2005 SAGES Abstracts

POSTER ABSTRACTS
P054–Bariatric Surgery
LESSONS LEARNED IN ESTABLISHING A SUCCESSFUL
BARIATRIC PROGRAM IN A NON-TEACHING COMMUNITY
HOSPITAL., Ajay Goyal MD, James M Houston, PAC,Charles
Tollinche MD, Department of Surgery, St. Mary Hospital,
Hoboken, NJ
Background: The aim of this paper is to document obstacles
involved in establishing a successful bariatric practice at a
non-teaching community hospital by a laparoscopic fellowship
trained surgeon (AG). Methods: From 3/03 to 6/04, 100
bariatric cases (75% LGB & 25% LB) were prospectively analyzed.
Patients were interviewed and filled out questionnaires
to evaluate improvements in co-morbid conditions.
Complications and excess weight loss were compared with literature.
Results: There were 88 women and 12 men with mean
age of 38.5 (range 21 to 70). Mean preoperative BMI and
weight were 135.5 kg and 48.9 kg/m2 (range 36 to 87). Overall
mean hospital stay was 2.7 days with 2.0 days for LB and 3
days for LGB. Percent excess weight loss (EWL) at 3, 6 and 12
months was 25.6%, 46.4% and 60% respectively with greater
than 80% follow-up. 3 pts had early complications: 2 pts had
distal SBO due to a kink distal to J-J anastomosis requiring
surgical revision, and 1 pt had wound infection at one trocar
site. 8 pts presented with late complications: 3 pts had partial
SBO (1 required surgical correction due to SB herniation
through transverse colon mesentery and 2 were treated conservatively),
3 had gastrojejunostomy stricture (endoscopic
balloon dilatation), and 2 patients required lap chole. There
was zero open conversion, anastomotic leak and mortality rate
in this series. Improvements in co-morbid conditions included
HTN (30% resolved/96% improved), NIDDM (50%/100%), GERD
(50%/100%), hypercholesterolemia (60%/90%), medications
(7%/98%), joint pain (10%/90%) and sleep apnea (47%/100%).
Overall, 75% had complete resolution and 100% of the patients
had significant improvements in their co-morbid conditions.
Conclusions: With laparoscopic fellowship training, LGP and
LB can be performed safely with comparable benefits and
complication rate at a non-teaching community hospital without
significant costly outside resources. Program set-up time is
approximately 6 months prior to 1st case and continues 6
months after with on-the-job training of hospital OR staff. In
addition, tapping into current resources available at the hospital
reduces start-up cost for the program. A successful practice
is the result of significant time and long-term commitment
from both the surgeon and the hospital.
P055–Bariatric Surgery
THE ROLE OF DIAGNOSTIC LAPAROSCOPY IN THE DIAGNO-
SIS AND MANAGEMENT OF THE POST-OPERATIVE COMPLI-
CATIONS OF GASTRIC BYPASS PATIENTS, Larry F Griffith MD,
Glenn J Forrester MD,Babak Moeinolmolki MD,Pratibha
Vemulapalli MD,Karen E Gibbs MD,Julio Teixeira MD,
Montefiore Medical center and Albert Einstein College of
Medicine, Bronx, NY
INTRODUCTION Roux-en-y gastric bypass is now the most frequently
performed surgical procedure for the treatment of
morbid obesity in the US. The number of these procedures is
increasing exponentially. Post-operative abdominal pain in
these patients presents a difficult diagnostic challenge.
Currently there is no consensus on the best diagnostic modality
to assess this subgroup. The objective of this study is to
determine the value of the CAT scan versus Diagnostic
Laparoscopy (DL) in this patient population.
METHODS A retrospective analysis was performed on 32 diagnostic
laparoscopy cases between January 1, 2001 and
September 1, 2004. All had a history of Roux-en-y gastric
bypass. Of them, 26 were also evaluated by CAT scanning during
the initial work-up. We report the efficacy of DL and compare
intra-operative findings with the CAT scan results.
RESULTS The CAT scan was positive in 59% of patients.
Overall the CAT scan had a false positive rate of 50% and false
negative rate of 35% based on operative findings. There was
correlation between the two modalities in 14% of cases. The
DL found a cause for pain in 38% of cases. The most common
findings in the two groups were internal hernias and small
bowel obstruction.
CONCLUSIONS The CAT scan was less accurate than DL especially
when evaluating internal hernias. DL allowed therapy in
addition to diagnosis and is a more useful modality in evaluating
this patient subgroup.
P056–Bariatric Surgery
JEJUNOJEJUNAL ANASTOMOTIC OBSTRUCTION FOLLOW-
ING LAPAROSCOPIC ROUX-Y GASTRIC BYPASS DUE TO
NON-ABSORBABLE SUTURE: A REPORT OF SEVEN CASES,
Andrew A Gumbs MD, Rohit Chadwani MD,Andrew J Duffy
MD,Robert Bell MD, Yale University School of Medicine,
Department of Surgery, New Haven, CT, 06520
Introduction: Small bowel obstruction is a well-known complication
of laparoscopic Roux-Y gastric bypass (LGBP). We
describe seven cases of jejunojejunal anastomotic obstruction
related to adhesion formation, a cause of SBO previously
described in the literature, more commonly in association with
open gastric bypass.
Methods: All patients undergoing LGBP from October 2002
until June 2004 were entered into a prospective, longitudinal
database. All patients who subsequently presented with small
bowel obstruction were analyzed.
Results: Jejunojejunal anastomotic obstruction occurred in
seven out of 152 patients (4.6%) on whom LGBP was performed
from October 2002 to February 2004. Since February
2004, suture used to close the jejunojejunal mesenteric
?leaves? defect was changed from non-absorbable Dacron
(Surgidac?) to absorbable suture material. Of the 76 patients
who have since undergone LGBP, none have presented with
small bowel obstruction. These seven patients ranged in age
from 23 to 53 years, with preoperative BMI ranging from 41 to
90, which was similar to the other patients. Six patients were
female and 1 was male. For each patient, the initial LGBP operation
was uncomplicated, without anastomotic leak, prolonged
operative time, or conversion to open operation. All presented
with nausea and vomiting and four of the seven patients also
reported abdominal pain. The mean interval between initial
LGBP and subsequent SBO was 153 days. Following initial history
and physical examination for each patient, the diagnosis
of small bowel obstruction was confirmed via imaging, either
by abdominal x-ray (3/7), small bowel follow-through (1/7), or
CT scan (3/7). Operative findings common to all seven cases
were dilated loops of proximal small bowel, and a single adhesion
just distal to the Roux-Y anastomosis. Following adhesiolysis,
each patient had prompt return of bowel function without
recurrence of obstruction.
Conclusions: This paper describes seven cases of SBO occurring
after laparoscopic Roux-Y gastric bypass. The rate of SBO
(4.6%) is consistent with the previous literature, though the
incidence of adhesions specifically at the jejunojejunal anastomosis
is higher than that previously encountered. It appears
that the incidence of postoperative SBO at the jejunojegunal
anastomosis is directly linked to the choice of suture intraoperatively.
As such, absorbable suture should be used to close the
jejunojejunal mesenteric leaves defect.
P057–Bariatric Surgery
RESOLUTION OF HYPERTENSION AND DIABETES FOLLOW-
ING LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING., Liam
A Haveran DO, Patrick McEnaney MD,Andras Sandor
MD,Donald R Czerniach MD,Rich A Perugini MD,Demetrius E
Litwin MD,John J Kelly MD, Department of Surgery, UMASS
Memorial Health Care Center
Laparoscopic Adjustable Gastric Banding (LAGB) is the most
common bariatric operation worldwide. It results in a nearly
50% reduction in excess body weight at 1 year. However, the
effects of LAGB on the resolution of medical co-morbidities
are less established. We evaluated our experience with resolution
of hypertension and diabetes in patients after LAGB.
METHODS: We retrospectively analyzed data that was collected
on consecutive morbidly obese patients who underwent
LAGB. Patient demographics, medical co-morbidities, preoperative
body mass index (BMI), and postoperative (>6 months)
resolution of hypertension and diabetes were analyzed.
Resolution of co-morbidities was defined by the absence of
anti-hypertensive or diabetic medications in the follow up period.
http://www.sages.org/
SAGES 2005
139