2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
150 http://www.sages.org/
CONCLUSION: Although surgeons commonly comment on the
degree of liver disease at the time of obesity surgery, the ability
to reliably identify liver pathology without biopsy in the
morbidly obese patient is limited. Even in patients with no
visually appreciable liver disease, it is commonplace for a
biopsy to histologically demonstrate steatosis, fibrosis, or
steatohepatitis. Because of the increased prevelence of liver
disease in the morbidly obese patient, we recommend that a
liver biopsy be routinely performed on all patients at the time
of obesity surgery to guide further monitoring, risk stratification,
and future treatment options.
P096–Bariatric Surgery
THE RELATIONSHIP OF GASTRIC EMPTYING & POSITION OF
THE GASTROJEJUNOSTOMY (GJ) IN THE LAPAROSCOPIC
ROUEX-EN-Y GASTRIC BYPASS (LRYGBP) PATIENTS, ANTE-
GASTRIC VS. RETROGASTRIC; IS THERE A DIFFERENCE?,
John Yadegar MD, Oliver Block MD,William Bertucci MD,Todd
Drasin MD,Eric Dutson MD,Salvador Valencia MD,Debbie
Frickel RN,Barbara Kadell MD,Carlos Gracia MD,Amir Mehran
MD, UCLA Medical Center, Los Angeles, California
Introduction: It is often claimed that retrogasric GJ, is more
anatomical/physiological & hence drains better. It was our contention
to assess this in the LRYGBP group.
Method: From 1/2003 to 6/2004, one hundred of each Retrcolic-
Retrogastric (RC/RG) vs. Antecolic-Antegastric (AC/AG), RYGBP
were performed by the UCLA bariatric group. The data pertaining
to gastric emptying, time to discharge, comorbidities &
any complications were collected in to a prospective database.
All the patients obtained an upper GI swallow on postoperative
day one. Same radiological techniques were used in all
the cases, and same group of radiologists reviewed the films.
All the studies with delayed emptying, i.e.: contrast hold up of
various degree, were labeled as such. The patient records
were subsequently reviewed and the data was then analyzed.
Results: There were 12 delayed gastric emptying in the RC/RG
group vs. 19 in the AC/AG group. Statistical analysis of the
data using Chi-Square test, showed no significant difference
between the 2 groups, with a P=0.17. There was also no association
with relation to Body Mass Index (BMI), diabetes or
hospitalization period.
Conclusion: Our data suggests that there does not appear to
be a statistically significant difference, between the gastric
emptying , in the RC/RG vs. AC/AG group in the RYGBP population.
This may also hold true in the Gastrojejunostomies performed
in the non-bariatric patient population, although a larger
study group should be reviewed.
P097–Bariatric Surgery
THE INCIDENCE OF SMALL BOWEL OBSTRUCTION AFTER
LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS USING AN
ANTECOLIC ROUX LIMB, Sherman Yu MD, Michael Snyder
MD,Patrick Sawyer, PA-C, University of Colorado Health
Sciences Center and Rose Medical Center
Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB)
is a safe and effective alternative to standard open Roux-en-Y
gastric bypass. Reports suggest that a retrocolic roux limb in
LRYGB may result in as high as a 5% incidence of small bowel
obstruction (SBO) due to internal hernias and mesocolonic
constrictions. The placement of the roux limb in an antecolic
position will eliminate the mesocolon as a source of SBO. We
hypothesized that an antecolic roux limb would result in a
decreased incidence of SBO in patients undergoing LRYGB.
Methods: The charts from the first 400 consecutive LRYGB
patients operated on from 3/01-2/04 at a university affiliated
community hospital were retrospectively reviewed. All cases
were performed using an antecolic, antegastric roux limb
placed through a small defect made in the omentum. A circular
stapler with transoral placement of the anvil was used for
the creation of the gastrojejunostomy. Omental and mesomesenteric
defects were not closed.
Results: Four hundred patients underwent LRYGB with a mean
BMI of 48 (34-79). The average age was 45 years. Eighty-six
percent of the patients were female. Five patients developed
SBO (1.3%). Three obstructions occurred at the omental window,
1 obstruction was secondary to a stricture at the jejunaljejunostomy,
and 1 obstruction occurred from an incarcerated
umbilical hernia resulting in an anastamotic leak. One additional
anastamotic leak occurred unrelated to a SBO. All
patients underwent operative repair of the SBO with no resultant
mortality.
Conclusions: In our series of 400 patients undergoing LRYGB,
the incidence of SBO was 1.3 %. The antecolic placement of
the roux limb eliminated the mesocolon as a source of SBO.
However, we did observe 3 omental window hernias (0.8%)
that resulted in SBO. Therefore, we conclude that the antecolic
placement of the roux limb decreases the risk of SBO compared
to a retrocolic roux limb.
P098–Bariatric Surgery
PORT COMPLICATIONS FOLLOWING LAPAROSCOPIC
ADJUSTABLE GASTRIC BANDING FOR MORBID OBESITY,
Subhi Abu-Abeid MD, Andrei Keidar MD,Dan Bar-Zohar
MD,Joseph Klausner MD, Department of Surgery B, Tel-Aviv
Sourasky Medical Center
Objectives: Laparoscopic adjustable gastric banding (LAGB) is
gaining widespread acceptance, but the technique has disadvantages
secondary to the material wear and tear around the
port and the connecting tubing, that can lead to system failure.
Port site complications are considered common; however, only
few authors analyze them, and no optimal technique of port
implantation and management is suggested.
Method and Procedure: LAGB includes placement of an
adjustable band, 2 cm below the gastroesophageal junction,
thus restricting the gastric reservoir. The inner part of the band
is a silicon sleeve connected to a subcutaneous port
(Bioenterics®, Carpenteria, CA, USA), which enables band
width adjustment. All patients who suffered from complications
involving the tubing or the access port were included in
the study. Their preoperative complaints, operative notes and
hospitalization files were retrospectively reviewed.
Results: Only 1272 patients (of a total of 2134 operated on)
were available for a mean follow-up of 57 months. During this
period, 91 (7.1%) patients suffered from port complications
that required 103 revisional operations. 63/91 suffered from
system leak, 17/91 from infectious problems and 10/91 from
miscellaneous problems. Overall, port complications led to
band removal in 6/91 patients and port replacement in one.
Conclusions: Although among the most common complications
of LAGB, access port complications are the most annoying
ones, rendering the device susceptible to failure. The combination
of careful surgical technique, routine use of radiological
guidance for band adjustment and improvement of the
port design may be the keys for minimizing complications,
obviating further, unnecessary surgical procedures.
P099–Colorectal/Intestinal Surgery
LAPAROSCOPIC LIGASURE SMALL BOWEL ANASTOMOSIS,
Abdullah Al Dohayan MD, King Khalid University Hospital
Ligasure is a machine used to seal vessels. The same concept
is applied to use the diathermy capiblity in cutting and sealing
the mucosa of small bowel. The procedure was done in 3 dogs
using 3 trocars size 5 mm. A loop of small bowel was choosen
and side to side anastomosis was carried out in two layers
with outer continous seromuscular suture using silk.
Entromtomy is done in both edge of the small bowel. The jaws
of the ligasure was introduced in both stomas and closed
diathermy is carried out followed by cutting of the coagulated
tissue. The procedure was completed, anterior seromuscular
suture was done. During the 3 months follow up no leak was
reported or vomiting.
P100–Colorectal/Intestinal Surgery
LAPAROSCOPIC RESECTION FOR COMPLETE AND INTERNAL
RP, Ravinder K Annamaneni MD, John H Marks MD,Thomas
Curran BA,Gerald Marks MD, The Lankenau Hospital and
Lankenau Institute of Medical Research, Wynnewood, PA,USA.
OBJECTIVE: The aim of this study is to assess the efficacy and
safety of laparoscopic (lap) resection for rectal prolapse (RP).
METHODS: From 1996 to 2004, 32 consecutive patients (27
women) had lap resection with rectopexy for complete (CRP)
(N=16), or hidden (HRP) (N=16) rectal prolapse. Data was analyzed
from a prospective database.