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The Safety and Effectiveness of Totally Robotic Revisional Bariatric Surgery
Poster Presentations / Surgery for Obesity and Related Diseases 12 (2016) S76–S232
hernia repair BMI was 31 ⫾ 5 kg/m2. 78% of patients required anti-reflux medications prior to surgery, and decreased to 33% following repair. Mean follow-up was 6 ⫾ 6months. Findings are further sub-divided by index operation. Laparoscopic repair of the hiatal hernia improved symptoms in most patients including reduction in use of anti-reflux medication. Conclusion: Hiatal hernias have a well documented association with morbid obesity. Denovo hiatal hernia repairs after bariatric surgery is uncommon, and symptoms may be difficult to differentiate from overeating or maladaptive eating habits. Diagnostic modalities are helpful in identifying the cause, and manometry may be helpful but may be inaccurate when identifying the gastroesophageal junction is difficult, particularly in this patient population. Most patients had resolution of symptoms. Development of esophageal dysmotility in this patient population may take longer to resolve and may possibly be permanent. Longer followup, a larger patient cohort and evaluation of postoperative upper GI studies at different intervals post-operatively would help shed more light on upper gastrointestinal symptoms in the post-bariatric surgery population.
S177
length of stay (LOS), 30-day readmissions for malaise or physical complications, 30-day reoperations, and mortality. Results: For all surgical procedures, total time in surgery was 190.2⫾74.9 min (range ¼ 40 to 517 min). Operative times were lowest for surgeries involving conversion to band or sleeve (162 min) and highest for gastrojejunal anastomotic revision (236 min). For all patients, the mean duration of hospital stay was 3.34⫾3.64 days (range ¼ 1 to 30 days). Perioperative, there were no conversions to open surgery, no leaks, and no mortality. Postoperatively, there were 0% mortalities, 0% anastomotic leaks, and 0% strictures (30-day). The total 30-day readmission rate was 10.25%. Half of these (n¼8 or 5.12%) were for malaise (nausea and vomiting, dehydration, constipation, benign pain or issues, failure to follow diet) and 8 or 5.12% represented physical complications including 2 ulcers, 1 cystic duct obstruction, 1 fever with abscess, 1 obstructed G-tube, 1 dilated remnant, 1 atrial fibrillation, 1 contact dermatitis). The 30-day reoperation rate was 3.2%, i.e. 4 surgeries during the hospital stay (2 evacuations of hematoma, 1 exploratory laparoscopic surgery, 1 perforated remnant) and one 30-day laparoscopic cholecystectomy. Conclusion: Utilization of the da Vinci surgery system for 'totally' robotic revisional bariatric surgery is safe and may be effective in lowering surgical risks and complications.
A5198
THE SAFETY AND EFFECTIVENESS OF TOTALLY ROBOTIC REVISIONAL BARIATRIC SURGERY Keith Kim; Sharon Krzyzanowski; Dennis Smith; Cynthia Buffington; Florida Hospital Celebration Health, Celebration FL Background: Patients undergoing secondary bariatric procedures and revisions, in comparison to primary surgeries, are at higher risk for mortality and morbidity, including the risk for gastrointestinal leaks. The da Vinci robotic surgery system, with its ergonomic advantage, 3-D vision and tremor control may improve operative outcomes for high risk patients. To our knowledge, there are currently no studies of the safety and effectiveness of 'totally' robotic procedures for revisional bariatric surgery. In this study, we report on the surgical outcomes and rates of morbidity and mortality of a relatively large number of revisional bariatric procedures performed 'totally' robotic. Methods: A retrospective analysis of a prospectively maintained database was performed and included 156 revisional surgeries performed by a single surgeon at a center of excellence hospital. The operations performed were grouped as follows: Group 1 Conversion to Roux-en-Y Gastric Bypass; RYGB (n¼74 band to RYGB one-stage, n¼12 band to bypass two-stage, n¼11 sleeve gastrectomy to RYGB, n¼21 vertical banded gastroplasty to RYGB, n¼1 jejunoileal bypass reversal to RYGB, n¼2 Billroth II to RYGB, n¼1 Billroth I to RYGB, 5 Nissen to RYGB, 1 horizontal gastroplasty to RYGB, n¼1 mini bypass to RYGB), Group 2 Gastrojejunal Anastomotic Revision (n¼23), Group 3 Surgery Reversal (n¼2 RYGB reversals), Group 4 Other Surgeries (n¼1 band to sleeve; n¼1 partial gastrectomy for possible fistula). In addition to the respective revisional operation, there were numerous additional procedures performed for repair of hiatal, incisional, umbilical hernias, for lysis of adhesion, partial gastrectomy, pouch reduction, cholecystectomy. Outcome measures included operative time, blood loss,
A5199
INDICATIONS AND OUTCOMES IN PATIENTS UNDERGOING GASTRIC BYPASS REVISION SURGERY Saad Ajmal; Lael Forbes; Joseph Johnson; William OMalley; University of Rochester, Rochester NEW YORK Background: Although gastric bypass is considered to be a durable procedure, a subgroup of patients may require revision surgery over time for various reasons. As our Bariatric surgery practice is the main referral center in our region we have developed considerable experience with revision surgery. We sought to identify the indications, methods and outcomes of gastric bypass revisions performed at our institution. Methods: A retrospective review of gastric bypass patients who required subsequent revision from January 2010 to December 2015 was performed. Data collected included demographics,
hernia repair BMI was 31 ⫾ 5 kg/m2. 78% of patients required anti-reflux medications prior to surgery, and decreased to 33% following repair. Mean follow-up was 6 ⫾ 6months. Findings are further sub-divided by index operation. Laparoscopic repair of the hiatal hernia improved symptoms in most patients including reduction in use of anti-reflux medication. Conclusion: Hiatal hernias have a well documented association with morbid obesity. Denovo hiatal hernia repairs after bariatric surgery is uncommon, and symptoms may be difficult to differentiate from overeating or maladaptive eating habits. Diagnostic modalities are helpful in identifying the cause, and manometry may be helpful but may be inaccurate when identifying the gastroesophageal junction is difficult, particularly in this patient population. Most patients had resolution of symptoms. Development of esophageal dysmotility in this patient population may take longer to resolve and may possibly be permanent. Longer followup, a larger patient cohort and evaluation of postoperative upper GI studies at different intervals post-operatively would help shed more light on upper gastrointestinal symptoms in the post-bariatric surgery population.
S177
length of stay (LOS), 30-day readmissions for malaise or physical complications, 30-day reoperations, and mortality. Results: For all surgical procedures, total time in surgery was 190.2⫾74.9 min (range ¼ 40 to 517 min). Operative times were lowest for surgeries involving conversion to band or sleeve (162 min) and highest for gastrojejunal anastomotic revision (236 min). For all patients, the mean duration of hospital stay was 3.34⫾3.64 days (range ¼ 1 to 30 days). Perioperative, there were no conversions to open surgery, no leaks, and no mortality. Postoperatively, there were 0% mortalities, 0% anastomotic leaks, and 0% strictures (30-day). The total 30-day readmission rate was 10.25%. Half of these (n¼8 or 5.12%) were for malaise (nausea and vomiting, dehydration, constipation, benign pain or issues, failure to follow diet) and 8 or 5.12% represented physical complications including 2 ulcers, 1 cystic duct obstruction, 1 fever with abscess, 1 obstructed G-tube, 1 dilated remnant, 1 atrial fibrillation, 1 contact dermatitis). The 30-day reoperation rate was 3.2%, i.e. 4 surgeries during the hospital stay (2 evacuations of hematoma, 1 exploratory laparoscopic surgery, 1 perforated remnant) and one 30-day laparoscopic cholecystectomy. Conclusion: Utilization of the da Vinci surgery system for 'totally' robotic revisional bariatric surgery is safe and may be effective in lowering surgical risks and complications.
A5198
THE SAFETY AND EFFECTIVENESS OF TOTALLY ROBOTIC REVISIONAL BARIATRIC SURGERY Keith Kim; Sharon Krzyzanowski; Dennis Smith; Cynthia Buffington; Florida Hospital Celebration Health, Celebration FL Background: Patients undergoing secondary bariatric procedures and revisions, in comparison to primary surgeries, are at higher risk for mortality and morbidity, including the risk for gastrointestinal leaks. The da Vinci robotic surgery system, with its ergonomic advantage, 3-D vision and tremor control may improve operative outcomes for high risk patients. To our knowledge, there are currently no studies of the safety and effectiveness of 'totally' robotic procedures for revisional bariatric surgery. In this study, we report on the surgical outcomes and rates of morbidity and mortality of a relatively large number of revisional bariatric procedures performed 'totally' robotic. Methods: A retrospective analysis of a prospectively maintained database was performed and included 156 revisional surgeries performed by a single surgeon at a center of excellence hospital. The operations performed were grouped as follows: Group 1 Conversion to Roux-en-Y Gastric Bypass; RYGB (n¼74 band to RYGB one-stage, n¼12 band to bypass two-stage, n¼11 sleeve gastrectomy to RYGB, n¼21 vertical banded gastroplasty to RYGB, n¼1 jejunoileal bypass reversal to RYGB, n¼2 Billroth II to RYGB, n¼1 Billroth I to RYGB, 5 Nissen to RYGB, 1 horizontal gastroplasty to RYGB, n¼1 mini bypass to RYGB), Group 2 Gastrojejunal Anastomotic Revision (n¼23), Group 3 Surgery Reversal (n¼2 RYGB reversals), Group 4 Other Surgeries (n¼1 band to sleeve; n¼1 partial gastrectomy for possible fistula). In addition to the respective revisional operation, there were numerous additional procedures performed for repair of hiatal, incisional, umbilical hernias, for lysis of adhesion, partial gastrectomy, pouch reduction, cholecystectomy. Outcome measures included operative time, blood loss,
A5199
INDICATIONS AND OUTCOMES IN PATIENTS UNDERGOING GASTRIC BYPASS REVISION SURGERY Saad Ajmal; Lael Forbes; Joseph Johnson; William OMalley; University of Rochester, Rochester NEW YORK Background: Although gastric bypass is considered to be a durable procedure, a subgroup of patients may require revision surgery over time for various reasons. As our Bariatric surgery practice is the main referral center in our region we have developed considerable experience with revision surgery. We sought to identify the indications, methods and outcomes of gastric bypass revisions performed at our institution. Methods: A retrospective review of gastric bypass patients who required subsequent revision from January 2010 to December 2015 was performed. Data collected included demographics,