2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
is reported to occur in 1% to 6% of cases and can be devastating.
The true incidence, however, is not known. Many authors
do not distinguish between staple line failure and anastomotic
leak. Another complication of lesser consequence than leak, is
staple line bleeding, that may require transfusion or reoperation.
In most cases, it’s a situation that can increase operative
time, requiring measures to stop the bleeding. We have been
using a biomembrane derived from porcine small intestinal
submucosa (SIS) to decrease staple line failure and bleeding.
SIS membrane was already used in Urology and even reinforcing
the gastojejunal anastomosis in laparoscopic RYGB.
Methods: The SIS biomembrane was used in 25 patients
undergoing laparoscopic Roux-en-Y gastric bypass. SIS membrane
was employed on a blue 45 mm Endogia cartridge (US
Surgical Instr, Norwalk, CT, USA) during the creation of the
gastric pouch. Operative time, intraoperative complications,
visual staple line bleeding, operative blood loss, postoperative
drainage output, and staple line leaks were recorded. Data was
compared to 25 non-SIS cases performed during the same
period.
Results: The average operative time in both groups was similar
(mean of 48 minutes). There were no intraoperative complications
in both groups. SIS patients had no visual staple line
bleeding and mean intraoperative blood loss was 25 ml. The
non-SIS group had 2 cases of staple line bleeding requiring
cauterization and longer operative time. Operative blood loss
in these patients was 75 ml. Drain output was significantly
lower in the SIS group. No staple line leaks were found in both
groups.
Conclusions: SIS device was easy and safe to use. Staple line
bleeding was non existant and intraoperative bleeding was
less after SIS application. Although no staple line leaks were
observed in both groups, handling the gastric reservoir was
much easier with SIS reinforcement. Postoperative drain output
was considerably lower in the SIS buttressed group. The
use of SIS reinforcement is quicker than oversewing the staple
line and less costly than using fibrin glue, while more practical
than covering it with omentum or jejunal limb coverage.
P082–Bariatric Surgery
LAPAROSCOPIC GASTRIC BYPASS AND PHYSICIANS. A CON-
TRAINDICATION?, Jose S Pinheiro MD, Ricardo Cohen
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 compare the
results of laparoscopic Roux-en-Y gastric bypass (LRYGB) in
physicians and in non-physician patients. Physicians are a
?special? group of patients. Generally, they are reluctant in
receiving and following medical instructions. LRYGB for the
treatment of morbid obesity requires multiple patient commitments
and a strict and life-long follow-up.
Methods: We reviewed the data of 19 physicians who underwent
LRYGB in our Institution (1.7% of our patients). OR time,
intraoperative and postoperative complications, length of hospital
stay, drain output, EWL, cure of comorbidities and followup
were compared to non-physicians patients data when possible.
Results: Most patients were women (15) and mean age was 38
(30 to 45). Mean preoperative BMI was 42. Patients presented
with a mean of 2 comorbidities. One general surgeon, 1
endocrinologist, and 17 from other medical specialties formed
the group. There were 3 revisional bariatric procedures. Two
due to adjustable gastric band erosion and one due to failed
open gastric bypass (weight regain). Mean OR time was 51
minutes. There were no intraoperative complications. There
was 1 pulmonary embolism. Mean length of hospital stay was
39 hours. These results were similar to non-physician patients.
Drain was removed in the first preoperative visit (a Jackson-
Pratt drain is placed in all patients). After this one visit, only 1
patient continued the regular follow-up (the endocrinologist).
This patient?s BMI is 24 and diabetes and GERD are cured.
Comparison of EWL and cure of comorbidities was impossible.
Conclusions: OR time, intraoperative complications, length of
hospital stay, and drain output were similar to non-physician
patients. Follow-up was extremely low resulting in a shocking
and worrisome situation.
146 http://www.sages.org/
P083–Bariatric Surgery
OUTCOME OF SIMULTANEOUS VS. DEFERRED LAPAROSCOP-
IC CHOLECYSTECTOMY FOR CHOLELITHIASIS IN BARIATRIC
SURGERY, Raul J Rosenthal MD, David Podkameni MD,Flavia
E Soto MD,Priscilla Antozzi MD,Fernando Arias MD,Natan
Zundel MD,Samuel Szomstein MD, Bariatric Surgery,
Cleveland Clinic Florida
Introduction: Lithogenesis and cholesterolosis are well-recognized
side effects after bariatric procedures. Prophylactic
cholecystectomy at the time of surgery remains controversial.
The aim of this study was to analyze the outcome of laparoscopic
cholecystectomy (LC) for cholelithiasis performed concomitant
with bariatric surgery or deferred until after bariatric
surgery when symptoms ensue. Materials & Methods: The
medical records of 820 patients undergoing Laparoscopic
Roux En-Y Gastric Bypass (LRYGBP) between January 2000
and October 2003 were retrospectively reviewed. All patients
were considered morbidly obese and had sonographic documented
cholelithiasis. Patients were divided into 2 groups:
Group A: patients underwent simultaneous LRYGBP + LC and
Group B: patients underwent deferred LC weeks or months
after LRYGBP due to cholecystitis. Results: 190 patients (23%)
presented with gallstones at the time of preoperative evaluation.
In Group A, 50 patients (26.3%) had simultaneous LC
while in Group B, 23 patients (16.4%) underwent deferred LC.
In group A, one patient (4.3%) developed a bile leak and was
successfully treated by laparoscopic assisted gastrostomy,
transgastric ERCP and stent placement. In Group B, one
patient (1%) developed acute cholecystitis and obstructive
jaundice and underwent successful LC and transcystic common
bile duct exploration. Conclusions: There appears to be
no significant difference in complications after simultaneous
LRYGBP+LC when compared to LRYGBP and deferred LC.
Complications of LC after LRYGBP require advanced laparoendoscopic
skills in order to be diagnosed and managed.
Indications for simultaneous versus deferred LC remain controversial.
P084–Bariatric Surgery
RADIO FREQUENCY ABLATION (STRETTA) IN PATIENTS WITH
PERSISTENT GERD AFTER ROUX-EN-Y GASTRIC BYPASS,
Faisal G Qureshi MD, Joy Collins MD,Debra Taylor RN,Laura
Velcu MD,Pandu Yenumula MD,Brian Lane MD,Tomasz Rogula
MD,Philip R Schauer MD,Samer G Mattar MD, University of
Pittsburgh, Department of Surgery
Background: Morbid obesity is associated with gastroesophageal
reflux disease (GERD), which in the majority of
cases, completely resolves after Roux-en-Y gastric bypass
(RYGB). Patients with persistent symptoms have limited surgical
options. We sought to evaluate the application of the
STRETTA procedure in these patients. Methods: The medical
records of all patients who underwent STRETTA for GERD following
RYGB were reviewed. Demographic, preoperative and
postoperative reflux data were collected. Follow up was
12.6±2.2 months. Data are mean±SEM; t-test was used for
comparison purposes. Results: Seven patients received
STRETTA 27±6.1 months after RYGB. All were women with a
mean age of 49.4 years ±2.5 yrs, All patients had pre-bypass
GERD symptoms for a duration of 45.6±8.0 months. Mean prebypass
BMI was 45.9±2.3 kg/m2 and this was reduced to
29.3±2.4 kg/m2 after RYGB (p