2005 SAGES Abstracts

ABSTRACTS Thursday, April 14, 2005
(failure) in 17 pts (14%). Weight loss was more substantial in
the pts with lower preop BMI and was not related to age (b=(-
)0.8, p=0.0003, 95%CI (–)1.15 to (–)0.35; b=(-)0.2,
p=0.2, 95%CI (–)0.4 to (–)0.08 respectively). BAROS
scores were found to be not related to both preop BMI and
age (b= 0.01, p=0.7; b= (-)0.01, p=0.2, respectively).Conclusion:
Moderate weight loss associated with LAGB at one year of follow
up produced improvement in QOL and substantial reduction
of comorbidities in the majority of pts. Diabetes, hypertension,
GERD and coronary artery disease completely resolved
or significantly improved in more than 75% of the pts.
Reduction of co-morbidities and improvement of QOL can be
anticipated in pts with any preop weight and age.
S027
LAPAROSCOPIC ADJUSTABLE GASTRIC BAND IN SUPER
MORBIDLY OBESE PATIENTS (BMI >50): A PROSPECTIVE,
COMPARATIVE ANALYSIS, Wilbur B Bowne MD, Kell Julliard
MS,Armando E Castro MD,Palak Shah MD,Craig B Morgenthal
MD,Emad Kandil MD,Abel Gonzalez MD,Anthony J Acinapura
MD,George S Ferzli MD, Department of Surgery, SUNY-Health
Science Center of Brooklyn and Lutheran Medical Center,
Brooklyn, NY
INTRODUCTION: The advantages of laparoscopic adjustable
gastric banding (LAGB) are well known. We review our experience
with emphasis on outcome compared to the standard
laparoscopic Roux-en-Y gastric bypass (RYGBP).METHODS: A
prospective database identified patients who underwent operative
management for severe obesity between February 2001
and June 2004. The study group included super morbidly
obese patients (BMI > 50) following LAGB and RYGBP.
RESULTS: 315 patients underwent operative management for
severe obesity. Among 108 patients with super morbid obesity,
55 (51%) and 53 (49%) underwent LAGB and RYGBP, respectively.
Overall median follow-up was 14 months (range, 1- 43
months). Preoperative factors of patient age, gender, BMI, and
medical comorbidity were similar between the 2 groups.
Compared to RYGBP, LAGB patients had a greater incidence of
late complications, reoperations, less weight loss, and
decreased overall satisfaction.
CONCLUSIONS: In super morbidly obese patients LAGB is significantly
associated with more late complications, reoperations,
less weight loss, and patient dissatisfaction compared to
RYGBP. Further evaluation of LAGB in this patient population
appears warranted.
S028
US EXPERIENCE WITH 760 LAPAROSCOPIC ADJUSTABLE
GASTRIC BANDS: INTERMEDIATE OUTCOMES, Manish S
Parikh MD, George A Fielding MD,Christine J Ren MD, New
York University School of Medicine, Department of Surgery
Laparoscopic adjustable gastric band (LAGB) has been consistently
shown to be a safe and effective treatment for morbid
obesity, especially in Europe and Australia. Data from the US
regarding the LAGB has been insufficient. This study reveals
our experience with 760 primary LAGB over a 3-year period.
All data was prospectively collected and entered into an electronic
registry. Characteristics evaluated for this study include
pre-operative age, BMI, gender, race, conversion rate, operative
time, hospital stay, percent excess weight loss (%EWL)
and post-operative complications. Annual esophagrams were
performed.
From July 2001 through September 2004, 760 patients (540
females, 220 males) underwent LAGB for the treatment of
morbid obesity, including 640 Caucasians, 61 African-
Americans, and 48 Latin Americans. Mean age was 42 years
+/- 11 (range 13,72) and mean BMI was 45.9 +/- 7 (range 30,
91.5). There was one conversion to open (0.01%). Median
operative time and hospital stay were 55 minutes and 24
hours, respectively. The mean %EWL at 1 year, 2 years, and 3
years was 44.6 +/- 17.6. 52.3 +/- 19.1, and 51.6 +/- 18.4, respectively.
There were no mortalities. Post-operative complications
occurred in 13% of patients: 2.6% gastric prolapse (?slip?),
2.1% concentric pouch dilatation (without slip), 1.4% acute
post-operative band obstruction, 1.4% port/tubing problems,
1.1% overall band removal, 0.79% wound infection, 0.79%
aspiration pneumonia, 0.66% port infection/abscess and 0.03%
severe esophageal dilatation (reversible).
These American results substantiate the data from abroad that
LAGB is a safe and effective treatment for morbid obesity.
S029
BANDED ROUX-EN-Y GASTRIC BYPASS AS A REVISIONAL
PROCEDURE AFTER FAILED LAPAROSCOPIC ADJUSTABLE
SILICONE GASTRIC BANDING, Akuezunkpa O Ude MD, Amna
Daud MD,Daniel Davis DO,Marc Bessler, Center for Obesity
Surgery, New York Presbyterian Hospital and Columbia
University, New York, NY.
Background: Laparoscopic Adjustable Silicone Gastric Banding
(LASGB) has become an increasingly popular surgical technique
for treatment of morbid obesity in the United States.
Failure to achieve and maintain adequate weight loss may
require revision to gastric bypass. We conducted a retrospective
review of seven patients who failed to achieve adequate
weight loss after LASGB, and were revised to a roux-en-y gastric
bypass (RYGB) distal to a deflated, gastric band.
Methods: We report on seven patients who presented with
either inadequate weight loss or significant weight regain after
LASGB. The revision consisted of deflating the existing band,
transecting the stomach distal to the band and creating a 75 x
150cm retrogastric, retrocolic RYGB. We have examined percent
excess weight loss (%EWL) and complications at their
most recent follow up visit
Results: Between April 2000 and May 2004, 148 patients underwent
LASGB and 14% (n=21) patients failed to achieve 25%
EWL by 12 months. Seven female patients underwent revision
of LASGB to RYGB. At the time of their primary procedure, the
patients had an average Body Mass Index (BMI) of 52.6 (36.4 ?
74.5) kg/m2. Patients lost an average of 10.8 %EWL from their
primary procedure, resulting in a BMI at the time of revision of
48.8 (36-66) kg/m2. After revision, patients lost an additional
31-49% (mean=42.2) of their excess weight, resulting in a total
%EWL of 27-60 (mean %EWL=46) from the combined surgeries.
All patients have seen improvement or resolution of their
co-morbidities. Two patients have undergone band adjustments
and are continuing to lose weight. No patients were lost
to follow up, which ranged from 3 to 46 months (mean=15).
Conclusions: These results indicate that leaving the deflated
band in situ and performing a RYGB distal to the band is a
safe and effective revisional strategy. Advantages of this procedure
include: 1) the ability to calibrate the size of the gastrojejunostomy
over time to produce even greater weight loss;
and 2) operating on unscarred gastric tissue which may
decrease the high leak rates associated with reoperative
bariatric procedures.
S030
ENDOSCOPIC EVALUATION OF THE GASTROJEJUNOSTOMY
IN LAPAROSCOPIC GASTRIC BYPASS: A SERIES OF 340
PATIENTS WITHOUT POST-OPERATIVE LEAK., Nikhilesh R
Sekhar MD, Alfonso Torquati MD,Rami E Lutfi MD,William O
Richards MD, Vanderbilt University, Department of Surgery
BACKGROUND: A significant and potentially deadly complication
of the Roux-en-Y Gastric Bypass is leakage from the gastrojejunostomy
(GJ). The aim of our study was to evaluate the
efficacy of intraoperative endoscopy in preventing postoperative
anastomotic leakage.
METHODS: The study enrolled 340 consecutive patients undergoing
laparoscopic gastric bypass procedures performed from
1/2001 to 7/2004. In all cases, an endoscopist performed video
gastroscopy to evaluate the integrity of the GJ using air insufflation
of the pouch after distal clamping of the Roux limb.
Intraoperative leaks were repaired and the anastomosis was
retested. Demographic, operative, and endoscopic data were
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