2005 SAGES Abstracts

POSTER ABSTRACTS
this practice by the general surgeon who performs gastrointestinal
procedures.
P292–Flexible Diagnostic &
Therapeutic Endoscopy
ULTRASOUND GUIDED PRE-OPERATIVE LOCALIZATION OF
THE THYROID GLAND AS A TOOL FOR ENDOSCOPIC AXIL-
LARY THYROID AND PARATHYROIDECTOMY, Titus D Duncan,
MD, FACS, Atlanta Medical Center and Morehouse School of
Medicine
Minimally invasive surgical techniques have become common
place in the treatment of surgical diseases processes once
necessitating major incisions. Improved cosmesis, less pain
and faster return to normal activity have been the driving force
behind innovative surgical procedures now seen as common
place. Improved surgical visualization with superior optics has
also spawned claims of some procedures being safer than
their open counterparts. Minimal access thyroid and parathyroid
surgery has been shown to offer superior cosmetic results
with improved patient satisfaction over its open counterpart.
Furthermore, recent results have espoused superior visualization
inferring improved safety for patients undergoing thyroid
and parathyroid surgery. However, disadvantages of such
techniques have prohibited them from enjoying much of the
popularity as other minimally invasive techniques. Such disadvantages
include increased costs, prolonged surgical times
and a steep learning curve. We recently reviewed our series of
patients undergoing minimal access surgery to the thyroid and
parathyroid gland. We compared our results of patients undergoing
surgery with pre-operative ultrasound guided localization
of the thyroid with patients who did not have pre-op ultrasound
localization.
Our theory was that pre-operative localization could reduce the
operative time of the surgical procedure. We concluded that
pre-operative ultrasound localization significantly reduced the
overall operative time of the minimal access procedure as well
as reduced the learning curve for surgeons learning the procedure.
We present our data in support of the above conclusions.
P293–Flexible Diagnostic &
Therapeutic Endoscopy
ENDOSCOPIC PARATHYROIDECTOMY AND THYROIDECTOMY
USING AN AXILLARY APPROACH: A VIABLE ALTERNATIVE TO
THE OPEN APPROACH, Titus D Duncan, MD, FACS, Ijeoma
Acholonu Ejeh MD, Department of Minimally Invasive Surgery
Morehouse School of Medicine and Atlanta Medical Center,
Atlanta, Georgia
A permanent transverse scar in the neck is the usual endpoint
for conventional surgical treatment for thyroid and parathyroid
diseases despite that the majority of these procedures are performed
for benign disease. The introduction of laparoscopic
surgery in the 1980?s ushered in an era of minimal access
techniques for many surgical fields. Endoscopic surgery can
be performed in anatomic regions with limited space unlike
the thoracic and abdominal cavities. The global acceptance of
minimal access surgery has been primarily due to the advantages
the procedures hold for the patient. Some of these
advantages include less pain, faster return to activity, shorter
hospital stay and improved cosmesis. However, it is well
known that there are similar advantages for the surgeon performing
surgery through minimally invasive approach. Better
view of the anatomy, perhaps leading to safer dissection, has
been one of the main advantages to this particular approach.
Unlike laparoscopic surgery where reports of less pain, faster
return to activity and shorter hospital stays have prevailed,
few reports espouse similar advantages using an endoscopic
technique over the open approach in thyroid and parathyroid
surgery. Therefore, advantages to such an approach appear to
be one of cosmesis for the patient and improved visualization
and safer dissection for the surgeon. We reviewed our series
of endoscopic thyroid and parathyroidectomies in a single
institution to assess whether such advantages outweigh the
difficult learning curve. We examined the technical aspects of
the procedure and the surgeons visualization of vital structures
as well as subjective patient scar analysis and cosmetic satisfaction.
Our results show that the axillary approach to the thyroid
and parathyroid can be performed safely with minimal
complications. It is expected as is seen in other series, that the
operative time will diminish as the plateau of the learning
curve is reached. Though the advantages commonly seen in
most minimally invasive procedures (i.e., less pain, faster
recovery, shorter hospital stay, etc.) are not evident using this
technique, the superior cosmetic outcome and patient satisfaction
from such an approach appear to outweigh the technical
obstacles in hands of experienced minimally invasive surgeons.
Improved visualization, that allows safer dissection for
the surgeon, may make this a viable alternative to the open
technique in select patients requiring these surgeries.
P294–Flexible Diagnostic &
Therapeutic Endoscopy
THE CASE FOR PREOPERATIVE ESOPHAGOGASTRODUO-
DENOSCOPY IN BARIATRIC PATIENTS, D Francis MD, N
Fearing MD,M Bozuk MD,R Altieri MD,P Leggett MD,T
Scarborough MD,E Wilson, Department of Surgery, University
of Texas Medical School at Houston
Introduction: There currently is no standard preoperative workup
for the morbidly obese patient undergoing gastric bypass
(GB) surgery. Once the stomach is divided it is difficult to evaluate
for pathology that may have been present prior to bypass
surgery. We reviewed the results of the preoperative workup
for GB in our patients to determine whether esophagogastroduodenoscopy
(EGD) is warranted.
Methods: We reviewed a prospectively compiled database of
findings in patients undergoing preoperative EGD in their
workup for GB surgery. We have been performing routine EGD
for over two years with routine biopsies on these
patients. Data collected included, age, body mass index, clinical
findings, pathological findings, and presence of H. pylori
and treatment.
Results: Over a two-year period, 240 patients underwent preoperative
EGD. Only 22 had normal findings and thus, no biopsy
was performed. A total of 451 abnormal findings were
noted on clinical exam. They included findings such as gastritis,
esophagitis, and hiatal hernias. Pathology results in those
that were biopsied showed abnormalities in 206 specimens.
Gastritis was most often noted clinically in 189 patients (79%
of all the EGD?s). Pathological evaluation of biopsies revealed
gastritis in 120 patients(63%). Reflux esophagitis was found on
EGD in 107 patients(45%). However, on pathological evalution,
74 of those 107 patients (69%) had some grade of esophagitis.
Interestingly, 7 of the patients with esophagitis were thought
to have Barrett?s metaplasia and pathologically it was found in
10 of 218 (4.5%) patients biopsied. These patients had previously
undiagnosed disease. One patient had severe high-grade
dysplasia. Hiatal hernias were seen in 31% of patients. Other
findings included gastric polyps, duodenitis, ulcerations,
Schatzki?s rings and gastroesophageal strictures. Most
patients were tested for H. pylori, which was seen in 18% of
those biopsied for the bacteria.
Discussion: The distal remnant created with GB surgery leaves
a potential diagnostic challenge for the bariatric surgeon.
Based on these results, EGD prior
to surgical isolation of this remnant is warranted to rule out
pathology that may become a source for problems in the
future. In addition, our findings led to medical treatment in a
significant number of patients and will help improve our surveillance
of those patients with Barrett?s esophagus.
P295–Flexible Diagnostic &
Therapeutic Endoscopy
INTERFACE OF ENDOSCOPY X ADJUSTABLE GASTRIC BAND
(AGB). 356 ENDOSCOPIES IN 1111 BANDS, Manoel P Galvao
Neto MD, Almino C Ramos MD,Manoela S Galvao MD,Andrey
Carlo MD,Edwin Canseco MD,Thiago Secchi MD, Gastro
Obeso Center ? São Paulo ? Brazil
BACKGROUND: The Adjustable Gastric Band (AGB) is one of
the approved options in terms of bariatric surgery witch is less
invasive with lower mortality rates, but the reports inform
more complications and re-operation rates that the so-called
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SAGES 2005
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