, BMI 37Kg/m2, time of follow-up 112 months) submitted to Roux-en-Y gastric bypass more than 7 years, Group B - 50 patients (82% females, age 44, BMI 31Kg/m2, time of follow-up 17 months) submitted to Roux-en-Y gastric bypass 1-2 years, Group C - 50 patients (80% females, age 42, BMI 47Kg/m2) morbid obese in the pre-operative period. We use the MOS 36-Item Short-Form Health Survey (SF-36) to analyze the quality of life differences among the 3 groups. Results: Groups were similar for gender. Group A was older than the other groups due to the time from operation. BMI was significantly lower for Group B compared to Group C and higher for Group A compared to Group B. SF-36 parameters are depicted in Table 1. Physical Functioning, Social Functioning, Emotional Problems and Mental Health were not different when the 3 groups were compared (p=1). Role Functioning, Pain, General Health Perceptions and Vitality showed an increase after the operation and a significant decrease at the 7 year follow-up (p<0.0001) (Figure 1). Conclusions: Some Quality of Life parameters are not changed by Roux-en-Y gastric bypass while others are improved by the operation even though a significant decreased is noted at a long term follow-up. SF-36 Concepts for the 3 groups
Table 2 - Comparison of Mean EGG Values
data presented as median (interquartile range 25-75)
Table is displayed to reinforce physiological similarity between the two groups. Su1564 Thromboembolic Events After Laparoscopic Adjustable Gastric Band: Identification of High-Risk Factors Chad Gonczy, Imran Hassan, Sajida Ahad, Stephen Markwell Introduction: In-hospital prophylaxis against thromboembolic events (TE) is considered routine for patients after laparoscopic adjustable gastric band (LAGB) for morbid obesity due to the increased risk of TE in this patient population. However, there are limited data regarding the benefit of extending this prophylaxis beyond discharge. Utilizing the American College of Surgeons-National Surgery Quality Improvement Project (ACS-NSQIP) database, we analyzed patients undergoing LAGB to determine the incidence of pre- and post-discharge TE and associated risk factors. Methods: Patients undergoing LAGB between 2005-2009 were identified from the public use file of the ACS-NSQIP database using the Current
SSAT Abstracts
S-1064
Procedural Terminology code for LAGB. Univariate comparison and regression analysis of demographics and comorbidities of patients with and without TE were performed to determine independent risk factors for the development of TE. Results: During the study period, 16,015 patients underwent LGB, of whom 19 (0.12%) developed a TE (10 (0.062%) developed a pulmonary embolus, 11 (0.069%) developed a deep-vein thrombosis, and 2 developed both) within 30 days of surgery. Eighty percent of the pulmonary embolisms and ninety-one percent of the deep venous thromboses were diagnosed after discharge. On regression analysis several patient characteristics, medical comorbidities and postoperative complications were independently associated with increased risk of TE. (Table) Conclusion: The 30-day incidence of thromboembolic events after LAGB in ACS-NSQIP hospitals is exceedingly low, although the majority of these events occur following discharge. Certain patients are at higher risk for TE, and may represent a cohort that could benefit from extended post-operative prophylaxis.
Evaluation and Treatment of Gastric Stimulator Failure Nancy Salloum, Micah R. Walker, Patrick A. Williams, Yana Nikitina, Thomas S. Helling, Thomas L. Abell, Christopher J. Lahr, James Griffith Introduction: Some patients who undergo gastric electrical stimulation (GES) for gastroparesis (GP) develop recurrent symptoms i.e.: vomiting, nausea, early satiety, bloating, and abdominal pain despite an initial good result, replete with a functioning stimulator and unbroken leads. This study evaluates treatment for these patients, which includes temporary stimulation at a new gastric location and if symptoms are relieved this is followed by implantation of new leads and stimulator. We expect symptom scores to significantly decrease in the control group; we hypothesize that the symptom scores will also show a significant decrease in the replacement group. Patients: 15 patients with recurrent symptoms after placement of GES have undergone surgical insertions of a new gastric electrical stimulation (GES) system. Of the 15 replacement surgeries, 10 (67%) were female, 5 were male (33%) (mean age of all: 45), and 3 (20%) had diabetes-induced gastroparesis; the remainder (80%) were either idiopathic, post-surgical, or sarcoidosis-induced. Of 87 patients without recurrent symptoms after placement of GES who have not needed a replacement, 15 were selected as the control arm, matched by the three variables of investigator-derived independent outcome score (IDIOMS), baseline symptom scores before initial GES implantation, and etiology of disease (i.e. diabetic or idiopathic). Methods: Each patient met specific indications to receive GES replacement surgery. All patients had a preoperative diagnosis of either diabetic or idiopathic, drug-refractory, or post-surgical gastroparesis, and disordered gastric emptying with significant weight change. Patients with failed GES were evaluated over a 1-2 week period with insertion of a temporary endoscopic gastric stimulator. Patients with a positive response to temporary stimulation undergo GES replacement surgery. Common gastroparesis symptoms were evaluated before and after gastric pacemaker replacement using the Likert score system 0-4. These symptoms include vomiting, nausea, epigastric pain, early satiety and bloating. Results: See Tables 1 and 2. Total score of symptoms improved for 12 out of the 15 (80%) patients that underwent the GES replacement surgery. The frequency, amplitude, freq/ amplitude ratio (FAR), and gastric emptying times (GET) are displayed to reinforce physiological similarity between the two groups. Conclusion: Trial gastric mucosal electrical stimulation followed by implantation of new leads and stimulator successfully salvages the majority of patients whose gastric electrical stimulator is no longer relieving symptoms. Table 1 - Comparison of Mean Pre-Op and Mean Post-Op Symptom Scores
Significant Independent Risk Factors After LAGB Su1565 Changes in Quality of Life Before Roux-en-Y Gastric Bypass for Morbidity Obesity and After a Short and Long Term Follow-up Rafael M. Laurino Neto, Fernando A. Herbella
SSAT Abstracts
Introduction: Roux-en-Y gastric bypass is considered an effective therapy for weight loss although weight regain may be observed in a long-term follow-up. It is unclear if quality of life is sustained in a long-term follow-up when weight regain occurs. Methods: Three groups were studied: Group A - 50 patients (88% females, age 51, BMI 37Kg/m2, time of follow-up 112 months) submitted to Roux-en-Y gastric bypass more than 7 years, Group B - 50 patients (82% females, age 44, BMI 31Kg/m2, time of follow-up 17 months) submitted to Roux-en-Y gastric bypass 1-2 years, Group C - 50 patients (80% females, age 42, BMI 47Kg/m2) morbid obese in the pre-operative period. We use the MOS 36-Item Short-Form Health Survey (SF-36) to analyze the quality of life differences among the 3 groups. Results: Groups were similar for gender. Group A was older than the other groups due to the time from operation. BMI was significantly lower for Group B compared to Group C and higher for Group A compared to Group B. SF-36 parameters are depicted in Table 1. Physical Functioning, Social Functioning, Emotional Problems and Mental Health were not different when the 3 groups were compared (p=1). Role Functioning, Pain, General Health Perceptions and Vitality showed an increase after the operation and a significant decrease at the 7 year follow-up (p<0.0001) (Figure 1). Conclusions: Some Quality of Life parameters are not changed by Roux-en-Y gastric bypass while others are improved by the operation even though a significant decreased is noted at a long term follow-up. SF-36 Concepts for the 3 groups
Table 2 - Comparison of Mean EGG Values
data presented as median (interquartile range 25-75)
Table is displayed to reinforce physiological similarity between the two groups. Su1564 Thromboembolic Events After Laparoscopic Adjustable Gastric Band: Identification of High-Risk Factors Chad Gonczy, Imran Hassan, Sajida Ahad, Stephen Markwell Introduction: In-hospital prophylaxis against thromboembolic events (TE) is considered routine for patients after laparoscopic adjustable gastric band (LAGB) for morbid obesity due to the increased risk of TE in this patient population. However, there are limited data regarding the benefit of extending this prophylaxis beyond discharge. Utilizing the American College of Surgeons-National Surgery Quality Improvement Project (ACS-NSQIP) database, we analyzed patients undergoing LAGB to determine the incidence of pre- and post-discharge TE and associated risk factors. Methods: Patients undergoing LAGB between 2005-2009 were identified from the public use file of the ACS-NSQIP database using the Current
SSAT Abstracts
S-1064