2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
with a VG band for symptomatic dysphagia with a normal
radiologic and endoscopic evaluation, 1 band replacement for
erosion (0.3%), and 12 port replacement or revisions (3.7%).
Overall reoperation rate was 10.4%, and 2.7% of patients have
had their bands removed. Weight loss, expressed as percent
excess BMI lost, was 19% at 3 months, 32% at 6 months, 44%
at one year, 50% at 18 months, and 61% at 2 years.
Conclusions: Laparoscopic adjustable gastric banding with the
Lap-Band® system produces excellent weight loss with low
major morbidity.
P043–Bariatric Surgery
HOW MUCH OF THE WEIGHT LOSS AFTER LAPAROSCOPIC
GASTRIC BYPASS SURGERY IS FAT?, D Farkas MD, S Laker
MD,V Iannace MD,A Wasielewski RN,D Ewing MD,A Trivedi
MD,H Schmidt MD,G Ballantyne MD, Hackensack University
Medical Center
Introduction: The objective of this study was to determine the
changes in body composition after gastric bypass surgery.
There is an abundance of data regarding overall weight loss
after surgery. However, little is known about the composition
of this weight loss. How much of this weight loss is made up
of fat?
Methods: 100 consecutive patients undergoing laparoscopic
gastric bypass surgery were examined. Body composition was
analyzed using a bipedal bioelectrical impedance analyzer
(TBF-310, Tanita, Tokyo, Japan). Measurements were obtained
prior to surgery as well as postoperatively, at regularly scheduled
followup visits.
Results: Median excess body weight loss after surgery was
69% after one year. In actual weight, the median weight loss
was 96 pounds. This consisted of 77 pounds of fat mass lost,
and 19 pounds of lean body mass lost. Fat loss made up a
median of 79% of the total weight loss for each patient. Body
fat percentage decreased from 51% to 34%. The following
table shows the changes over time.
Conclusion: In addition to losing weight after laparoscopic gastric
bypass surgery, patients also significantly lower their percentage
of body fat. Fat mass loss accounts for a major portion
of the total weight loss, while lean body mass lost only
accounts for a small portion. These results are helpful in
understanding the many health benefits seen after gastric
bypass surgery.
P044–Bariatric Surgery
PATIENTS 12 MONTHS AFTER LAPAROSCOPIC GASTRIC
BYPASS HAVE BODY COMPOSITIONS SIMILAR TO CON-
TROLS., D Farkas MD, S Laker MD,V Iannace MD,A
Wasielewski RN,D Ewing MD,A Trivedi MD,H Schmidt MD,G
Ballantyne MD, Hackensack University Medical Center
Introduction: After gastric bypass surgery patients undergo
changes in their body composition. The objective of this study
was to compare the body composition of patients having
undergone gastric bypass surgery, with the body composition
of control patients not undergoing this surgery.
Methods: 100 consecutive patients undergoing laparoscopic
gastric bypass surgery were examined. Body composition was
measured using a bipedal bioelectrical impedance analyzer.
Measurements were obtained prior to surgery and at followup
visits postoperatively. These measurements were compared
with 100 patients seen in consultation for non-bariatric surgery.
The relationship between BMI and body fat percentage
was compared between the different groups using the heterogeneity
of regression test.
Results: Prior to gastric bypass, patients in the study group
had a median BMI of 47 and 51% body fat. By 12 months postoperatively
this group had a median BMI of 29 and 32% body
fat. The control group had a median BMI of 28 and 34% body
fat. Regression analysis demonstrated that while the preoperative
bariatric patients were different from the other two
groups, postoperatively they were similar to the control
patients.
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Conclusion: Patients undergo significant body composition
changes following laparoscopic gastric bypass surgery. By 12
months postoperatively these patients not only have similar
BMI’s as the non-bariatric controls, they have similar
body composition as well. This implies that the body composition
abnormalities seen in morbidly obese patients are corrected
by gastric bypass surgery.
P045–Bariatric Surgery
DRAINS AND TESTING DURING LRYGB: DOGMA OR NECES-
SITY?, Edward L Felix MD, Daniel E Swartz MD,Richard Hwang
MD, Advanced Bariatric Center of Fresno
Background: Are prophylactic drains, intra-operative testing &
postoperative contrast studies mandatory when performing
laparoscopic Roux-en-Y Gastric Bypass (LRYGB)? The purpose
of this study was to determine if laparoscopic gastric bypass
can be performed safely without employing such measures.
Methods: We retrospectively reviewed the records of all
patients undergoing laparoscopic roux-en-y gastric bypass at
our center between 4/99 and 7/04. The gastrojejunostomy was
laparoscopically hand sewn in 2 layers and the pouches were
constructed using a 3.5 mm endo-stapler. Routine intra-operative
leak tests, drains and post-operative contrast studies were
not used. Intra-operative leak studies with air were performed
in only suspicious cases selected by the operating surgeon.
Results: In 2369 patients, 7 developed a postoperative pouch
leak; 0.2% (5/2297) of LRYGB and 3% (2/72) of patients converted
to an open RYGB. No leaks occurred post-operatively in the
last 800 patients, including 3 patients that required conversion
because of an air leak on selective testing. Because of symptoms,
5 patients had post-operative radiological studies, but all
were interpreted as negative. In all patients the leak was confirmed
by laparoscopy and in 5 an open exploration was
required to manage the leak. No patients died as a result of a
leak, but 3 had prolonged hospitalizations that were greater
than 2 weeks. Long term follow-up of all 7 patients that developed
a leak from the pouch has been uneventful.
Conclusion: Despite not using routine drains, intra-operative or
post-operative testing, leaks after laparoscopic roux-en-y gastric
bypass using our technique were rare and safely managed
when they occurred. The risk of a leak, however, increased if
the patient required conversion to an open bypass. Intra-operative
testing was found to be beneficial when used in suspicious
cases. If a leak was suspected postoperatively, immediate
laparoscopic surgical intervention and open exploration
when necessary successfully managed all patients. The routine
use of contrast studies and drains can be avoided when performing
laparoscopic gastric bypass potentially reducing confusion,
cost, and morbidity associated with these measures
without jeopardizing the safety of the procedure.
P046–Bariatric Surgery
UNEXPECTED PATHOLOGY IN LAPAROSCOPIC BARIATRIC
SURGERY, Christopher W Finnell MD, Atul K Madan MD,Craig
A Ternovits MD,Suraj J Menachery MD,David S Tichansky MD,
University of Tennessee, Memphis
Background: The popularity of bariatric surgery in recent years
has increased with the escalating incidence of morbid obesity
in our society. The improvement in minimally invasive technology
and increased number of laparoscopic bariatric procedures
being performed has resulted in the discovery of unexpected
pathology that was not suspected preoperatively. We
hypothesized that the occurrence of unexpected pathology is
not associated with immediate adverse outcomes during
laparoscopic bariatric procedures.
Methods: From December 2002 to June 2004, 398 patients
underwent laparoscopic bariatric surgery for morbid obesity. A
retrospective chart review was performed to determine the
incidence of unexpected findings and their effect on patient
results.