2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
RESULTS: Between October 2001 through June 2004, 106
patients underwent LAGB at our institution. There were 81
women and 25 men with an average age of 45 years (range
26-76 years) and an average body mass index (BMI) of 45
kg/m2 (range 34-64 kg/m2). Of the 106 patients, 39 (37%) suffered
from hypertension and 26 (25%) suffered from diabetes
preoperatively. Hypertension resolved in 12% (3 of 25) and diabetes
resolved in 45% (9 of 20) of patients with a follow up of
at least six months. There were no incidences of newly developed
diabetes or hypertension in the postoperative period.
CONCLUSION: : In this study we present data showing resolution
of hypertension and diabetes with a follow up of at least
six months postoperatively. Laparoscopic adjustable gastric
banding appears to be an effective bariatric procedure leading
to the reduction of serious co-morbidities. These results compare
favorably to those outside the United States.
P058–Bariatric Surgery
DOES THE SF-36 PREDICT POST-OPERATIVE WEIGHT LOSS?,
Gloria P Hsu BS, John M Morton MD,Li Jin BS,Bassem S
Safadi MD,Myriam J Curet MD, Department of Surgery,
Stanford University School of Medicine
Objective: Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is
an effective treatment option for obesity that carries inherent
risks. As a result, efforts have been made to distinguish which
patients may benefit the most from LRYGB. The SF-36 is a
well-validated and easily administered quality of life survey.
We hypothesized that the SF-36 would predict post-operative
weight loss in LRYGB.
Methods: Pre-operative SF-36 surveys were administered and
demographic, intra-operative, and weight data were collected
(n=44). Multiple regression analysis was performed for percent
of post-operative excess weight loss and BMI loss while controlling
for confounding variables. P-values were considered
significant at p < 0.05.
Results: The total SF-36 score was positively predictive of percent
excessive weight loss at 6 months. At 2 weeks, the general
health score was positively predictive of BMI loss while both
emotional well-being and social functioning scores were negatively
predictive of percent excessive weight loss. At 6 weeks,
social functioning score was negatively predictive while the
energy level score was positively predictive of BMI loss.
Ultimately, only the preoperative BMI was predictive of both
6mth and 1yr BMI losses.
Conclusions: The SF-36 score may be useful for predicting
post-operative weight loss in LRYGB. Individual scores were
more useful for predicting weight loss earlier post-op, with the
total score having a positive predictive result at 6 months.
Further investigation will incorporate more patients, and
attempt to determine additional correlations as well as a
threshold score at which these correlations take effect.
P059–Bariatric Surgery
INFECTION RATES USING WOUND PROTECTORS IN LAPARO-
SCOPIC GASTRIC BYPASS, Albert Im MD, Keith Zuccala
MD,Pierre Saldinger MD, Danbury Hospital
There is an increase wound infection rate associated with
being morbidly obese. The increase incidence of wound infections
is multifactorial including decrease oxygen tension due
to the thickness of the abdominal wall to contamination of the
wound from enteric contents. The use of laparoscopic techniques
has decreased the incidence of wound infections from
15 to 5%. At our institution we have tried to document the
change in wound infection rate with using a wound protector(Alexis
wound retractor - Applied Medical ref:c8301 2.5-6
cm) at the left lower quadrant incision. This is the largest port
site where we remove tissue that results from the gastrotomy
and enterotomy closure. Additionally, we also use this site to
introduce the EEA when we are creating the gastrojejunostomy
anastomosis. Thus at no time is the subcutaneous tissue in
contact with enteric contents and we feel there is less tissue
trauma. To prevent leakage of CO2 after we have extended the
incision to introduce the wound protector, we use a ballontipped
trocar to keep an airtight seal. We have noticed a
decrease in the incidences of wound infection after using the
wound protector at our trocar site.
140 http://www.sages.org/
P060–Bariatric Surgery
LIVER DISEASE IN OBESE PATIENTS ? IS IT THE HEP C OF
NEXT DECADE?, Ashutosh Kaul MD, Karl Strom MD,Joanne
Weiskopf,Edward Yatco MD,Xun Li MD,Gita Ramaswamy
MD,Thomas Cerabona MD, New York Medical College. New
York
Aim of this presentation is to highlight the increasing prevalence
of liver disease in obese population. In a prospective
study of 184 patients undergoing laparoscopic bariatric surgery
liver biopsy was done. Their BMI ranged from 37 to 70
(mean 50.1) and age from 23 to 67 years (mean42.7 years. Of
these 147 were females and 37 male patients.
Pathologic evidence of NASH (Non-Alcoholic Steatohepatitis)
was found in 67 patients. Of these 15 had low grade (1 +2)
steatosis and 52 had high grade (3+4) steatosis. Low grade
inflammation (1 +2) was present in 65 cases and high grade
(3+4) in 2 cases. In our series we found NASH with fibrosis in
19 cases but 48 of the patients had NASH with fibrosis. Thus
36.4% of all patients undergoing bariatric surgery had NASH.
In our presentation we plan to highlight the significant correlation
we found with pre-op Body Mass index, duration of obesity,
diabetic and medication status. The high prevalence of
NASH is a cause of concern. If by conservative estimates
about 30 million Americans are morbidly obese and our data
is representative of the national disease burden then over 10
million Americans presently are at risk of NASH. We plan to
discuss the risk of developing liver failure based on published
literature in patients with NASH. In view of these statistics
NASH and resulting liver failure may be a major health problem
in US in the coming decade. There have been recent
reports to suggest improvement in liver biopsy findings after
weight reduction. If so then Bariatric surgery may be one of
the strategies which should be emphasized for potential to
limit this epidemic in the coming decade.
In 8 cases we took repeat biopsies during reexploration for
other causes. Our data on change in liver biopsy findings is
too small to make any broad generalizations.
Thus we plan to highlight the high incidence of NASH in our
patient population despite minimal liver function tests abnormalities.
We did find significant direct co relationship with
patient?s diabetic status and duration of obesity. We feel that
this may be the tip of the iceberg and in the coming decades
Obesity related liver disease may be a major health problem
with significant financial burden on the nations health
resources. Attempts to loose weight may thus be important to
prevent long-term liver failure. If there is also co relationship
with duration of obesity then it becomes paramount for all
health care personals and HMOs to encourage early weight
loss.
P061–Bariatric Surgery
RADIOLOGICAL FINDINGS IN INTERNAL HERNIAS IN
PATIENTS OF LAPAROSCOPIC GASTRIC BYPASS?, Ashutosh
Kaul MD, Glorimer Atiles MD,Frank Nami MD,Edward Yatco
MD,Thomas Cerabona MD, New York Medical College. New
York
Aim of this presentation is to critically analyze our findings of
internal hernias in laparoscopic Gastric bypass. At our center
we bring our roux loop in laparoscopic gastric bypasses in a
retro colic and retro gastric fashion. Despite stitching the
defect we still have had 16 cases of internal hernias over the
last 3 years. Aim of this presentation is to highlight the presentation
of these patients and to clinically analyze the radiologic
findings in these cases. CT scans were done in 14 of these
cases and in only one of them was the finding of internal hernia
entertained by the radiologic service. Certain findings were
noted on retrospective analysis of these patients and they
included small bowel massing on left side, caecum displaced
towards the midline, delayed/non filling of distal small bowel,
thickened proximal small bowel, presence of air in the biliarypancreatic
limb of small bowel. All except one were repaired
laparoscopically and patients stayed a mean of 2 days post
operatively in the hospital. Two of the patients were rehospitalized
subsequently for abdominal pain.
In conclusion we aim to present our clinical and radiologic
findings in patients presenting with internal hernias after