2005 SAGES Abstracts

POSTER ABSTRACTS
Laparoscopic gastric bypass procedure requires anastomosis
of the bowel or closure of the mesentery, requiring stitching.
Stitching itself is a complicated maneuver. A primary requirement
of stitching is knot tying. Laparoscopic procedures are
two dimentional in their view. Two-dimensional procedures
make knot tying a daunting task. If the knots are not tied
securely and adequately, an anastomotic leak would then be a
natural consequence. It is because of this dreaded complication
that we looked at an alternative to knot tying. The main
focus of this study was to look for an easy alternative to suturing.
To accomplish this we used a device called Lapra-Ty
(Eithicon-Endosurgery).
Lapra-Ty is an absorbable device that once snapped/locked
around a suture, it stays in place. There is little to no slippage.
The dissolution time is longer than six weeks; therefore, it
allows the completion of the anastomosis healing. A common
fear is that if it dissolves early the anastomosis would leak.
Another complication would be internal hernia.
Lapra-Ty was used in 300 consecutive laparoscopic gastric
bypass cases. Both anastomotic suture, as well as suturing
the entire mesenteric defect was done with the use of Lapra-
Ty. The suturing material was used as absorbable or nonabsorbable.
Suturing was done with the running lock style.
All 300 cases were then carefully followed for any sign or
symptom of complication. The follow up on these 300 cases
has been 3 months to 3 years. No untoward complications,
secondary to the use of Lapra-Ty were noted.
Conclusion: This study’s results validate that the use of Lapra-
Ty obviates the complicated knot-tying maneuver and at the
same time presents no increased complications related to the
Lapra-Ty.
P040–Bariatric Surgery
INTERNAL HERNIAS ARE MUCH MORE COMMON AFTER PER-
FORMING LAPAROSCOPIC GASTRIC BYPASS SURGERY
WHEN THE ANTECOLIC ROUX LIMB IS ORIENTED TO THE
LEFT COMPARED TO THE RIGHT., Ramsey M Dallal MD, Brian
B Quebbemann MD, The N.E.W. Program of Orange County,
California
Background: The antecolic Roux en Y technique has been
developed to eliminate the incidence of herniation of bowel
through the transverse mesocolon. Herniations through
Peterson’s defect or through the jejunojejunostomy mesentery
defect are still possible .
Hypothesis: Internal hernias underneath the roux limb mesentery
(Peterson’s space) occur more frequently when the roux
limb is oriented such that the cut end is toward the lesser
curve of the pouch and the bowel curves to the patient’s left
(Figure 1) compared with the opposite orientation (Figure 2).
Methods: A retrospective chart review was performed. A
change in surgical technique occurred June 2003 in attempt to
reduce internal hernia formation. We examined the 200 consecutive
antecolic, left-oriented-Roux gastric bypass procedures
performed immediately previous to June 2003 (group A)
and compared them with 200 consecutive antecolic, right-oriented-Roux
gastric bypass procedures performed after June
2003 (group B).Results: The average length of follow-up was
2.4 and 1.5 years in Groups A and B, respectively. Thirteen
internal hernias were identified. There was a 6.0 percent rate
of internal hernia formation in Group A and a zero rate of
internal hernia formation in group B. Internal hernias were
repaired an average of 12±4 months after surgery (range
4-19 months). The difference in hernia rate was statistically
significant with p<0.05.Conclusions: With a simple change in
technique, the incidence of internal herniation underneath the
Roux limb mesentery may be significantly reduced or eliminated.
P041–Bariatric Surgery
EVOLUTION OF SURGERY FOR MORBID OBESITY: FROM
OPEN TO LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS,
Damani T, MD, Fogato L, MD, Tedesco P, MD, Gorodner MV,
MD,Galvani C, MD, Ostroff JW, MD, Bagatelos KC, RN, Lobo E,
MD, Posselt A,MD, Rogers S, MD, and Patti MG, MD,
Department of Surgery, Medicine and Anesthesia, University
of California, San Francisco
Objective of the study: We hypothesized that: a) in an established
Bariatric Center, the change from open Roux-en-Y gastric
bypass (O-RYGB) to laparoscopic Roux-en-Y gastric bypass
(L-RYGB) is feasible and is not associated with an increased
complication rate;b) L-RYGB is as effective as O-RYGB in
weight loss and resolution of comorbid conditions.
Methods and procedures: Retrospective study in an academic
tertiary care center.
Between December 1998 and May 2004, 432 patients (median
age 41 years, 377 women / 55 men) who met NIH criteria for
bariatric surgery underwent RYGB. The median preoperative
body mass index (BMI) was 48 kg/m2. Follow-up was 12 ± 8
months in 272 patients (63%).
Main outcome measures were length of hospitalization, postoperative
complications,
change in BMI, change in co morbid conditions.
Results: Results are expressed as median value and P value