2005 SAGES Abstracts

POSTER ABSTRACTS
laparoscopic Gastric Bypass. In view of absence of clear-cut
radiologic findings in these cases even subtle radiologic signs
can be of great importance. It is important for all clinicians taking
care of bariatric patients to understand these subtle signs
and to use them as an aid to their clinical judgment. As the
consequences of missing an internal hernia can be catastrophic
recognition and knowledge of these signs is of great importance.
P062–Bariatric Surgery
LESSONS FROM HISTORY AND NEW YORK STATE: TRENDS
IN OBESITY SURGERY, Ashutosh Kaul MD, Laura Choi
MD,Thomas Sullivan BS,Edward Yatco MD,Thomas Cerabona
MD, New York Medical College. New York
Aim of this presentation is to analyze data from Statewide
Planning And Research Cooperative Systems (SPARCS) that is
a database maintained by New York State. We analyzed the
data by DRG, patient demographics and trends in complications
and mortality. We further analyzed institutions based on
high volume (i.e. > 50 cases per year). According to data the
total number of cases of bariatric surgery in New York State
increased seven fold from about 500 in 1991 to 3500 in 2001.
Though the female to male ratio of patients remained stable to
about 4:1, the average age of patients undergoing bariatric
surgery increased from about 35 years in 1995 to 41 years in
2001. The number of institutions doing Bariatric surgery also
doubled from about 31 in 1995 to 62 in 2001. Interestingly
though the number of high volume institutions remained stable
around 30 to 40, the number of low volume centers has
mushroomed from a low of 2 in 1993 to about 22 in 2001. The
average mortality rate in the state has gone down from a high
of 0.8% in 1998. However, on analyzing the date the average
mortality in high volume centers was 0.4% in comparison to
1.2% in low volume centers. Surgical history has shown from
days of budding cardiac surgery to introduction of laparoscopic
Cholecystectomy that when there is a rapid increase in the
number of a procedure, initially the complication rate increases
more rapidly than the volume of cases. This can be seen in
the mushrooming of low volume centers in New York State
and their higher complication rates. As a surgical society we
have thus to make sure that sharply increasing numbers of
bariatric surgeries do not translate into dramatically increasing
complication rates.
P063–Bariatric Surgery
LAPAROSCOPIC ROUX EN Y GASTRIC BYPASS AFTER THE
AGE OF 60: A SAFE ALTERNATIVE FOR WEIGHT LOSS,
Colleen Kennedy MD, Samuel Szomstein MD,Emmanuele
LoMenzo MD,David Podkameni MD,Alexander Villares
MD,Flavia Soto MD,Raul Rosenthal MD, Cleveland Clinic
Florida
Background: Bariatric surgery has traditionally been limited to
patients between the ages of 18-55. With the advancing age of
our population and the advancement of laparoscopic techniques
for surgery this age limitation needs to be re-evaluated.
We report a series of patients over age 60 who underwent the
Roux-en-Y gastric bypass for treatment of morbid obesity.
Methods: A retrospective review was performed examining
patients over the age of 60 who met the criteria for laparoscopic
gastric bypass and underwent the procedure.
Results: Two surgeons at our institution performed 814 gastric
bypass procedures over 3 years, 25 were performed on
patients greater than 60 years of age. The average age of the
patients undergoing the procedure was 66 (60-75). The average
BMI of the patients was 48 kg/mm2 (35-64). Comorbidities
preoperatively included diabetes mellitus (65%), hypertension
(80 %), sleep apnea (25%), GERD (30%) and depression (60%).
The excess weight loss was 54% at 6 months, 68% at 1 year.
Diabetes resolved in 75% of the patients, hypertension in 35%
and sleep apnea in 80%. The postoperative morbidity rate was
20%, mortality was 0%.
Conclusion: Laparoscopic gastric bypass is a feasible and safe
option for weight loss in patients over the age of 60 with proper
preoperative evaluation and screening. With the prolonged
life span and overall aging of our population, it is becoming
more evident that this population will require a reliable solution
for treatment of morbid obesity.
P064–Bariatric Surgery
MALLORY-WEISS TEAR AFTER LAPAROSCOPIC ROUX-EN-Y
GASTRIC BYPASS, Samuel J Kuykendall BS, Atul K Madan
MD,Craig A Ternovits MD,David S Tichansky MD, University of
Tennessee, Memphis
In the United States, the most common surgical procedure for
morbid obesity is Roux-en-Y gastric bypass. Pulmonary
embolism, leak, bowel obstruction, and gastrointestinal bleed
are some of the early and potentially fatal complications. Early
post-operative bleeding after laparoscopic bypass, although
uncommon, presents a dilemma due to the danger of postoperative
endoscopy and the inability to easily access the gastric
remnant. The usual sites of gastrointestinal hemorrhage
after gastric bypass are at the gastrojejunostomy site, the gastric
pouch, the gastric remnant, or the jejunojejunostomy.
We encountered a case of massive upper gastrointestinal hemorrhage
one week after laparoscopic Roux-en-Y gastric bypass.
She had been discharged on post-operative day three from her
original surgery. After failure of endoscopy and multiple blood
transfusions, the patient was taken to the operating room.
During exploration, the hemorrhage was found to be from a
disrupted blood vessel secondary to a Mallory-Weiss
esophageal tear. Oversewing the vessel resulted in hemostasis.
The patient stabilized after the procedure and was discharged
without any evidence of continued hemorrhage. In
retrospect, both the patient and her family recalled that she
had continual retching at home before her massive hemorrhage.
Mallory-Weiss tears are an uncommon cause of upper gastrointestinal
hemorrhage after laparoscopic gastric bypass.
Bariatric surgeons need to consider this diagnosis especially
when encountering a patient with a history of significant retching
after gastric bypass.
P065–Bariatric Surgery
AMELIORATING THE SHORTCOMINGS OF PERCENTAGE
EXCESS WEIGHT LOSS (EWL): THE ?BARIATRIC SURGERY
SUCCESS RATE? (BSSR) AS A NEW WEIGHT LOSS METRIC
FOLLOWING BARIATRIC SURGERY, Crystine M Lee MD, Janos
Taller MD,John J Feng MD,Paul T Cirangle MD,Gregg H
Jossart MD, Dept. of Surgery, California Pacific Medical Center,
San Francisco, CA.
INTRODUCTION: Bariatric surgery weight loss is often quantified
using EWL. Sole use of EWL however can be misleading
because percent weight lost is expressed as a function of
preop weight. A new metric, BSSR, is introduced to complement
EWL.
METHODS: Data analysis after laparoscopic vertical gastrectomy
(VG), R-en-Y gastric bypass, and duodenal switch (DS) was
done. EWL = weight lost/(preop weight - ideal body weight).
BSSR was defined as the % of patients that successfully lost
enough weight such that they no longer met the NIH criteria
for bariatric surgery (BMI