2005 SAGES Abstracts

POSTER ABSTRACTS
allows identification and treatment of occult endoscopic
pathology prior to gastric bypass.
P032–Bariatric Surgery
ACUTE RENAL FAILURE ASSOCIATED WITH LAPAROSCOPIC
GASTRIC BYPASS SURGERY, Melissa M Schnell MD, Reena
Bhargava MD, Calvin A Selwyn MD,Keith S Gersin MD,
University of Cincinnati
Hospital acquired acute renal failure (ARF) increases the risk of
morbidity and mortality. Roux-en-Y laparoscopic gastric
bypass is a common surgical treatment for morbid obesity.
Comorbid conditions such as heart disease, hypertension, and
diabetes increases the risk of post-operative ARF in these
patients. Treatment of comorbidities with agents that impair
renal autoregulatory responses can potentially exacerbate
peri-operative ARF.
We present a case series of five laparoscopic gastric bypass
surgery patients who experienced post-operative ARF between
November 2003 and May 2004. Our hospital performs approximately
500 laparoscopic gastric bypasses per year. There was
one male and four female patients with body mass index
between 45-73. The baseline serum creatinine ranged from
0.6mg/dl to 1.2mg/dl. None of these patients received other
nephrotoxic agents. Anaesthetic records did not show any evidence
of intra-operative hypotension. The magnitude of
increase in serum creatinine by post-operative day two ranged
from 60% to 350% above baseline. Of the five patients, four
were on either an angiotensin converting enzyme (ACE)
inhibitor or angiotensin receptor blocker (ARB) and a diuretic
preoperatively. Three patients were also taking a COX-II
inhibitor. These patients were instructed to take a clear liquid
diet 24 hours prior to surgery and the standard overnight fast
and continued scheduled medications. All five patients
resolved their ARF and no other patients undergoing laparoscopic
Roux-en-Y gastric bypass had ARF.
Peri-operative volume depletion, insensible fluid loss, and the
hemodynamic effects of laparoscopic surgery may create a
setting for the development of ischemic renal injury. This risk
can be exacerbated by use of ACE inhibitors or an ARB in
combination with prostaglandin inhibitors and diuretics by
impairing renal autoregulation and blunting the sympathetic
nervous system response to volume depletion. In patients
undergoing elective bypass surgery, it may be prudent to discontinue
such medications 48-72 hours prior to surgery to
minimize the risk of post-operative ARF. Further studies are
necessary to evaluate the appropriate period for discontinuation
of these medications prior to laparoscopic Roux-en-Y gastric
bypass.
P033–Bariatric Surgery
THE UTILITY OF ESOPHAGOGASTRODUODENOSCOPY PRIOR
TO LAPAROSCOPIC ROUX EN Y GASTRIC BYPASS SURGERY,
D Camacho MD, D J Reichenbach MD,C Badgwell BA,W Fisher
MD,J F Sweeney MD, Michael E. DeBakey Department of
Surgery, Baylor College of Medicine
PURPOSE: The need for routine esophagogastroduodenoscopy
(EGD) prior to laparoscopic gastric bypass surgery
(LGBS) remains controversial. The current study was undertaken
to determine the prevalence of upper gastrointestinal disease
(UGD) in morbidly obese patients prior to LGBS. METH-
ODS: 51 patients (43 female, 8 male) with a mean age of 44
years and a mean BMI of 46.7 kg/m2 underwent LGBS for morbid
obesity. All patients underwent pre-operative EGD. A retrospective
chart review was conducted to document the presence
of UGD symptoms or known UGD prior to surgery. Preoperative
EGD interpretations and biopsy results were
reviewed to document the presence of UGD prior to LGBS.
Pre-operative findings where compared to pathology reports
from gastric tissue collected at the time of surgery. RESULTS:
Thirty-three of 51 (64.7%) patients reported symptoms of UGD
prior to surgery. Of the 33 symptomatic patients, 28 (84.8%)
had positive findings on EGD and were placed on acid suppressive
medications. Eighteen of 51 (36%) patients reported
no symptoms of UGD prior to surgery, of which 11 (61.1%)
had UGD on EGD. Out of all 51 patients screened, 39 (76.4%)
showed positive endoscopic findings at the time of pre-operative
EGD. Of the 39 patients with evidence of UGD, chronic
gastritis was present in 10 (25.6%) patients, active gastritis was
present in 13 (33.3%) patients, and esophagitis was present in
17 (43.5%) patients. One patient (2.6%) had chronic gastritis
and esophagitis. Three patients (7.6%) had both active gastritis
and esophagitis. Pre-operative biopsy revealed H. pylori in 5
(12.8%) patients, one of whom also had non-dysplastic
Barrett?s. All patients with H. pylori were treated prior to
LGBS. Seven (13.7%) of the operative biopsies showed evidence
of chronic gastritis; none demonstrated active gastritis
or H. pylori. CONCLUSIONS: In light of the significant amount
of gastrointestinal pathology observed prior to surgery in
symptomatic and asymptomatic patients, upper endoscopy
with biopsy should be considered integral in the pre-operative
evaluation of candidates for gastric bypass surgery.
P034–Bariatric Surgery
LAPAROSCOPIC REVISIONS OF ROUX-EN-Y GASTRIC
BYPASS, Federico Ceppa MD, Daniel Gagné MD,Pavlos
Papasavas MD,Philip Caushaj MD, The Western Pennsylvania
Hospital, Temple University Medical School Clinical Campus
Introduction: We investigated whether laparoscopic revisional
surgery following failed Roux-en-Y gastric bypass (RYGBP) is
safe and effective in achieving further weight loss.
Methods: Retrospective chart review of all patients undergoing
revisional surgery following failed RYGBP. Failed RYGBP was
determined by