2005 SAGES Abstracts

POSTER ABSTRACTS
becomes increasingly popular, more information is needed to
determine the effect of rapid maternal weight loss on pregnancy
and childbirth. Specifically, management of patients who
have undergone laparoscopic adjustable gastric banding
(LAGB) requires vigilant follow-up to define the optimal balance
between maternal weight loss and appropriate fetal
growth with relation to band adjustments during pregnancy.
Methods: A retrospective study of 331 patients who underwent
(LAGB) between November 2001 and August 2004 was performed.
Women of childbearing age were identified and further
surveyed for history of pregnancy. Patients who had
become pregnant since LAGB were questioned regarding their
pre and post-banding obstetric history, maternal complications,
neonatal history, and band management during pregnancy.
Results: Of the 216 women who underwent LAGB, 14 pregnancies
among 12 women were identified resulting in 7 live births
and 1 miscarriage. Six women are currently pregnant. Patients
became pregnant an average of 7 months after their banding
surgery (1-27 months). They had lost 25.9 kg prior to becoming
pregnant (2.3-45.5 kg) resulting in an average BMI of 38.2
(30.1-60.0 kg/m2) at conception. During pregnancy, the average
weight gain was 4.8 kg (-11.8 to 22.7kg), and the patients
underwent an average of 1 band adjustment (0-3). The only
maternal complication occurred in 1 patient who developed
gestational diabetes. The average birth weight was 3.6 kg (2.8-
4.5 kg) with delivery at 39 weeks (38-40 weeks).
Conclusions: Morbidly obese patients undergoing LAGB have
no increased incidence of maternal complications relating to
pregnancy. In our patient population, weight gain or loss during
pregnancy is not an indication of fetal health. Although
close follow-up is essential, removal of fluid from the band is
not mandated in asymptomatic patients.
P078–Bariatric Surgery
FIBRIN SEALANT REDUCES SEVERITY OF ANASTOMOTIC
LEAKS FOLLOWING ROUX-EN-Y GASTRIC BYPASS, Lana G
Nelson DO, Rodrigo Gonzalez MD,Krista Haines BA,Taylor
Martin BA,Scott F Gallagher MD,Michel M Murr MD,
Department of Surgery, University of South Florida, Tampa,
FL, USA.
INTRODUCTION: Anastomotic leaks contribute significantly to
morbidity and mortality of Roux-en-Y gastric bypass (RYGB).
We hypothesized that intraoperative application of fibrin
sealant to the cardiojejunostomy decreases the incidence and
severity of leaks after RYGB. METHODS: Prospectively collected
data on 144 consecutive patients who underwent RYGB
using fibrin sealant (Tiseel, Baxter) (Group 1) were compared
to our last 158 consecutive patients who underwent RYGB
without fibrin sealant (Group 2). Clinical characteristics and
operative outcomes were compared. Data are mean±SD.
RESULTS: Patients in Group 1 and 2 had similar age (46±11 vs.
45±9 years), BMI (51±10 vs. 51±10 kg/m2) and gender distribution
(81% vs. 81% women) (all p=NS). A significantly higher
percentage of patients in Group 1 underwent laparoscopic
RYGB (Table). The incidence of leaks was similar in both
groups. However, 3/6 leaks in Group 1 and 3/5 leaks in Group
required operative treatment. Of the 3 patients in Group 2 who
required operative treatment, 2 were found to have diffuse
peritonitis. The 3 patients who required operative treatment in
Group 1 had localized peritonitis. The remaining patients were
treated non-operatively. Length of stay was significantly shorter
in Group 1. CONCLUSION: Applying fibrin sealant to the
cardiojejunostomy reduces the severity of leaks in patients
undergoing RYGB and significantly reduces length of hospital
stay, which may translate into cost savings, and supports the
ongoing use of fibrin sealant.
Laparoscopic Leaks Length of stay
Group 1 52%* 4% 12±5**
Group 2 41% 3% 43±27
*p=0.049; **p=0.01
P079–Bariatric Surgery
“ALTERATIONS IN PERIPHERAL BLOOD LYMPHOCYTE FRE-
QUENCY IN OBESE PATIENTS”, Robert W O’Rourke MD,
Thomas Kay BS,Clifford W Deveney MD,Lewinsohn David
MD,Antony Bakke MD, Oregon Health and Science University
Background:
Recent data suggests that obesity is associated with a state of
immunocompromise. The mechanisms of altered immune
function in obesity are unknown. Lymphocyte function is
altered in many co-morbidities of obesity. Lymphocytes are
therefore excellent targets for study of the mechanisms of
obesity?s effects on immunity.
Methods:
A panel of antibodies directed against lymphocyte cells surface
CD markers was used to study peripheral blood lymphocyte
phenotype in obese patients and lean controls.
Results
Obese patients demonstrate elevated total lymphocytes (mean
difference = 17%, p < 0.001) and monocytes (mean difference =
1.4%, p= 0.001), and decreased frequency of CD8+ cells (mean
difference = 8%, p = 0.02). Obese patients also demonstrated
alterations in expression of CD95 and CD62L on a CD4dim
lymphocyte subset, likely a monocyte population based on forward
and side scatter characteristics.
Conclusion:
These data support the hypothesis that lymphocyte phenotype
and function is altered in obese patients. These alterations
affect primarily monocytes and CD8+ lymphocytes. Alterations
in CD95 and CD62L expression on monocyte subsets suggest
accompanying functional abnormalities in lymphocytes in
obese patients.
P080–Bariatric Surgery
USE OF 48 HOUR CONTINUOUS INFUSION LOCAL ANES-
THETIC SYSTEM IN LAPAROSCOPIC ROUX-EN-Y GASTRIC
BYPASS APPEARS TO REDUCE POSTOPERATIVE PAIN, J T
Paige MD, B P Gouda MPH,P G Scalia MD,T E Klainer MD,W J
Raum MD,L F Martin MD, The Weight Management Center at
St. Charles General Hospital and Louisiana State Health
Sciences Center, New Orleans, LA USA
Background: Laparoscopic Roux-en-Y gastric bypass (RNYGB)
is currently a very popular bariatric procedure in the United
States. Although less painful than an open incision, lap
RNYGB port sites can cause postoperative discomfort. Since
2003, we have been using a 48 hour continuous infusion local
anesthetic system (On-Q®) from I-Flow Corporation at our
largest port incision in an attempt to reduce postop discomfort.
We have reviewed our experience using this system.
Methods: A retrospective, single institution review of 80
patients undergoing lap RNYGB was performed. Thirty-nine
patients were selected from those undergoing the procedure
between July to Dec. 2002 (without On-Q®). Forty-one were
selected from July to Dec. 2003 (with On-Q®). Patient hospital
records were reviewed for collection of data.
Results: Patients undergoing lap RNYGB in 2002 were on average
younger (39.6 vs. 42.2 yrs) with slightly more comorbidities
(8.2 vs. 7.8) and higher BMI (46.7 vs. 46.2) than those in
2003. Patients from 2002, had, on average, lower admission
post anesthesia care unit (PACU) pain scores (1.6 vs. 2.2) but
higher discharge PACU pain scores (1.1 vs. 1.0) compared to
2003. Finally, on average, post-op pain scores for 2002 patients
were lower on admission to the floor (1.4 vs. 2.1), but higher at
8 hr (1.1 vs. 1.0), 16 hr (0.9 vs. 0.7), 24 hr (1.1 vs. 0.9), and 48
hr (1.0 vs. 0.6) following arrival to the floor.
Conclusion: Use of a 48 hour continuous infusion local anesthetic
system at the largest port incision site after lap RNYGB
appears to decrease postoperative pain immediately in the
PACU as well as up to 48 hours after arrival on the hospital
floor. Further validation of these findings via a randomized
prospective trial would be useful.
P081–Bariatric Surgery
REINFORCING GASTRIC STAPLE LINE WITH A BODEGRAD-
ABLE MEMBRANE FROM PORCINE INTESTINAL SUBMUCOSA
DURING LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS.,
Ricardo Cohen MD, Jose S Pinheiro MD, Jose Correa
MD,Carlos A Schiavon MD, Center for the Surgical Treatment
of Morbid Obesity, Hospital Sao Camilo, Sao Paulo, Brazil
Introduction: The purpose of this study was to evaluate the
ease of use, efficacy and safety of a porcine small intestinal
submucosa membrane applied over gastric staple lines. Acute
staple line leak after divided Roux-en-Y gastric bypass (RYGB)
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SAGES 2005
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