2005 SAGES Abstracts

POSTER ABSTRACTS
Results: A total of 9 unexpected pathologic lesions were found
in 8 (2%) patients. The findings include lesions on the small
bowel (3), stomach (4), and liver (2). In all except one case
(which was biopsied), the abnormal findings were found and
removed laparoscopically. The final pathology revealed: gastric
leiomyomas (2), gastric gastrointestinal stromal cell
tumors (2) ectopic pancreatic tissue (2), arteriovenous malformation
(1), biliary adenoma (1) and fibrosed hemangioma (1).
All patients underwent completion of their planned bariatric
procedures without incident, had no complications postoperatively,
and were discharged in 1-3 (mean = 2) days.
Conclusions: Unexpected findings occur relatively frequently
during laparoscopic bariatric procedures. Biopsy and/or
removal of these lesions does not increase complications nor
preclude continuation of the planned bariatric procedure.
P047–Bariatric Surgery
ETHNICITY AND WEIGHT LOSS FOLLOWING LAPAROSCOPIC
ROUX-EN-Y GASTRIC BYPASS, Glenn J Forrester MD, Karen E
Gibbs MD,Larry Griffith MD,Babak Moeinolmolki MD,Pratibha
Vemulapalli MD,Julio Teixeira MD, Montefiore Medical Center
and Albert Einstein College of Medicine, Bronx, NY
INTRODUCTION Several studies have attempted to predict
weight loss outcomes based on various preoperative criteria;
however, few have focused on ethnic background. The purpose
of this study was to compare the outcomes of patients
based on ethnicity following laparoscopic Roux-en-Y gastric
bypass (LRYGBP) for the treatment of morbid obesity.
METHODS A retrospective analysis was conducted on all
patients who underwent LRYGBP between April 2001 and
August 2004. Patients were classified into four ethnic groups;
Black (B), Hispanic (H), White (W) and Other (O). Patients were
compared for percent excess weight loss (%EWL) at the 6- and
12-month postoperative visits. Statistical analysis was performed
using ANOVA.
RESULTS Of the total patients studied, 86.7% were women
and 13.3% were men, ranging from 18 to 65 years of age.
Preoperative BMI ranged from 39 to 96 (mean 54). Six-month
%EWL ranged from 26 to 88 (mean 49) and twelve-month
%EWL ranged from 33 to 107 (mean 63) with the individual
groups shown in the table below. Difference in %EWL at 6
months reached statistical significance (p=0.033) while at 12
months was not significant (p=0.224).
CONCLUSIONS Short-term results suggest that ethnicity may
initially influence weight-loss following LRYGBP; however,
subsequent follow-up does not support these differences.
Longer-term follow-up data are necessary to validate these
preliminary results.
P048–Bariatric Surgery
SIMPLIFIED GASTRIC BYPASS APPROACH TO MORBID OBESI-
TY ? 1000 INITIAL CASES, Almino C Ramos MD, Manoel P
Galvao Neto MD, Manoela S Galvao MD,Andrey Carlo
MD,Edwin Canseco, Gastro Obeso Center ? Sao Paulo, Brazil
BACKGROUND: The gastric bypass is considered the golden
standard in the treatment of morbid obesity. It is considered
one of the most complex procedures in laparoscopy. So, any
maneuver, or approaches who can improve it´s feasibility are
welcome. AIM: Evaluate initial results of Simplified Gastric
Bypass (SGB) approach. CASUISTIC: From December of 2001
to March of 2004, 1000 SGB patients records were analyzed in
a retrospective manner, 651 were female , age range from 13 a
65y (M= 38,5y), weight range from 85 a 220 Kg (M= 137 Kg)
and BMI were between 36 a 68 Kg/m2 (M= 45,8 Kg/m2). The
Simplified technique (to be presented) is based in doing all of
the anastomosis in the supra-mesocolic floor with the trocars
in similar position of lap Nissen procedure. RESULTS: There
was no convertion to laparotomy at this series. BMI came from
a mean of 45,8 to 27,4 Kg/m2 (75,1% EWL). Operative time
stays between 39 to 154 min (M= 70 min), Hospital stay within
1,5 to 6d (M= 3d). Complications occurred in 2% of ulcers,
5,2% of gastrojejunostomy strictures, 1,2% of leakage, 0,7% of
digestive bleeding, 0,3% bowel obstruction. Re-operation was
done in 1,5% and there were 0,5% of deaths (3p with pulmonary
embolism. e 2p with sepsis due to gastrojejunostomy
leakage). CONCLUSION: The Simplified Gastric Bypass proved
to be at it?s initial results; safe, with low operative time and
efficient in reducing patients BMI with low complication and
death rates.
P049–Bariatric Surgery
LAP BARIATRIC SURGERY- A TAILORED APPROACH IN A 2843
SINGLE CENTER PATIENT SERIES, Almino C Ramos MD,
Manoel P Galvao Neto MD, Manoela S Galvao MD,Andrey
Carlo MD,Edwin Canseco, Gastro Obeso Center ? São Paulo ?
Brazil
BACKGROUND: Lap bariatric surgery is quickly taking its place
around the world with the benefits of minimally invasive surgery.
The three main techniques done by lap are the
Adjustable Gastric Band (AGB), Gastric Bypass (GBP) and the
Bilio Pancreatic Diversion (BPD). To choose the best option to
each patient our group tailored the surgical due to patient profile.
AIM: Analyze the results and indication of each technique in
this series. CASUÍSTIC: Between December of 1999 and July of
2004, 2843 patients were submitted to lap bariatric procedures,
being: 1111AGB (Mean 34,5y; 128Kg; 45,2BMI) 1107GPB (Mean
36,5y; 137Kg; 44,7BMI) plus 486 with Fobi-Capella Bypass -
FCB (Mean 37,5y; 129Kg; 46,1BMI) and 139 with BPD (Mean
40y; 162Kg *; 49BMI * ) - (*p>0,005) .
RESULTS: (see table), complementary to table, there was zero
mortality rate on AGB * , 0,43% on GBP, 0,33% on FCB and
1,6% on BPD. (*p > 0,05 ).
2843 TAILORED LAP BARIATRICS - RESULTS
BMI - FINAL COMPLIC RE-OP
AGB 30,1Kg/m2 5,1%* 5,3%*
GBP 27,4Kg/m2 7,7% 1,51%
FCB 28Kg/m2 6,7% 0,66%
BPD 26,8Kg/m2 10,2%* 1,8%
CONCLUSION: Comparing the numbers, goods results with
low complications and mortality rates can be achieved with
different Lap bariatric surgeries in a tailored approach
P050–Bariatric Surgery
SLEEVE GASTRECTOMY VS BIB PLACEMENT IN SEVERE
MORBID OBESITY PATIENTS: PRELIMINARY RESULTS, Alfredo
Genco MD, Luca Musmeci MD,Luigi Raparelli
MD,Massimiliano Cipriano MD,Alessandro Pecchia MD,Nicola
Basso MD, Department of Surgery “P. Stefanini”
Background
Laparoscopic biliopancreatic diversion/duodenal switch (BPD-
DS) is indicated in severe morbid obesity patients. The technique
combines gastric restriction achieved by sleeve gastrectomy
and intestinal malabsorption by BPD-DS.
Due to the high incidence of postoperative complications a
two-stage technique has been proposed: sleeve gastrectomy
first in order to achieve an initial weight loss with reduction of
moribidity and mortality rates and BPD-DS after a 6 -12 month
period.
Preliminary reports on Bioenterics Intragastric Balloon (BIB)
placement have suggested that it can lead to significant
weight loss especially in the short term period.
The aim of this retrospective study was to evaluate the effect
on excess weight and comorbidities of BIB placement (6
months) or sleeve gastrectomy (6 months) in severe obese
patients.
Method
We reviewed our computer database charts of patients treated
at the Department of Surgery ?P. Stefanini? Policlinico
Umberto I, Rome (Italy). From March 1998 to May 2004, 18
patients candidate to BPD-DS and 17 patients candidate to
endoscopic BIB placement were selected on the base of age,
sex and BMI for a matched cohort study. The mean preoperative
weight was 156.8 Kg in the sleeve gastrectomy patients
group and 155.2 Kg in the BIB patients group, with mean BMI
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