Excess Body Weight Loss Research Articles

Efficacy of a Required Preoperative Weight Loss Program for Patients Undergoing Bariatric Surgery

The efficacy of mandatory medically supervised preoperative weight loss (MPWL) prior to bariatric surgery continues to be a controversial topic. The purpose of this observational study was to assess the efficacy of a MPWL program in a single institution, which mandated at least 10 % excess body weight loss before surgery, by comparing outcomes of patients undergoing primary bariatric surgery with and without a compulsory preoperative weight loss regimen. We analyzed our database of 757 patients who underwent primary bariatric surgery between March 2008 and January 2015. Patients were placed into two cohorts based on their participation in a MPWL program requiring at least 10 % excess weight loss (EWL) prior to surgery. Patients were evaluated at 3, 6, 12, and 24 months after surgery for weight loss, comorbidity resolution, and the occurrences of hospital readmissions. A total of 717 patients met the inclusion criteria of whom 465 underwent surgery without a preoperative weight loss requirement and 252 participated in the MPWL program. One year after surgery, 67.1 % of non-participants and 62.5 % of MPWL participants showed a resolution of at least one of five associated comorbidities (p = 0.45). Non-participants showed an average of 58.6 % EWL, while MPWL participants showed 59.1 % EWL at 1 year postoperatively (p = 0.84). Readmission rates, excluding those which were ulcer-related, at 30 days (3.4 vs. 6.40 %, p = 0.11) and 90 days (9.9 vs. 7.5 %, p = 0.29) postoperatively were not significantly different between the non-participants and MPWL patients, respectively. A mandatory preoperative weight loss program prior to bariatric surgery did not result in significantly greater %EWL or comorbidity resolution 1 year after surgery compared to patients not required to lose weight preoperatively. Additionally, the program did not result in significantly lower 30- or 90-day readmission rates for these patients. The value of a MPWL program must be weighed against the potential loss of bariatric surgery candidates. Patients who fail to lose 10 % excess weight preoperatively are thus ineligible for a procedure from which they would otherwise benefit. Our data suggest these patients will have similar positive outcomes.

Weight loss after bariatric surgery: a propensity score analysis

BackgroundLaparoscopic vertical sleeve gastrectomy (LSG) has replaced laparoscopic Roux-en-Y gastric bypass (LRYGB) as the most commonly performed bariatric surgical procedure in the US for more than the past several years. Identifying which patients will achieve optimal outcomes remains challenging. We compared 90-d and 1-y outcomes between LSG and LRYGB patients and identified predictors of surgery type and excess body weight loss (EBWL). MethodsPatient demographics, comorbidities, and weight loss were extracted from electronic health records of patients who underwent LRYGB (n = 270) or LSG (n = 74) from January 2010 through March 2014 at a single institution. Variables hypothesized to be associated with surgery type were included in a multivariable model to generate a propensity score for each patient. Propensity score–adjusted multivariable odds ratios (ORs) for characteristics associated with EBWL >50% were calculated. ResultsOverall 90-d complication rates were similar between the LRYGB and LSG cohorts. LRYGB patients had more frequent emergency department visits (27.1% versus 14.1%; P = 0.029) but similar rates of readmission (12.3% versus 8.5%; P = 0.53). Female sex, presence of gastroesophageal reflux disease, and surgeon age ≥40 were associated with a greater likelihood of undergoing LRYGB. On propensity score–adjusted multivariable analysis, lower body mass index (OR 3.00 [95% confidence interval (CI) 1.66–5.40]), absence of type 2 diabetes (OR 2.55 [95% CI 1.43–4.54]), and undergoing LRYGB (OR 5.29 [95% CI 2.52–11.09]) were associated with EBWL >50%. ConclusionsSleeve gastrectomy patients had similar rates of complications compared with gastric bypass patients. Lower body mass index and absence of type 2 diabetes were associated with optimal weight loss. Incorporating these findings into preoperative discussions may help patients set reasonable postoperative goals.

One-year Surgical Outcomes and Costs for Medicaid Versus Non-Medicaid Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass: A Single-Center Study.

To compare 1-year outcomes and costs between severely obese Medicaid and non-Medicaid patients who underwent laparoscopic Roux-en-Y gastric bypass surgery. This is a single-institution retrospective review comparing 33 Medicaid patients to 99 randomly selected non-Medicaid patients (1:3 case-control). Ninety-day and 1-year outcomes were extracted from the electronic health record. Costs were obtained from the UW information technology division. Bivariate analyses were used to compare study variables. Emergency department visits (48.2% vs. 27.4%; P=0.06) and readmissions (37.0% vs. 14.7%; P=0.01) were more common for Medicaid patients. Medicaid patients had less excess body weight loss (50.7% vs. 65.6%; P=0.001) but similar comorbidity resolution and complication rates. One-year median costs were similar between Medicaid and non-Medicaid patients ($21,160 vs. $24,215; P=0.92). One-year comorbidity resolution, complications, and costs following laparoscopic Roux-en-Y gastric bypass were similar between Medicaid and non-Medicaid patients. Focusing on reducing emergency department presentations and readmissions would be a high-impact area for future quality improvement initiatives.

Is Endoluminal Bariatric Therapy a New Paradigm ofTreatmentfor Obesity?

The prevalence of obesity has steadily increased throughout recent decades, and along with it, the costs of caring for the associated comorbid conditions has increased as well. Traditional bariatric surgical procedures generally are safe and effective, but patient acceptance, the risk of minor and sometimes serious complications, costs, and insurance coverage have limited the application of these techniques to the treatment of a minority of patients. Endoluminal techniques represent newer approaches to weight loss that can be used independently or in concert with traditional medical and surgical treatments for obesity, with varying degrees of success. It is anticipated that less invasiveness will increase the appeal across a broader representation of patients, perhaps increasing the number of obese patients who choose an intervention over medical management and possibly resulting in a greater total loss of excess body weight across a population; this may reduce costs involved in treating the complications of weight-related comorbidities. Acceptance of endoluminal bariatric procedures and devices will hinge on proving safety, efficacy, and value.

Excess Body Weight Loss After Laparoscopic Gastric Plication

Gastric plication was selected for cases with potential for continuous diet and exercise after operation. The appetite of patients decreased after operation due to total gastric volume restriction. The study aimed at finding if it is worth or not to plicate in relation to excess body weight loss (EBWL). 47 patients were enrolled in the study between May 2014 till Nov 2015 with follow up till Nov 2015 with body mass index (BMI) of 38 -65. Laparoscopic gastric placation (LGP) was done to all using two rows of continuous o prolene thread aided with harmonic scalpel. BMI and EBW were calculated prior to LGP then EBWL was estimated at six months and one year. The following scale was applied regarding EBWL 0- 14 %failure, 15% -39% poor, 40%- 69% medium, 70% or more excellent outcome, while regain of 10% or more marked as regain. We had one (2.1%) deplication, six (12.7%) regained weight, two (4.2%) failures, fourteen (29.7%) poor, sixteen (34%) medium outcome and eight (17%) with excellent outcome regarding EBWL. We concluded that it is very difficult to roll out LGP, we found it is worth to do LGP although only 17% got excellent EBWL and 34% got medium EBWL which was acceptable to those patients which represent more than 50% of our patients. This acceptance was supported by the low cost, safety and the potential reversibility of the procedure.

Selective Serotonin Re-uptake Inhibitors (SSRIs) Induced Weight Changes: A Dose and Duration Dependent Study on Albino Rats.

Selective Serotonin Re-uptake Inhibitors (SSRIs) are the most significant and safe drugs among the antidepressants. Fluoxetine is the prototype drug of SSRIs. Various clinical studies showed that SSRI causes change in body weight in patients. This study was conducted to know the extent of weight change with different doses for different durations. The aim of this study was to find out whether fluoxetine causes weight gain or weight loss, and to deduce the comparative weight change after intraperitoneal injection of fluoxetine for different duration and doses. Present study was conducted on 72 adult (36 males and 36 females) albino rats, in 3 phases of 2 weeks, 4 weeks and 12 weeks duration. Each phase consisted of 24 (12 males and 12 females) albino rats. These 24 rats were further randomly subdivided into 4 Groups of 6 albino rats each (3 males & 3 females). Group 1(Control) received normal saline (vehicle). Rest 18 rats of each phase were experimental rats, of Group 2, Group 3 and Group 4 (6 rats each). Group 2, group 3 and group 4 experimental rats received 10mg/kg, 20 mg/kg and 40mg/kg of intraperitoneal injection of fluoxetine respectively. All rats were weighed on each day for growth monitoring. Data was subjected to statistical analysis (Mean, standard deviation and Student's t-Test). All experimental group rats which received fluoxetine showed decrease of body weight. Rats which received high doses of fluoxetine could not tolerate the drug for more than two weeks and died due to excessive body weight loss, loose stools and muscle twitching. Present study conclude that SSRIs can cause weight change in the form of decrease of body weight. This property of SSRIs can be used clinically by prescribing these drugs to obese psychiatric patient without any fear of withdrawal of drug.

Revisional bariatric surgery: A review of the current recommendations

Revisional bariatric surgery is increasingly becoming popular as the number of primary procedures for the treatment of obesity gains popularity. It is estimated that about 10% of patients who underwent a bariatric procedure will need revisional surgery. The most common indications for revisional bariatric surgery are inadequate weight loss (<25% of excess body weight loss) and weight regain (gain of more than 10 kg based on the nadir weight); however, procedure-specific complications are also indication of the need for revisional surgery. In this article, we review the current most common bariatric procedures with its complications, indications for revision, alternative procedures, and outcomes.

Laparoscopic sleeve gastrectomy for morbid obesity: does the size of the bougie matter?

Background Laparoscopic sleeve gastrectomy (LSG) is a safe and effective surgical treatment modality for morbid obesity. Variations in surgical technique could affect the results. The optimal size of the bougie remains controversial. The aim of this study was to evaluate the first-year outcome of LSG using two different sizes of bougies. Patients and methods Between March 2011 and January 2014, 102 morbidly obese patients underwent LSG. These patients were divided into two groups: group 1 (50 patients) and group 2 (52 patients). In group 1, 32-Fr bougies (orogastric calibration tube) were used, and in group 2 40-Fr bougies were used. Patients completed at least 6 months of follow-up visits. Results The excess body weight loss percentage in group 1 was 53.6 ± 10.96% at 6 months and 69.4 ± 15.6% at 1 year postoperatively, whereas in group 2 it was 52.7 ± 11.27% at 6 months and 66.4 ± 13.4% at 1 year postoperatively, with no statistically significant difference between the two groups. There were neither intraoperative complications nor postoperative mortalities. The overall complication rate was 14.7% (15 patients) with no statistically significant difference between the two groups (14% in group 1 vs. 15.4% in group 2). The postoperative hospital stay was 2.3 days in group 1 versus 2.2 days in group 2. There was 58.8% complete resolution of diabetes mellitus, 60% resolution of hypertension, and 87.5% resolution of sleep apnea 6 months after sleeve gastrectomy with no statistically significant difference between the two groups. Conclusion LSG is a safe and effective treatment method for morbid obesity. Bougie size does not affect the short-term outcomes.

Assessment of two different diagnostic guidelines criteria (National Cholesterol Education Adult Treatment Panel III [ATP III] and International Diabetes Federation [IDF]) for the evaluation of metabolic syndrome remission in a longitudinal cohort of patients undergoing Roux-en-Y gastric bypass

Bariatric surgery has proven to provide durable weight loss and control of comorbid conditions, including the metabolic syndrome (MS). Existing definitions of MS have caused substantial confusion regarding their concordance for identifying the same individuals. The aim of this study was to assess the value of 2 different diagnostic guidelines criteria (National Cholesterol Education Adult Treatment Panel III [ATP III] and International Diabetes Federation [IDF]) for the evaluation of remission of MS after Roux-en-Y gastric bypass (RYGB). A cohort of 381 patients who underwent a primary RYGB, satisfied the criteria for MS, and had at least o1 postoperative visit were selected. Weight loss and MS remission were analyzed 6 and 12 months after surgery by ATP III and IDF criteria. Before surgery, 381 (48.9%) and 354 (45.4%) patients fulfilled the criteria for MS according to the ATP III and IDF, respectively. According to the ATP III definition, remission of MS after bariatric surgery occurred in 209 of 239 (87.4%) and 98/102 (96.1%) patients at 6 and 12 months, respectively. According to the IDF definition, this occurred in 180 of 232 (77.6%) and 54 of 64 (84.4%) at the same time periods. On the basis of different percentage of excess body weight loss cut-off values, the area under the curve in receiver operating characteristic analysis at 12 months was slightly better for ATP III (0.77) than IDF criteria (0.68) for remission of MS. With the use of the IDF definition, the remission rate of MS was 10% more rigorous than with use of the ATP-III criteria. This feature is attributable to a greater discrimination of patients with high blood pressure, glycemia, and dyslipidemia. The IDF criteria seem more accurate to evaluate MS remission.

Effect of weight loss on abnormal 24-hour blood pressure patterns in severely obese patients

BackgroundNocturnal hypertension (night systolic [S]/diastolic [D] blood pressure [BP]≥120/70 mm Hg), nondipper status (nocturnal BP fall<10% of daytime values), and pulse pressure ([PP]; difference between 24-h SBP and DBP readings) are associated with increased risk of cardiovascular disease. We evaluated the 1-year effect of significant surgical weight loss (WL) on abnormal BP patterns in patients with and without hypertension and identified the factors involved. SettingUniversity hospital, Spain. MethodsThis prospective study included 42 patients (28 normotensive [NT] and 14 hypertensive [HT]), 71% women with a mean age (standard deviation [SD]) of 48 (11) years undergoing bariatric surgery (BS): 22 laparoscopy Roux-en-Y gastric bypass (LRYGB) and 20 sleeve gastrectomy (SG). SG: 20. Before and 12 months post-BS, anthropometric data, BP (24-h ambulatory BP measurement), and metabolic parameters were determined. At 12 months post-BS ultrasonographic carotid assessment was performed in a subgroup of patients (22). ResultsBoth groups experienced significant WL (percent of excess body weight loss [%EBWL] 68%), a fall in 24-h SBP of−13 (11)/DBP−3 (7) mm Hg, and improvement in all the metabolic parameters evaluated and the homeostatic model assessment of insulin resistance (HOMA-IR). However, nondipper status remained high in NT (54%) and HT (64%) as well as 60% of the patients with carotid plaque. Additionally, in HT patients nocturnal hypertension and PP remained significantly higher, and basal fasting insulin values and the HOMA-IR score were significantly higher in those not normalizing dipper status. ConclusionSurgery-induced WL was associated with a sizeable decline in BP and metabolic parameters improvement. However, independent of the presence of hypertension, the prevalence of abnormal 24-h BP patterns remained high, and thus, cardiovascular risk continued to be high in these patients.

Laparoscopic adjustable gastric banding in adolescents: Results at two years including psychosocial aspects

Background/purposeObesity now affects 3%–4% of the pediatric population and contributes to the increase in cardiac mortality in adulthood. Bariatric surgery is the best treatment for weight loss and the obesity-associated comorbidities in adults. We report here our experience of laparoscopic adjustable gastric banding (LAGB) in adolescents. MethodsThe medical charts of the first 16 patients operated on in our center were reviewed. Data were compiled concerning weight loss, physical and biological comorbidities, health-related quality of life (QOL) and surgical complications before surgery and during 24months of follow-up. ResultsThe maximal pre-operative median body mass index was 43.0kg·m−2, decreasing to 33.0kg·m−2 at 2years post-LAGB, which corresponded to a 49.2% excess body weight loss (p<0.001). Most comorbidities (glucose intolerance, hypertension and sleep apnea) resolved within the first year post-LAGB and QOL was improved on the PedsQL™ scales. No severe surgical complications were noted, with only three re-interventions for device failure (2) or band removal (1). ConclusionLAGB is well tolerated in adolescents and shows a beneficial impact on weight loss and obesity-related comorbidities. Associated with global management, it may have a positive impact on patients' QOL and social and psychological status.

Circulating SIRT1 Increases After Intragastric Balloon Fat Loss in Obese Patients.

Sirtuins (SIRTs), ubiquitous deacetylases, are main regulators of energy homeostasis and metabolism. SIRT1 has a positive impact on obesity, diabetes mellitus, liver steatosis, and other metabolic disorders. Lean subjects have higher expression of SIRT1 in the adipose tissue compared to obese. However, it is not known whether weight loss associates with changes in blood SIRT1. We evaluated the effect of weight loss on circulating SIRT1, metabolic parameters, and body composition. Thirty-two obese subjects were studied before and 6months after BioEnterics® Intragastric Balloon (BIB®) [22 patients, BMI 41.82 ± 6.28kg/m(2)] or hypocaloric diet [10 patients, BMI 38.95 ± 6.90kg/m(2)]. Plasma SIRT1, body composition, measures of metabolic syndrome (waist circumference, fasting plasma glucose, blood pressure, HDL cholesterol, triglycerides), and inflammation markers (ESR, CRP, fibrinogen) were recorded. SIRT1 levels showed a significant increase, together with a significant reduction of BMI, excess body weight, and total fat mass either after BIB or diet intervention. The percent excess body weight loss was 33.73 ± 19.06 and 22.08 ± 11.62% after BIB and diet, respectively, a trend toward a metabolic and inflammatory amelioration was observed with both treatments. Negative correlation between SIRT1 and % fat mass (BIB, ρ = -0.537, p = 0.017; diet, ρ = -0.638, p = 0.047) was also seen. The reduction of fat mass associates with increased plasma SIRT1 indicating that, besides tissue levels, circulating SIRT1 is stimulated by a negative caloric balance. The rise of plasma SIRT1 may represent a parameter associating with fat loss rather than weight lowering regardless of the weight reduction system method used.

Observed Variability in Sleeve Gastrectomy Volume and Compliance Does Not Correlate to Postoperative Outcomes.

Restrictive bariatric procedures reduce gastric capacity as a primary mechanism of action. Intraoperatively, surgeons observe variability in size and compliance of specimens. We hypothesized that higher gastric specimen volume or tissue compliance would respond better to restrictive procedures. Consecutive patients undergoing laparoscopic sleeve gastrectomy between September 2012 and September 2013 were enrolled. Specimens were insufflated at graduated pressure points creating pressure volume curves, and compliance was calculated. Postoperative weight loss and a hunger scores were recorded. Correlations were determined by Spearman correlation. Eighty-four patients consented to enrollment. Mean age, weight, and body mass index (BMI) were 45 ± 12 years, 126 ± 23 kg, and 45.4 ± 6 m/kg2, respectively. The resected specimens varied in insufflated capacity from 0.3 to 1.8 (0.71 ± 0.32) L and compliance varied from 14.3 to 85.7 (36.1 ± 14.7) cc/mm Hg. Male patients had a larger greater curvature length (GCL) (P < 0.001), staple line length (SLL) (P = 0.03), gastric volume (GV) (P = 0.002), and gastric compliance (GC) (P < 0.001). Neither GV nor GC correlated to excess body weight loss (EBWL%) as hypothesized. There was an inverse correlation between hunger score and GV (P = 0.010). The mean 1-month, 3-month, 6-month, and 12-month EBWL was 17.4%, 33.2%, 43.7%, and 54.1%, respectively. Follow-up was 71.4% at 1 month, 39.3% at 3 months, 54.8% at 6 months, and 42.9% at 12 months. Sleeve gastrectomy specimens exhibit nearly 6-fold variability in both volume and compliance. A large GC is anticipated in male and tall subjects. These observations do not appear to be correlated to %EBWL.

Improvement in severe pulmonary hypertension in obese patients after laparoscopic gastric bypass or sleeve gastrectomy.

Case reports have suggested that bariatric surgery improves pulmonary hypertension. We performed a retrospective, case-control study to evaluate the safety and efficacy of bariatric surgery in obese patients with severe pulmonary hypertension. Morbidly obese patients followed in a specialty pulmonary hypertension clinic who underwent laparoscopic gastric bypass or sleeve gastrectomy between 2008 and 2013 (n = 10) were compared to a BMI-matched cohort managed with maximal medical therapy (n = 10). Patients with advanced malignancy, prior heart/lung transplantation, and pulmonary hypertension from thromboembolism were excluded. Primary outcomes assessed were changes in use of pulmonary vasodilatory and diuretic medications, need for home oxygen therapy, and mean pulmonary arterial pressures. Secondary outcomes measured were excess body weight loss, perioperative mortality and morbidity, and hospital length of stay. More patients who underwent bariatric surgery experienced improvements in pulmonary arterial pressures (75 vs. 0%, p = 0.02), reduction in or discontinuation of pulmonary vasodilatory therapy (67 vs. 0%, p = 0.01), and decreased diuretic requirements (86 vs. 13%, p = 0.01) than the control cohort. Seventy-five percent of patients previously on home oxygen discontinued therapy after surgery, while oxygen requirements increased in 50% of the control cohort. Excess body weight loss was greater in the surgical group (EWL 68 vs. 19%, p < 0.001). Seven significant complications in five patients occurred in the first postoperative year, but there were no mortalities. Mean inpatient length of stay was 5 days. Laparoscopic gastric bypass and sleeve gastrectomy in obese patients improves pulmonary hypertension in the short term.

Effects of Sorafenib Dose on Acquired Reversible Resistance and Toxicity in Hepatocellular Carcinoma.

Acquired evasive resistance is a major limitation of hepatocellular carcinoma (HCC) treatment with the tyrosine kinase inhibitor (TKI) sorafenib. Recent findings suggest that resistance to sorafenib may have a reversible phenotype. In addition, loss of responsiveness has been proposed to be due to a gradual decrease in sorafenib plasma levels in patients. Here, the possible mechanisms underlying reversible sorafenib resistance were investigated using a Hep3B-hCG orthotopic human xenograft model of locally advanced HCC. Tissue and plasma sorafenib and metabolite levels, downstream antitumor targets, and toxicity were assessed during standard and dose-escalated sorafenib treatment. Drug levels were found to decline significantly over time in mice treated with 30 mg/kg sorafenib, coinciding with the onset of resistance but a greater magnitude of change was observed in tissues compared with plasma. Skin rash also correlated with drug levels and tended to decrease in severity over time. Drug level changes appeared to be partially tumor dependent involving induction of tumoral CYP3A4 metabolism, with host pretreatment alone unable to generate resistance. Escalation from 30 to 60 mg/kg sorafenib improved antitumor efficacy but worsened survival due to excessive body weight loss. Microvessel density was inhibited by sorafenib treatment but remained suppressed over time and dose increase. In conclusion, tumor CYP3A4 induction by sorafenib is a novel mechanism to account for variability in systemic drug levels; however, declining systemic sorafenib levels may only be a minor resistance mechanism. Escalating the dose may be an effective treatment strategy, provided toxicity can be controlled.

Robotic sleeve gastrectomy for morbid obesity: report of a 5 year experience.

Robotic bariatric procedures are nowadays in the surgeon's arsenal for the treatment of morbid obesity. With proven efficacy and advantages in gastric bypass procedures, we attempted to employ robotics and study the results in the other major bariatric procedure, sleeve gastrectomy. We used the da Vinci S® system to perform 19 robotic sleeve gastrectomies (RSGs) and reviewed the 5-year results as far as excess body weight loss is concerned, and amelioration of obesity-related comorbidities. Mean percentage of excess body weight loss (%EWL) was 64.4%, 67.1%, 61.7%, 63.1%, 64.8% for the first, second, third, fourth and fifth year, respectively. Neither of our two patients with diabetes mellitus (0%) or hypertension (0%) showed remission, while all six of our patients (100%) showed remission of their sleep apnoea after 5 years. Robotic sleeve gastrectomy is an effective procedure as far as initial excess weight loss is concerned and this loss is well maintained 5 years post-operatively, a finding similar to relevant data after conventional laparoscopic sleeve gastrectomy. Copyright © 2015 John Wiley & Sons, Ltd.

Internal Hernia After Laparoscopic Antecolic Roux-en-Y Gastric Bypass

We evaluated the incidence and presentations of internal hernias (IH) after laparoscopic antecolic Roux-en-Y gastric bypass (RYGB) at our institution. We retrospectively reviewed the records of 594 patients who underwent laparoscopic antecolic RYGB at our institution between December 2004 and December 2010. Five hundred ninety-four patients underwent laparoscopic antecolic RYGB with a mean follow-up of 50.5 months. Thirty-six patients developed 37 IH (6.2 %) requiring surgical intervention. Mean age of IH patients was 36.9 years. Thirty-one out of 36 were female. Mean preoperative BMI was 44.3 Kg/m(2). The mean time of presentation after their RYGB was 25.9 months. The mean % excess body weight loss at time of presentation was 54.0 %. Twenty-five out of 37 of IH occurred at Petersen's space; 9/37 IH occurred under the jejunojejunostomy; three patients had hernias at both locations. Mesenteric swirling was the most common CT scan finding in 20/36 (55.6 %). Six out of 36 CT were initially read as normal; however, on retrospective review by a radiologist, abnormalities indicating IH were found in 4/6. Patients presented with different degrees of acuity: 6/37 with chronic abdominal pain and 28/37 with acute abdominal pain. Bowel necrosis was found in 3/37. IH is a serious and potentially fatal complication of RYGB. Presentation can vary from chronic abdominal pain to bowel necrosis. CT is helpful in providing diagnosis; however, careful attention to the specific signs of small bowel volvulus, such as mesenteric swirl sign, should be given. IH should be considered in RYGB patients who present with even vague symptoms.

PWE-151 A 'long, tight' laparoscopic sleeve gastrectomy is safe, effective and improves quality of life in an elderly population

Introduction Laparoscopic Sleeve Gastrectomy (LSG) is an increasingly popular procedure for the management of obesity. Despite good evidence to support the efficacy of LSG, there is a paucity of data in relation to outcomes in the elderly. Here we present our initial experience. Method Data from 38 patients aged 60 years or over, who underwent LSG within a single surgeon experience of 712 cases between 2007 and 2013 was analysed. A long, tight' sleeve was performed over a 29Fr bougie. A prospectively maintained database included information on patient demographics, Body Mass Index (BMI), excess body weight loss (EBWL), complications and comorbidity resolution. Quality of life was assessed using the Impact of Weight on Quality of Life Questionnaire - Lite (IWQOL-Lite) tool. Results 12 patients were male (31.6%) and 26 were female (68.4%). The mean age at the time of surgery was 64.1 +/- 1.0 years and the mean pre-operative BMI was 44.4 +/- 2.1 kg/m2 (range 34.9 – 60.7, 95% CI). Follow-up rates were 100% at 6 months, 93% at 12 months and 74% at 24 months. Mean EBWL at 6 months, 12 months and 24 months was 64%, 72% and 80%, respectively. The prevalence of comorbidity in the cohort pre-operatively was: diabetes mellitus 57.9% (n = 22), obstructive sleep apnoea 36.8% (n = 14) and hypertension 65.8% (n = 25). Diabetes resolved in 31.8% of subjects and improved in 54.5%. Sleep apnoea resolved in 50% of patients and 28.6% reported an improvement. Hypertension resolved in 48% of our cohort, with an improvement evident in 24%. At a mean of 21.2 months, all patients who had completed the IWQOL-Lite questionnaire reported an improvement in quality of life. A lower percentage score indicates a better quality of life. The mean IWQOL-Lite score was significantly lower following a long, tight' LSG, 29.6% vs. 59.1% pre-operatively (p < 0.001). There were no deaths or leaks within the elderly cohort. No patients required endoscopic dilatation post-operatively. One patient was re-operated on for hiatus hernia/reflux following LSG. The incidence of post-operative venous thromboembolism was higher in the elderly group following LSG, 5.3% (n = 2) vs. 0.5% (n = 3) in the 674 patients under the age of 60. Conclusion Our data supports the 'long, tight' LSG as an option for the surgical management of obesity and metabolic disease in the elderly. It is safe and effective in terms of weight loss and comorbidity resolution within a population over 60 years of age. Furthermore, we have demonstrated an improvement in quality of life within this patient group. Disclosure of interest None Declared. Reference 1. Willkomm CM, Fisher TL, Barnes GS, Kennedy CI, Kuhn JA. Surgical weight loss >65 years old: is it worth the risk? Surg Obes Relat Dis. 2010;6(5):491-496

Biliopancreatic Diversion With Duodenal Switch. Long Term Weight Loss

Summary Biliopancreatic derivation with duodenal switch (BPDDS) as an operative technique in the management of morbid obesity was created as an alternative to BPD (Scopinaro's operation), because of BPD-DS's fewer malabsorption side effects, better restrictive effect to the stomach remnant, fewer peptic ulcers and dumping syndromes, as well as lower morbidity and mortality rate. Between January 2003 and June 2012 in the University Hospital Center of Albacete, 141 patients with morbid obesity underwent BPD-DS. The patients were divided in groups according to four criteria: length of the common channel, age, gender and initial Body Mass Index. On the 6th postoperative year in our study the percent of excessive body weight loss was 67.6% and the percentage of excessive BMI loss was 73%. According to the evaluation announced by Hess D.S. &amp; Hess D.W, our results could be assessed as successful after 6 months, good on the first year, excellent on the second, and good from 3rd to 9th postoperative years. Our results confirm the hypothesis that the biliopancreatic derivation with duodenal switch is a bariatric intervention, which leads to a significant weight loss, well preserved in time.

The relationship of quality of life of patients, body weight and comorbidities in different periods after surgical treatment of morbid obesity

The main goal of any surgical intervention in morbid obesity is to improve the quality of life of patients which is considered directly related to the loss of excess body weight and a reduction in the incidence of related diseases. The aim of this study was to determine the interdependence of these indicators. In 2005-2013 we performed 457 operations of gastric banding (GB) and 198 - gastric bypass (GBP). After GB only body mass index (BMI) and quality of life index (QOL) had significant linear correlation, i.e., the higher the weight of the patient, the worse the quality of life. After GBP there was is a significant linear relationship only between the patient's body weight and dynamics of comorbidities, i.e. the higher the weight of the patient, the higher the level of comorbidity. The QOL of patients after GBP does not depend on the body weight or on the frequency of comorbidities.