2005 SAGES Abstracts

POSTER ABSTRACTS
to have a fewer complications and similar efficacy to the perigastric
approach, it is unclear what results can been achieved
by general surgeons using the pars flaccida technique without
extensive previous gastric banding experience. We sought to
clarify this by analysing the results of all LAGB’s placed using
the pars flaccida approach by a general surgeon pars flaccida
technique is an intrinsically better technique or Laparoscopic
Adjustable Gastric banding is now the technique of choice in
the surgical treatment of morbid obesity in Europe and
Australasia, and is rapidly gaining popularity in North
America. Previously, the perigastric approach was used for
band placement, but an unacceptably high incidence of band
related complications lead to the change to the pars flaccida
approach, which has been shown by with similar efficacy. We
sought to investigate the results achievable using the pars
flaccida technique when adopted by a.
METHODS. The first 500 consecutive cases of laparoscopic
adjustable gastric banding performed by a single surgeon
using the Pars Flaccida technique were retrospectively
reviewed, with particular reference to the incidence of band
slippage, erosion and reoperation.
RESULTS. Five hundred patients (79% female) with a mean
age of 45 years and mean preoperative body mass index of
44.5 underwent laparoscopically placed adjustable gastric
banding. Percentage excess weight lost was 40%, 51%, 48%
and 54.5% at 1,2,3,and 4 years follow-up respectively. Band
slippage occurred in 5 (1%), erosion in 2 patients (0.4%).
Twenty two patients (4.4%) required reoperation for band
related problems in 10 (2%) and port related problems in 12
(2.4%). There was one death (0.2%)
CONCLUSION. The Pars flaccida technique is inherently associated
with a low incidence of complications whilst producing
effective weight loss, and is the preferred approach for band
placement. Our results provide the laparoscopic surgeon
preparing to embark on gastric banding with an indication of
those achievable using the technique.
P093–Bariatric Surgery
PREDICTIVE VALUE OF UPPER GASTROINTESTINAL STUDIES
VERSUS CLINICAL SIGNS FOR LEAKS AFTER LAPAROSCOPIC
GASTRIC BYPASS, Craig A Ternovits MD, Holbrook H
Stoecklein,David S Tichansky MD,Atul K Madan MD,
Department of Surgery, University of Tennesse Health Science
Center - Memphis
Introduction: The topic of utility of upper gastrointestinal (UGI)
studies immediately after laparoscopic gastric bypass is of
great debate. Since the morbidity and mortality of an unrecognized
postoperative leak is high after gastric bypass, diagnosis
of a postoperative leak earlier would be of benefit. However,
clinical signs may make the diagnosis of a postoperative leak
obvious. This study explored the hypothesis that UGI studies
were more predictive than clinical signs for the early diagnosis
of laparoscopic gastric bypass.
Methods: All laparoscopic gastric bypasses performed at our
institution were included in this study. Charts were reviewed
to examine immediate clinical signs (heart rate, temperature,
and white blood cell count within the first 24 hours), UGI studies,
and clinical course. Sensitivity (Sens), specificity (Spec),
positive predictive value (PPV), negative predictive value
(NPV), and efficiency (EFF) of clinical signs and UGI studies
were calculated.
Results: There were 245 patients in this study with a 3% rate of
leak. The overall positive and negative predictive value of the
UGI studies and clinical signs are demonstrated in the table.
Conclusions: According to our data, UGI studies are the most
predictive of the early diagnosis of a leak. Clinical signs are
not as useful in predicting leaks early after laparoscopic gastric
bypasses. UGI studies should be performed early after laparoscopic
gastric bypasses.
P094–Bariatric Surgery
LAPAROSCOPIC BARIATRIC PATIENTS? WILL TO HELP: THE
FOUNDATION OF CLINICAL RESEARCH, David S Tichansky
MD, Craig A Ternovits MD,Kimberly Turman,Atul K Madan MD,
Department of Surgery, University of Tennessee Health
Science Center, Memphis, TN
INTRODUCTION: Bariatric surgery is one of the fastest growing
surgical specialties. Clinical research is essential to its safe
delivery. Studies subjectively refer to bariatric patient enthusiasm
for research participation. However, this has never been
objectively measured. Our hypothesis is that most laparoscopic
bariatric surgery patients will participate in and comply with
obesity related clinical research.
METHODS: Postoperative laparoscopic bariatric surgery
patients were given a fifteen-question survey querying their
commitment to participate in studies and then quantified the
level of time, effort, and commitment they would comply with.
Responses were analyzed and Fisher?s Exact and chi-square
tests was used to determine statistically significant differences.
RESULTS: Eighty-nine of the 97 (92%) patients were willing to
participate. Willingness was independent of race (30/33 [91%]
of black patients vs. 59/64 [92%] of white patients, p=ns).
Diabetics were not more likely than non-diabetics to participate
(29/32 [91%] of diabetics vs. 60/65 [92%] of non-diabetics,
p=ns). 93% agreed to additional blood tests done during to
routine blood draws, but only 75% would have additional
blood draws. 100% agreed to donate fat samples during surgery,
but only 80% would donate one-month post-op. 57%
agreed to catheterization for sample collection. 82% would
spend 6 hours in the hospital for preoperative research. This
decreased to 58% and 57% for 12 and 24 hours, respectively
(p=0.001). 74% committed to 6 hours per month in the hospital
for postoperative research. This decreased to 61% and 55% for
12 and 24 hours (p=0.004). There were no trends in the financial
reimbursement that patients desired for this hospital time.
CONCLUSION: Almost all laparoscopic bariatric surgery
patients will participate in obesity related research, including
invasive procedures, when it coincides with their surgery.
Enthusiasm depreciates with increasing time commitment in
the pre- and post-operative period but remains in the majority
of patients. Weight loss surgery patients? strong willingness to
promote obesity related research is the backbone of successful
clinical research in this field.
P095–Bariatric Surgery
VISUAL IDENTIFICATION OF LIVER PATHOLOGY DURING
LAPAROSCOPIC BARIATRIC PROCEDURES, Darren S Tishler
MD, Toni Leeth MPH,Teresa Leath RN,Brandon Roy MD,Gary
Abrams MD,Ronald H Clements MD, University of Alabama at
Birmingham
BACKGROUND: Liver disease, particularly non-alcoholic
steatohepatitis, is commonly encountered in the morbidly
obese patient. There are currently no clear-cut recommendations
as to the appropriate management of liver pathology
when encountered at laparoscopy for obesity surgery. It has
been recommended that because of the hight prevelence of
liver disease, biopsies should be taken in all patients to guide
further management. The relationship between the visual
appearance of a diseased liver and actual pathology in the
morbidly obese patient is undefined.
METHODS: A total of thirty-seven morbidly obese patients
undergoing laparoscopic Roux-en-Y gastric bypass were
enrolled in a prospective study. The appearance of their livers
were independently scored by two surgeons on a 4 point scale
based on the degree of fat deposition visualized (>67% fat -
severe; 33-66% fat - moderate;