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common for CCE (100%), APP and COL (85% each). For COL, intrabdominal drains are placed by 47%
of surgeons, while subcutaneous drains remain an exception (19%). Wound dressings are mainly nonocclusive
(60%). Dressing changes are performed after hand disinfection or under sterile conditions
by 87 and 55% of the surgeons, respectively. First dressing change is in 75% on postoperative day
(POD) 2 and wounds rest undressed on POD 2-3 or POD 4-5 (36% each). Surgeons with 2;
operative time >180 min; wound classification contaminated or dirty-infected. The Charlson score is a
weighted index based on the number and the severity of 16 comorbid conditions. It was designed to
predict the cumulative mortality. The PSS SSI risk score is based on 14 pre-operative factors intended
to predict the surface and deep SSI rate. All scores increase in steps of 1 and range from 0-3 (NNIS),
0-32 (Charlson) and 0-21 (PSS SSI RI), for colon surgery 6-21 (index includes the type of surgery).
Scores were compared by the p-value of the logistic regression and by the c-index (c = 1 perfect, c =
0.5 random correlation). The outcome was total surgical site infection rate.
Results: The surgical site infection rate was 20.7% among 227 operations surveyed. The p-values of
the logistic regression of NNIS, Charlson and PSS SSI RI were 0.165, 0.996 and 0.011, respectively.
Furthermore, the odds ratio (OR) for each score point was 1.31, 1.0003 and 1.23, respectively. The
c-index was 0.565, 0.528 and 0.625. The values of the PSS SSI RI for surface and deep infections only,
were p = 0.018, OR = 1.26 and c-index = 0.634.
Conclusion: NISS and Charlson score show no significant correlation to the surgical site infection rate.
In particular the Charlson score has no predictive value at all (odds ratio close to 1). However, the
PSS SSI RI shows a significant correlation even with a moderate c-index (0.70 in original publication).
Although the PSS SSI RI was designed to predict the risk of surface and deep SSI it is also a useful tool
to predict the overall SSI rate.
Visceral Surgery – Morbid Obesity 21
21.1
Effects of weight loss after bariatric surgery on adipocytokines and metabolic parameters: comparison
of laparoscopic Roux-en-Y gastric bypass (LRYGB) with laparoscopic sleeve gastrectomy (LSG)
R. Peterli, B. Wölnerhanssen, Y. Borbély, T. Peters, C. Christoffel-Courtin, B. Kern, M. von Flüe, R. Steinert,
C. Beglinger (Basel)
Objective: Adipocytokines are closely linked to obesity and insulin-resistance. Both laparoscopic Rouxen-Y
gastric bypass (LRYGBP) and laparoscopic sleeve gastrectomy (LSG) improve insulin-sensitivity.
In this randomized, prospective, parallel-group study, we sought to evaluate and compare the one-year
follow-up results of LRYGB with LSG on weight loss, metabolic control and adipocytokine levels.
Methods: Thirteen patients were randomized to LRYGB and 14 patients to LSG. Patients were investigated
before, 1 week, 3 months, and 12 months after surgery. A standard test meal was given after
an overnight fast, and blood samples were collected before and after food intake in both groups for
insulin,glucose and fasting adipocytokine concentrations.
Results: Body weight and BMI decreased markedly (P < 0.001) after either procedure. Excess BMI loss
did not differ significantly at 3 months (35±10% for LRYGB and 31±8% for LSG) and at 12 months
79±23% and 64±20% (p=0.08). HOMA index declined from preop 9.1 to 6.1 at 1 week and 4 after 3
months and reaching almost normal levels at 12 months in both groups. Concentrations of circulating
adiponectin significantly increased and leptin levels decreased progressively with weight loss after
surgery. FSG-21 levels did not change over time.
Conclusion: Both procedures were followed by a marked reduction in body weight and BMI associated
with improved glucose homeostasis. Serum leptin levels decreased and adiponectin levels increased
with weight loss, paralleled by improved insulin sensitivity.
18 swiss knife 2010; 7: special edition
21.2
Graft survival and complications following laparoscopic gastric banding for morbid obesity – lessons
learned from a 12-year experience
M. Naef, W. G. Mouton, U. Naef, O. Kummer, B. Muggli, H. E. Wagner (Thun)
Objective: Laparoscopic adjustable gastric banding has been considered by many as the treatment
of choice for morbid obesity, because of its simplicity and encouraging early results. The aim of this
prospective study was to critically assess the effects, complications and outcome following laparoscopic
Swedish adjustable gastric banding (SAGB) over the long term, based on a 12-year experience.
Methods: Between June 1998 and June 2009 all patients with implantation of a SAGB were enrolled
in a prospective clinical trial. Results were recorded and classified, with special regard to long term
complications, re-operation rate and graft survival.
Results: SAGB was performed in 167 patients (120 female, 47 male) with a mean age of 40.1±5.2
years. Operative mortality was 0%, overall 1.2% (not band-related). Overall patient follow-up was
94.0%. Mean excess weight loss (EWL) after 1, 2, 5 and 8 years was 31.1±7.5% (p