2005 SAGES Abstracts

POSTER ABSTRACTS
P225–Complications of Surgery
PITFALLS AND COMPLICATIONS OF LAPAROSCOPIC NISSEN
FUNDOPLICATION, Mohey El-Banna, Mahmoud El-
Meteini,Osama Fouad, Department of General Surgery, Ain
Shams University
Background: Since the introduction of laparoscopic Nissen
fundoplication by Dallmagne 1991, its importance increased
dramatically. In this study, the lessons learned from 60 consecutive
laparoscopic Antireflux procedures (LAP) procedures are
analyzed.
Methods: Between March 2001 and March 2004, 60 cases were
subjected to LAP for gastroesophageal reflux disease (GERD).
The preoperative decision depended on
Esophagogastroduodenoscopy (EGD) and Esophageal
Manometry (EM) to record the lower esophageal sphincter
pressure and length and the esophageal body motility pattern.
Barium study was done for hiatus hernia. The operative details
were recorded, as well as the postoperative outcome and complications.
The postoperative study included a standardized
questionnaire, EGD and EM.
Results: Of the sixty cases studied, 6 cases were converted to
open fundoplication due to gastric perforation, equipment failure
and procedural difficulties. Four patients underwent
Laparoscopic Toupet Fundoplication (LTF). Except three
patients, all demonstrated subjective and objective improvement
or cure of GERD.
Conclusion: We concluded that LAP is a safe and effective
approach for the management of GERD. However, the success
of LAP depends on the ability of the surgeon to take into consideration
the possible intra-operative complications and factors
contributing to dissatisfaction with the functional outcome.
P226–Complications of Surgery
BLADELESS TROCAR HERNIA RATE IN UNCLOSED FASCIAL
DEFECTS IN BARIATRIC PATIENTS, Alison M Fecher MD, Ross
L McMahon MD,John P Grant MD,Aurora D Pryor MD, Duke
University Medical Center
Objective
Utilization of the bladeless step trocar system has the perceived
advantage of minimal trocar related hernias in patients
undergoing laparoscopic Roux en Y Gastric Bypass surgery
(RYGB). We propose a retrospective review of hernias in these
patients and a review of the literature.
Methods & Procedures
A retrospective chart review was performed on 591 patients
who underwent RYGB at Duke University Weight Loss Surgery
Center from July 2002 through June 2004. A total of 2955
bladeless trocar sites were used. Step trocars were used in all
cases. The configuration of ports included one Hasson port,
two 12-mm and three 5-mm ports . The Hasson port was
closed with a figure of eight number 1 Polysorb. All other trocar
sites did not have fascial closure. The gastrojejunal anastomosis
was created with a linear stapler in all of the laparoscopic
cases with hand suturing of the residual enterotomy.
The charts were reviewed for fascial defect, subsequent surgeries
and intra-operative findings.
Results
There were no hernias seen at any of the unclosed bladeless
trocar sites for a 0% incidence. There were four ventral hernias
at the Hasson port site which required re-operation for repair
for a 0.68% incidence.
Conclusion
There were no hernias from the unclosed bladeless trocar site
with radial expanders out of a total of 1182 12-mm ports. Four
hernias occurred at the Hasson port site. In the bariatric RYGB
population the routine closure of radially expanding step trocars
does not appear to be necessary due to the extremely low
rate of subsequent hernia.
P227–Complications of Surgery
DELAYED PRESENTATION OF SPLENIC RUPTURE AFTER
COLONOSCOPY, Richard Fortunato DO, Daniel Gagné
MD,Pavlos Papasavas MD,Philip Caushaj MD, The Western
Pennsylvania Hospital, Temple University Medical School
Clinical Campus
Splenic rupture after a colonoscopy is a rare but potentially
fatal complication. Patients typically present with signs of
abdominal pain and hemorrhagic shock within minutes to
days after the procedure.
We present a case of a 59 year-old woman with a past history
of Hodgkin?s disease and gastric bypass who developed
increasing abdominal pain three weeks after a routine
colonoscopy and polypectomy. The patient presented with
hypotension and underwent aggressive resuscitation with IVF
and IV pressors. CT scan demonstrated a large subcapsular
hematoma of the spleen. Angiography did not reveal active
bleeding. Due to the patient?s continued clinical deterioration,
she was taken emergently to the operating room for an
exploratory laparotomy, which demonstrated a full splenic
capsular avulsion and hemorrhage. The patient underwent
splenectomy and had an uneventful recovery.
Though usually presenting hours to a few days after
colonoscopy, severe splenic injury can have an insidious onset
weeks from the original insult. This is the most delayed presentation
of such an injury after colonoscopy to date.
P228–Complications of Surgery
INCIDENCE OF INTERNAL HERNIA FOLLOWING LAPARO-
SCOPIC RETROCOLIC RETROGASTRIC ROUX-EN-Y GASTRIC
BYPASS, Giselle G Hamad MD, Gina M Kozak, PA-C, University
of Pittsburgh
The optimal route of the Roux limb in the laparoscopic Rouxen-Y
gastric bypass remains controversial. The retrogastricretrocolic
approach to Roux-en-Y gastric bypass has been criticized
for the incidence of internal hernias at Petersen?s defect
and the transverse mesocolon window. The postoperative
weight loss coupled with the reduction in postoperative adhesions
associated with the laparoscopic approach may contribute
to a higher incidence of internal hernias. Internal herniation
may lead to a closed loop obstruction and necessitates
early surgical intervention. The purpose of this study was to
determine the incidence of internal hernias among patients
who underwent a retrocolic-retrogastric Roux-en-Y gastric
bypass. Between 2001 and 2004, 520 patients underwent a
retrocolic-retrogastric Roux-en-Y gastric bypass with continuous
sutured closure of Petersen?s, transmesenteric, and small
bowel mesenteric defects. Three patients were converted to
open procedure (0.6%). There were 500 females and 20 males.
Mean age was 40 years (range 18-65) and mean preoperative
body mass index was 46.4 kg/m2 (range 36-68). Mean followup
for all patients was 11 months and mean excess weight
loss at 18 months was 70%. One patient (0.19%) who had lost
57% of excess weight three months after laparoscopic gastric
bypass developed a high-grade small bowel obstruction and
was diagnosed with an internal hernia by CT scan. An
exploratory laparotomy was performed for reduction and
repair of Petersen?s defect and the patient recovered uneventfully.
Internal herniation is an infrequent complication following
retrocolic-retrogastric laparoscopic Roux-en-Y gastric
bypass. Meticulous continuous suture closure of the potential
hernia defects is essential to reduce the incidence of this
dreaded complication.
P229–Complications of Surgery
INCIDENCE OF STOMAL STENOSIS FOLLOWING LAPARO-
SCOPIC RETROCOLIC-RETROGASTRIC ROUX-EN-Y GASTRIC
BYPASS, Giselle G Hamad MD, Gina M Kozak PA-C, University
of Pittsburgh
Stomal stenosis is a complication reported in 3 to 37% of
patients following Roux-en-Y gastric bypass. Contributing factors
include tension of the Roux limb, ischemia, preserved acid
secretion in the gastric pouch, NSAID use, and smoking. The
optimal route of the Roux limb in the laparoscopic Roux-en-Y
gastric bypass remains controversial. The retrocolic-retrogastric
route has been said to subject the Roux limb to less tension
on the gastrojejunal anastomosis than the antecolic-antegastric
approach. The purpose of this study was to determine
the incidence of stomal stenosis among patients who underwent
a retrocolic-retrogastric Roux-en-Y gastric bypass.
Between 2001 and 2004, 520 patients underwent a retrocolicretrogastric
Roux-en-Y gastric bypass with gastric pouch size
of 15 mL and Roux limb lengths of 75 or 150 cm. The gastroje-
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