2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
tive LC. Of the 97 pts with an initial negative US 13 pts (13.4%)
developed symptomatic cholelithiasis and underwent subsequent
LC after a median follow-up period of 48.5 months. The
mean delay period from the LGPB to LC was 14 months. In
Group II (n=73; median follow-up=28.5 months) 17 pts were
identified with cholelithiasis preoperatively, of whom 3 pts
(17.6%) developed symptomatic disease requiring LC after a
mean delay of 21 months. Of the pts with negative US (n=56) 7
pts (12.5%) developed symptomatic disease requiring LC
(mean delay = 17 months). The two ratios are not significantly
different with 95% confidence (CI=-16.86 to 27.06). None of the
interval cholecystectomies had any complications and one pt
underwent successful lap common bile duct exploration.
Simultaneous LC coincident with laparoscopic bariatric surgery
can be difficult due to trocar positioning and anatomic
constraints. Patients with or without preoperative evidence of
cholelithiasis can be followed clinically for the development of
symptomatic gallstone disease. LC can be performed safely at
a later time in this population should symptoms arise.
P089–Bariatric Surgery
AVOIDING OBSTRUCTION AT THE JEJUNO-JEJUNOSTOMY
DURING LAPAROSCOPIC GASTRIC BYPASS, Rebecca Shore
MD, Scott Shikora MD,Julie Kim MD,Michael Tarnoff MD,
Center for Minimally Invasive Surgery, TUFTS-New England
Medical Center
Introduction: Laparoscopic gastric bypass (LGB) is rapidly
gaining popularity in the treatment of morbid obesity in the
United States. Many technical variations of the operation currently
exist. Commonly a side to side anastomosis is created
between the bilio-pancreatic limb and the roux limb with a
60mm Endo GIA (USSC, Norwalk, CT). The entry site for the
stapler must then be closed. Initially, we closed this opening
linearly, along the length of the jejuno-jejunostomy (JJ), with
this technique we encountered a 4.8% JJ obstruction rate.
Subsequently, we changed our technique in an attempt to
decrease this troubling complication. This abstract describes a
bi-directional stapled JJ to assure a wide opening between the
two limbs.
Method: After the 60mm Endo GIA is used to create the side to
side anastomosis a 30 mm Endo GIA is positioned in the
opposite direction and fired creating a 90mm anastomosis.
The opening is then closed transversely similar to the Heineke-
Mikulicz pyloroplasty with a single firing of the 60 mm Endo
GIA. The stapled jejunal specimen is removed and inspected
to assure continuity of the serosal layer. We then close the
mesenteric defect with a running suture and incorporate an
anti-obstruction stitch.
Results: A review of our institution?s data reveals that with the
unidirectional closure we had a 4.8% anastomotic obstruction
rate (6/125 cases). Four of these six patients required operative
intervention. Since implementing the bi-directional anastomosis
our obstruction rate is 0% (0/733 cases).
Conclusion: Bi-directional stapling of the JJ results in a wide
opening, is technically feasible and decreases the incidence of
obstruction.
P090–Bariatric Surgery
A NEW DEVICE BY USING OMENTUM FOR PREVENTING
COMPLICATIONS DURING LAPAROSCOPIC ROUX-EN-Y GAS-
TRIC BYPASS FOR MORBID OBESITY, Nobumi Tagaya PhD,
Kazunori Kasama MD,Yasuharu Kakihara MD,Shoujirou
Taketsuka MD,Kenji Horie MD,Norio Suzuki MD,Keiichi Kubota
PhD, 1) Department of Surgery, Horie Hospital, Gunma, Japan,
2) Second Department of Surgery, Dokkyo University School of
Medicine, Tochigi, Japan
Laparoscopic Roux-en-Y gastric bypass has emerged as a standard
surgical treatment for morbid obesity. However, the prevention
of postoperative complications related with bariatric
surgery is necessary. To reduce postoperative complications
and achieve the adequate body weight loss, we introduce a
new device using separated omentum during laparoscopic
Roux-en-Y gastric bypass. The actual aim of these devices is to
prevent the gastro-gastric fistula due to the re-entry of alimentary
tract and the leakage from gastric pouch or anastomosis.
Between February 2002 and August 2004 we have performed
laparoscopic Roux-en-Y gastric bypass for morbid obesity in
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21 cases. Recent 8 cases were introduced our new device
using separated omentum. They were one male and seven
females. Their mean age was 33 years old (range, 18-50), and
mean BMI was 40 Kg/m2 (range, 34-46). At surgery, omentum
is routinely separated using laparoscopic coagulating shares
before performing gastro-jejunostomy to reduce the tension of
anastomosis. After performing hand-sewn gastro-jejunostomy,
a left side of separated omentum is moved cranially and interposed
between a gastric pouch and a residual stomach. And
then omentum was sutured to the posterior aspect of the gastric
pouch, or the gastric pouch was rapped by omentum circumferentially.
Our procedure using omentum during bariatric
surgery is feasible and safe to obtain better outcomes without
artificial materials. Although the long-term outcome of this
technique is still unclear, we believe that this technique will
provide to decrease the particular complications related with
laparoscopic Roux-en-Y gastric bypass for morbid obesity.
P091–Bariatric Surgery
GASTRIC BYPASS IN PATIENTS 55 YEARS AND OLDER: A
COMPARISON OF YOUNG VS OLD AND THE LAPAROSCOPIC
VS OPEN TECHNIQUE, Mark Takata MD, Suhail Shaikh
MD,Bruce Bernstein PhD,Martindale Carolyn RN,Manuel
Lorenzo MD,Richard Newman MD,Carlos Barba MD,
Department of Surgery, St. Francis Hospital and Medical
Center, University of Connecticut School of Medicine
The purpose of this study is to compare the safety and efficacy
of Roux-en Y gastric bypass (RYGB) surgery for morbid obesity
between patients 55 years and older with patients younger
than 55 years and to evaluate whether or not the laparoscopic
approach provides a better outcome in the older age group.
A retrospective chart review was conducted at a single tertiary
care institution. Morbidly obese patients 55 years and over
were included if they underwent laparoscopic (lap) or open
RYGB surgery between January 1999 and March 2004. A random
sample of 122 patients were selected from a total of 494
patients younger than 55 who had lap or open RYGB during
the same study period. Demographics, preoperative body
mass index (BMI), comorbidities, length of stay (LOS), perioperative
complications, and percent weight loss were compared
between the two age groups.
A total of 61 consecutive patients 55 years and over underwent
RYGB surgery during the study period. There were no significant
differences between the two age groups with respect to
gender, preoperative BMI, LOS, and percent weight loss at 3,
6, and 12 months. When comparing comorbidities (young vs
old), there were significant differences (p < 0.05) in the prevalence
of coronary artery disease (3.3 vs 13.1%), diabetes mellitus
(20.7 vs 39.3%), and hypertension (39.8 vs 77.0%). There
were no significant differences between the prevalence of
COPD and sleep apnea. There were two perioperative mortalities
in the younger group and one in the older group. When
comparing perioperative complications between the two age
groups (young vs old) there were no significant differences in
the rates of cardiopulmonary complications (1.6 vs 6.6%),
anastomotic leaks (4.1 vs 4.9%), postoperative bleeding (0 vs
3.3%), and wound infections (15.0 vs 18.0%). The lap approach
was utilized in 49.2% of the younger group and 29.5% of the
older group (p < 0.05). When comparing the lap and open
approach in the older age group there were no significant differences
in demographics (except BMI), LOS, and perioperative
complications.
Despite the higher rate of comorbidities in the older age
group, this study demonstrates that RYGB surgery for morbid
obesity in properly selected patients age 55 years and over
can safely and efficaciously be performed when compared to
younger patients. In addition, the lap approach in patients 55
and over does not result in a shorter LOS or less perioperative
complications.
P092–Bariatric Surgery
LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING: RESULTS
OF THE FIRST 500 CASES USING THE PARS FLACCIDA TECH-
NIQUE., craig J taylor MD, Laurent Layani MD, Gold Coast
Obesity Surgery Centre, Gold Coast Queensland Australia
INTRODUCTION. Whilst the Pars Flaccida technique of LAGB
placement has been shown by experienced bariatric surgeons