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The utility of diagnostic laparoscopy in post-bariatric surgery patients with chronic abdominal pain of unknown etiology
Posters of Distinction / Surgery for Obesity and Related Diseases 12 (2016) S56–S75
(8.2%), and 7 patients have been operated in these 10 years to enlarge the common channel for severe or recurrent hypoproteinemia. Sixty-six patients were diabetics, and 57 of them were under oral (27) or insulin (30) therapy. Their mean preoperative HbA1c was 8% (5.4 - 14%) and only 4% had values below 6%. At 5 years, 70% of the patients (36/51) were off-treatment, and 74% (32/43) had a normal HbA1c (below 6%). Conclusions: In the long term SADI-S behaves as an effective surgery both for the treatment of morbid obesity and type-2 diabetes associated to obesity.
A5022
FIVE YEARS RESULTS AFTER RESLEEVE GASTRECTOMY Adrian Marius Nedelcu1; Imane Eddbali2; Patrick Noel3; 1CHU Montpellier, Montpellier Languedoc; 2American Surgecenter, AbuDhabi, UAE, Abu Dhabi Abu Dhabi; 3Aubagne Bouches du rhone Introduction: Laparoscopic sleeve gastrectomy(LSG) has rapidly become increasingly popular in bariatric surgery. However, in the long-term follow-up, weight loss failure and intractable severe reflux after primary LSG can necessitate further surgical interventions. The aim of our study was to evaluate long term results (5 years) following resleeve gastrectomy(ReSG). Methods: Thirteen patients underwent ReSG between October2008-June 2011 from a total of 66 cases of ReSG. All patients with failure after primary LSG underwent radiological evaluation and an algorithm of treatment was proposed. We have analyzed the 5-year outcome concerning weight loss and long-term complication after ReSG. Results: Thirteen patients (12 women; mean age-41.6 years) with a body mass index (BMI) of 39.1 Kg/m2 underwent ReSG. The mean interval time from the primary LSG to ReSG was of 29.6 months (11-67months). The indication for ReSG was insufficient weight loss-8 patients (61.5%), weight regain - 4 patients (30.7%), and gastroesophageal reflux disease (GERD) - 1 patient. In 9 cases the gastrografin swallow results were interpreted as primary dilatation and in the remaining 4 cases as secondary dilatation. One patient died from gynecological cancer. Of the remainder, 1 patient underwent SADI at 33 months after ReSG for a BMI of 39.2 and 1 patient underwent ReSG for reflux. The rest of 10 patients had available data at 5 years follow up. The mean excess weight loss (EWL) was 58.2% (range 3.3-100%). Of the 10 patients, 7 patients had 450% EWL at 5 years. All the 3 patient with failure of EWL (o50%) were the first 3 cases of our series and 2 out of them had secondary dilatation. All cases were completed by laparoscopy with no intraoperative incidents. One case of gastric stenosis was recorded. No other complications or mortality were recorded. Conclusions: At 5 years postoperative, the ReSG as a definitive bariatric procedure remained effective for 58.3 %. The results appear to be more favorable especially for the non-super-obese patients and for primary dilatation. ReSG is a well-tolerated bariatric procedure with low long-term complication rate. Further prospective clinical trials are required to compare the outcomes of ReSG with those of LRYGB or DS for weight loss failure after LSG.
S71
A5023
THE UTILITY OF DIAGNOSTIC LAPAROSCOPY IN POST-BARIATRIC SURGERY PATIENTS WITH CHRONIC ABDOMINAL PAIN OF UNKNOWN ETIOLOGY Mohammad Alsulaimy; Suriya Punchai; Stacy Brethauer; Philip Schauer; Ali Aminian; Cleveland Clinic Foundation, Cleveland OH Background: Chronic abdominal pain after bariatric surgery is associated with diagnostic and therapeutic challenges. The aim of this study was to evaluate the yield of laparoscopy as a diagnostic and therapeutic tool in post-bariatric surgery patients with chronic abdominal pain who had negative imaging and endoscopic studies. Methods: A retrospective analysis was performed on post-bariatric surgery patients who underwent laparoscopy for diagnosis and treatment of chronic abdominal pain at a single academic center. Only patients with both negative pre-operative CT-scan and upper endoscopy were included. Results: Total of 35 post-bariatric surgery patients met the inclusion criteria, and all had history of Roux-en-Y gastric bypass. Median duration from bariatric surgery to first abdominal pain presentation was 26 months (IQR 12-41). Median operative time was 64 minutes (IQR 52-85), and median length of hospital stay was 1 day (IQR 0 to 2). Twenty out of 35 patients (57%) had positive findings on diagnostic laparoscopy including presence of adhesions (n¼12), chronic cholecystitis (n¼4), mesenteric defect (n¼2), internal hernia (n¼1), and necrotic omentum (n¼1). Half of the adhesions occurred at the jejunojejunostomy. All four patients with intraoperative diagnosis of cholecystitis had histopathological findings compatible with chronic cholecystitis. One patient with an internal hernia required conversion to a laparotomy for reduction of hernia and closure of mesenteric defect at the jejunojejunostomy. Two patients developed postoperative complications within 30 days including a pelvic abscess requiring percutaneous image-guided drainage, and an abdominal wall abscess necessitating incision and drainage. No mortalities occurred. Overall, 15 patients (43%) had symptomatic improvement after laparoscopy; 14 of these patients had positive laparoscopic findings requiring intervention (70% of the patients with positive laparoscopy). Conversely, 20 (57%) patients (14 out of 15 with negative laparoscopy and 6 patients with positive laparoscopy) required long-term medical treatment for management of chronic abdominal pain. Conclusion: This study highlights the importance of offering diagnostic laparoscopy as both a diagnostic and therapeutic tool in post-bariatric surgery patients with chronic abdominal of unknown etiology. Diagnostic laparoscopy, which is a safe procedure, can detect pathological findings in more than half of post-bariatric surgery patients with chronic abdominal pain of unknown etiology. About 70% of patients with positive findings on diagnostic laparoscopy experience significant symptom improvement. The vast majority of patients with negative laparoscopy had chronic abdominal pain with no organic cause, necessitating long-term pain management. Patients should be informed that diagnostic laparoscopy is associated with no symptom improvement in about half of cases. Keywords: Bariatric surgery, diagnostic laparoscopy, abdominal pain, gastric bypass
(8.2%), and 7 patients have been operated in these 10 years to enlarge the common channel for severe or recurrent hypoproteinemia. Sixty-six patients were diabetics, and 57 of them were under oral (27) or insulin (30) therapy. Their mean preoperative HbA1c was 8% (5.4 - 14%) and only 4% had values below 6%. At 5 years, 70% of the patients (36/51) were off-treatment, and 74% (32/43) had a normal HbA1c (below 6%). Conclusions: In the long term SADI-S behaves as an effective surgery both for the treatment of morbid obesity and type-2 diabetes associated to obesity.
A5022
FIVE YEARS RESULTS AFTER RESLEEVE GASTRECTOMY Adrian Marius Nedelcu1; Imane Eddbali2; Patrick Noel3; 1CHU Montpellier, Montpellier Languedoc; 2American Surgecenter, AbuDhabi, UAE, Abu Dhabi Abu Dhabi; 3Aubagne Bouches du rhone Introduction: Laparoscopic sleeve gastrectomy(LSG) has rapidly become increasingly popular in bariatric surgery. However, in the long-term follow-up, weight loss failure and intractable severe reflux after primary LSG can necessitate further surgical interventions. The aim of our study was to evaluate long term results (5 years) following resleeve gastrectomy(ReSG). Methods: Thirteen patients underwent ReSG between October2008-June 2011 from a total of 66 cases of ReSG. All patients with failure after primary LSG underwent radiological evaluation and an algorithm of treatment was proposed. We have analyzed the 5-year outcome concerning weight loss and long-term complication after ReSG. Results: Thirteen patients (12 women; mean age-41.6 years) with a body mass index (BMI) of 39.1 Kg/m2 underwent ReSG. The mean interval time from the primary LSG to ReSG was of 29.6 months (11-67months). The indication for ReSG was insufficient weight loss-8 patients (61.5%), weight regain - 4 patients (30.7%), and gastroesophageal reflux disease (GERD) - 1 patient. In 9 cases the gastrografin swallow results were interpreted as primary dilatation and in the remaining 4 cases as secondary dilatation. One patient died from gynecological cancer. Of the remainder, 1 patient underwent SADI at 33 months after ReSG for a BMI of 39.2 and 1 patient underwent ReSG for reflux. The rest of 10 patients had available data at 5 years follow up. The mean excess weight loss (EWL) was 58.2% (range 3.3-100%). Of the 10 patients, 7 patients had 450% EWL at 5 years. All the 3 patient with failure of EWL (o50%) were the first 3 cases of our series and 2 out of them had secondary dilatation. All cases were completed by laparoscopy with no intraoperative incidents. One case of gastric stenosis was recorded. No other complications or mortality were recorded. Conclusions: At 5 years postoperative, the ReSG as a definitive bariatric procedure remained effective for 58.3 %. The results appear to be more favorable especially for the non-super-obese patients and for primary dilatation. ReSG is a well-tolerated bariatric procedure with low long-term complication rate. Further prospective clinical trials are required to compare the outcomes of ReSG with those of LRYGB or DS for weight loss failure after LSG.
S71
A5023
THE UTILITY OF DIAGNOSTIC LAPAROSCOPY IN POST-BARIATRIC SURGERY PATIENTS WITH CHRONIC ABDOMINAL PAIN OF UNKNOWN ETIOLOGY Mohammad Alsulaimy; Suriya Punchai; Stacy Brethauer; Philip Schauer; Ali Aminian; Cleveland Clinic Foundation, Cleveland OH Background: Chronic abdominal pain after bariatric surgery is associated with diagnostic and therapeutic challenges. The aim of this study was to evaluate the yield of laparoscopy as a diagnostic and therapeutic tool in post-bariatric surgery patients with chronic abdominal pain who had negative imaging and endoscopic studies. Methods: A retrospective analysis was performed on post-bariatric surgery patients who underwent laparoscopy for diagnosis and treatment of chronic abdominal pain at a single academic center. Only patients with both negative pre-operative CT-scan and upper endoscopy were included. Results: Total of 35 post-bariatric surgery patients met the inclusion criteria, and all had history of Roux-en-Y gastric bypass. Median duration from bariatric surgery to first abdominal pain presentation was 26 months (IQR 12-41). Median operative time was 64 minutes (IQR 52-85), and median length of hospital stay was 1 day (IQR 0 to 2). Twenty out of 35 patients (57%) had positive findings on diagnostic laparoscopy including presence of adhesions (n¼12), chronic cholecystitis (n¼4), mesenteric defect (n¼2), internal hernia (n¼1), and necrotic omentum (n¼1). Half of the adhesions occurred at the jejunojejunostomy. All four patients with intraoperative diagnosis of cholecystitis had histopathological findings compatible with chronic cholecystitis. One patient with an internal hernia required conversion to a laparotomy for reduction of hernia and closure of mesenteric defect at the jejunojejunostomy. Two patients developed postoperative complications within 30 days including a pelvic abscess requiring percutaneous image-guided drainage, and an abdominal wall abscess necessitating incision and drainage. No mortalities occurred. Overall, 15 patients (43%) had symptomatic improvement after laparoscopy; 14 of these patients had positive laparoscopic findings requiring intervention (70% of the patients with positive laparoscopy). Conversely, 20 (57%) patients (14 out of 15 with negative laparoscopy and 6 patients with positive laparoscopy) required long-term medical treatment for management of chronic abdominal pain. Conclusion: This study highlights the importance of offering diagnostic laparoscopy as both a diagnostic and therapeutic tool in post-bariatric surgery patients with chronic abdominal of unknown etiology. Diagnostic laparoscopy, which is a safe procedure, can detect pathological findings in more than half of post-bariatric surgery patients with chronic abdominal pain of unknown etiology. About 70% of patients with positive findings on diagnostic laparoscopy experience significant symptom improvement. The vast majority of patients with negative laparoscopy had chronic abdominal pain with no organic cause, necessitating long-term pain management. Patients should be informed that diagnostic laparoscopy is associated with no symptom improvement in about half of cases. Keywords: Bariatric surgery, diagnostic laparoscopy, abdominal pain, gastric bypass