Laparoscopic Gastric Banding Surgery Research Articles

S3582 Disguised as Post-Operative Ileus: A Case of a Giant Gastric Ulcer Causing Outlet Obstruction and Gastric Pneumatosis

Introduction: Giant gastric ulcers (GGU), defined as ulcers larger than 2-3cm, are relatively rare in the setting of widespread proton pump inhibitor (PPI) use. Though usually located in the lesser curvature, GGU may occur in any part of the stomach. Typical symptoms are similar to that of peptic ulcer disease (PUD), i.e. epigastric pain and gastrointestinal bleeding, however GGU are highly prone to perforation and are more likely to be malignant in the elderly. Overall, gastric outlet obstruction is the least common complication of PUD. Case Description/Methods: A 74-year-old obese male with history diabetes, sleep apnea, and prior laparoscopic gastric banding surgery was admitted for elective surgery for Charcot arthropathy. Post-operatively, he developed nausea, vomiting and abdominal bloating. Abdominal x-ray showed distention of the small bowel concerning for ileus. Exam showed a non-tender abdomen with distention and tympany on percussion. His emesis resolved with antiemetics, however distention persisted despite passing gas and stool. Three days after surgery, he developed acute anemia without overt bleeding requiring blood transfusions. Abdominal X-ray and CT was performed which showed marked gaseous distention of the stomach and gastric wall pneumatosis. Nasogastric tube was placed for decompression with subsequent resolution of his distention. Due to concern for gastric band erosion, Gastroenterology was consulted. Upper endoscopy was performed which revealed a 4cm clean-based ulcer with overlaying eschar along the greater curvature with surrounding erythema and edema. Biopsies of the ulcer border showed acute erosive gastropathy with focal clustering of eosinophils without evidence of dysplasia. He was started on PPI and sucralfate, and remained clinically stable without further gastrointestinal symptoms. (Figure) Discussion: Gastric pneumatosis due to gastric emphysema is caused by disruption of mucosa leading to air migrating into the gastric wall. Etiologies vary, including injury from instrumentation, severe vomiting, pulmonary pathology, penetrating gastric ulcers, or gastric outlet obstruction. Few cases reports have described gastric emphysema resulting from gastric band erosion, however there are no reports describing this occurring in the absence of full erosion. Overall, gastric emphysema is relatively rare, as is development of GGU. To our knowledge, this is the first reported case of unperforated giant gastric ulcer resulting in outlet obstruction with gastric pneumatosis.Figure 1.: CT abdomen showing marked gaseous distention of the stomach and gastric wall pneumatosis (Figure 1a). Upper endoscopy findings of a friable, erythematous giant ulcer with clean-base overlaying the greater curvature with significant surrounding erythema and edema in the fundus/cardia (Figure 1b and 1c), as well as multiple surrounding small ulcerations, some with clean-base and some with flat pigmented spots, throughout (not pictured). No evidence of active bleeding, visible vessel, or high-risk features for bleeding.

Surgery for the treatment of obesity in children and adolescents.

Child and adolescent overweight and obesity have increased globally and are associated with significant short- and long-term health consequences. To assess the effects of surgery for treating obesity in childhood and adolescence. For this update, we searched Cochrane Central Register of Controlled Trials, MEDLINE, Latin American and Caribbean Health Science Information database (LILACS), World Health Organization International Clinical Trials Registry Platform (ICTRP)and ClinicalTrials.gov on 20 August 2021 (date of the last search for all databases). We did not apply language restrictions. We checked references of identified studies and systematic reviews. We selected randomised controlled trials (RCTs) of surgical interventions for treating obesity in children and adolescents (age < 18 years) with a minimum of six months of follow-up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or which included participants with a secondary or syndromic cause of obesity, or who were pregnant. We used standard methodological procedures expected by Cochrane. Two review authors independently extracted data and assessed the risk of bias using the Cochrane Risk of Bias 2.0 tool. Where necessary, we contacted authors for additional information. With this update, we did not find any new RCTs. Therefore, this updated review still includes a single RCT (a total of 50 participants, 25 in both the intervention and comparator groups). The intervention focused on laparoscopic adjustable gastric banding surgery, which was compared to a control group receiving a multi-component lifestyle programme. The participating population consisted of Australian adolescents (a higher proportion of girls than boys) aged 14 to 18 years, with a mean age of 16.5 and 16.6 years in the gastric banding and lifestyle groups, respectively. The trial was conducted in a private hospital, receiving funding from the gastric banding manufacturer. For most of the outcomes, we identified a high risk of bias, mainly due to bias due to missing outcome data. Laparoscopic gastric banding surgery may reduce BMI by a mean difference (MD) of -11.40 kg/m2 (95% CI -13.22 to -9.58) and weight by -31.60 kg (95% CI -36.66 to -26.54) compared to a multi-component lifestyle programme at two years follow-up. The evidence is very uncertain due to serious imprecision and a high risk of bias. Adverse events were reported in 12/25 (48%) participants in the intervention group compared to 11/25 (44%) in the control group. A total of 28% of the adolescents undergoing gastric banding required revisional surgery. The evidence is very uncertain due to serious imprecision and a high risk of bias. At two years of follow-up, laparoscopic gastric banding surgery may increase health-related quality of life in the physical functioning scores by an MD of 16.30 (95% CI 4.90 to 27.70) and change in health scores by an MD of 0.82 (95% CI 0.18 to 1.46) compared to the lifestyle group. The evidence is very uncertain due to serious imprecision and a high risk of bias. No data were reported for all-cause mortality, behaviour change, participants' views of the intervention and socioeconomic effects. Finally, we have identified three ongoing RCTs that are evaluating the efficacy and safety of metabolic and bariatric surgery in children and adolescents. Laparoscopic gastric banding led to greater body weight loss compared to a multi-component lifestyle program in one small study with 50 participants. These results have very limited application, primarily due to more recent recommendations derived from observation studies to avoid the use of banding in youth due to long-term reoperation rates. This systematic review update still highlights the lack of RCTs in this field. The authors are concerned that there may be ethical barriers to RTCs in this field, despite the lack of other effective therapies for severe obesity in children and adolescents and the significant morbidity and premature mortality caused by childhood obesity. Nevertheless, future studies, whether pre-registered and planned non-randomised or pragmatic randomised trials, should assess the impact of the surgical procedure and post-operative care to minimise adverse events, including the need for post-operative adjustments and revisional surgery. Long-term follow-up is also critical to comprehensively assess the impact of surgery as participants enter adulthood.

Skeletal muscle mitochondrial network dynamics in metabolic disorders and aging

With global demographics trending towards an aging population, the numbers of individuals with an age-associated loss of independence is increasing. A key contributing factor is loss of skeletal muscle mitochondrial, metabolic, and contractile function. Recent advances in imaging technologies have demonstrated the importance of mitochondrial morphology and dynamics in the pathogenesis of disease. In this review, we examine the evidence for altered mitochondrial dynamics as a mechanism in age and obesity-associated loss of skeletal muscle function, with a particular focus on the available human data. We highlight some of the areas where more data are needed to identify the specific mechanisms connecting mitochondrial morphology and skeletal muscle dysfunction.

Effect of Medical and Surgical Interventions on α-Cell Function in Dysglycemic Youth and Adults in the RISE Study.

To compare effects of medications and laparoscopic gastric band surgery (LB) on α-cell function in dysglycemic youth and adults in the Restoring Insulin Secretion (RISE) Study protocols. Glucagon was measured in three randomized, parallel, clinical studies: 1) 91 youth studied at baseline, after 12 months on metformin alone (MET) or glargine followed by metformin (G/M), and 3 months after treatment withdrawal; 2) 267 adults studied at the same time points and treated with MET, G/M, or liraglutide plus metformin (L+M) or given placebo (PLAC); and 3) 88 adults studied at baseline and after 12 and 24 months of LB or MET. Fasting glucagon, glucagon suppression by glucose, and acute glucagon response (AGR) to arginine were assessed during hyperglycemic clamps. Glucagon suppression was also measured during oral glucose tolerance tests (OGTTs). No change in fasting glucagon, steady-state glucagon, or AGR was seen at 12 months following treatment with MET or G/M (in youth and adults) or PLAC (in adults). In contrast, L+M reduced these measures at 12 months (all P ≤ 0.005), which was maintained 3 months after treatment withdrawal (all P < 0.01). LB in adults also reduced fasting glucagon, steady-state glucagon, and AGR at 12 and 24 months (P < 0.05 for all, except AGR at 12 months [P = 0.098]). Similarly, glucagon suppression during OGTTs was greater with L+M and LB. Linear models demonstrated that treatment effects on glucagon with L+M and LB were largely associated with weight loss. Glucagon concentrations were reduced by L+M and LB in adults with dysglycemia, an effect principally attributable to weight loss in both interventions.

Predictors of the effect of bariatric surgery on knee osteoarthritis pain

Bariatric surgery reduces obesity and knee osteoarthritis (OA) pain, but some patients improve more than others. We aimed to identify characteristics that predict this knee pain improvement. We reviewed NYU Langone Health bariatrics records (2002-2015) and called eligible patients reporting pre-operative knee pain. Patients were asked to rate their pain on a 10-point scale at three time points: before surgery, one year post-surgery, and time of survey administration. Subjects were asked about pre-operative knee injuries and surgeries, presence of OA in other joints, and OA family history. Data were analyzed using paired t-tests and ANOVA. Of 125 eligible patients reporting knee pain, we analyzed the 120 patients who had laparoscopic gastric band (LAGB) surgery. The cohort was 78.3% female, with an average age at surgery of 49.7 ± 10.2 years. There was no correlation between pre-operative body mass index (BMI) and knee pain reduction at one year post-LAGB, but the subgroup with the most BMI improvement reported the most knee improvement (p = 0.043). We found significantly better pain reduction after one year in younger patients (p = 0.009). Those with prior knee injuries improved less than those who were injury-free (p = 0.044), but a history of prior knee surgery was not similarly significant. Patients with multifocal OA improved less (p = 0.001). Younger knee OA patients and those without prior knee injury or other OA involvement, experience more knee pain relief from LAGB weight loss surgery. LAGB may be a viable treatment option for knee OA pain, irrespective of the degree of obesity.

Reoperation and Medicare Expenditures After Laparoscopic Gastric Band Surgery

Following the US Food and Drug Administration approval for laparoscopic gastric band surgery in 2001, as many as 96 000 devices have been placed annually. The reported rates of reoperation range from 4% to 60% in short-term studies; however, to our knowledge, few long-term population-level data on outcomes or expenditures are known. To describe the rate of device-related reoperations occurring after laparoscopic gastric band surgery as well as the associated payments in a longitudinal national cohort. This retrospective review of 25 042 Medicare beneficiaries who underwent gastric band placement between 2006 and 2013 identifies gastric band-related reoperations, including device removal, device replacement, or revision to a different bariatric procedure (eg, a gastric bypass or sleeve gastrectomy). The rates of reoperation were risk adjusted using a multivariable logistic regression model that included patient age, sex, race/ethnicity, Elixhauser comorbidities, and the year that the operation was performed. Rate of device-related reoperation nationally and across individual hospital referral regions. Thirty-day total episode Medicare payments to hospitals for the index operation and any subsequent reoperations. Of the 25 042 patients who underwent gastric band placement, 20 687 (82.61%) were white, 18 143 (72.45%) were women, and the mean age was 57.56 years. Patients (mean age, 57.5; 76.2% women) requiring reoperation had lower rates of hypertension (64.9% vs 73.4%; P < .001) and diabetes (40.4% vs 44.6%; P < .001) and were more likely to have their index operation at a for-profit hospital (34.6% vs 22.0%; P < .001). With an average of 4.5-year follow-up, 4636 patients (18.5%) underwent 17 539 reoperations (an average of 3.8 procedures/patient). Hospital referral regions demonstrated a 2.9-fold variation in risk- and reliability-adjusted rates of reoperation (lower quartile average, 13.3%; upper quartile average, 39.1%). During the study period, Medicare paid $470 million for laparoscopic gastric band associated procedures, of which $224 million (47.6%) of the payments were for reoperations. From 2006 to 2013, the proportion of payments from Medicare for reoperations increased from 16.4% to 77.3% of their annual spending on the gastric band device. Among Medicare beneficiaries undergoing gastric band surgery, device-related reoperation was common, costly, and varied widely across hospital referral regions. These findings suggest that payers should reconsider their coverage of the gastric band device.

A comparison of outcomes of bariatric surgery in patient greater than 70 with 18 month of follow up.

BackgroundThere is a scarcity of data available to determine the safety and effectiveness of bariatric surgery in the elderly population. Additionally, there are no studies showing the effect of the single anastomosis duodenal switch (SADS) has on the elderly obese, in comparison with other more popular procedures. Here we compare laparoscopic gastric band surgery (LAGB), Laparoscopic Roux-en-Y gastric bypass surgery (LRYGB), and the SADS to analyze the weight loss, perioperative and postoperative morbidity in the patients >70 years of age at a single US center.MethodsA retrospective analysis was performed on 53 consecutive patients ≥70 years old who underwent weight loss surgery from 2009 to 2015.Weight loss in terms of the percentage excess body mass index lost (%EBMIL), percentage excess weight lost (%EWL) and body mass index (BMI) points lost, resolution of comorbidities, length of stay, early (30-day) and late complication rates were compared using descriptive statistics and non-linear regression analysis.ResultsOf 53 patients, 24 underwent LAGB, 14 underwent LRYGB and 15 underwent SADS. The average patient age was 72.7 ± 2.5 years (range, 70–81.4) and 66 % were females. There was no statistical difference in the demographic data between three groups except for age and sleep apnea. There were no operative or early deaths. There were differences in complication rates between the surgical arms; however, with our small data set statistical significance was not achieved. There was 1 patient who lost to follow up in SADS group. Follow up time period was 18 months. % EBMIL and BMI reduction showed a statistically significant difference between the procedures, where the SADS had the highest loss of %EBMIL and BMI points. Comorbidities prevalence decreased post-operatively with SADS having higher percentage of patients who had resolution of their comorbidities.ConclusionEach of the three procedures can be performed on patients older than 70 with low morbidity rate. However, when the focus is weight loss alone, the SADS procedure is the most effective of the three procedures in regards to weight loss in the short term for patients older than 70. The SADS is as safe as RYGB but LAGB with all its limitations is still the safest bariatric procedure.

Reoperation after Laparoscopic Gastric Band Surgery among Medicare Beneficiaries

Reoperation after Laparoscopic Gastric Band Surgery among Medicare Beneficiaries

Predictive Factors of Insulin Resistance Resolution With Adjustable Gastric Band Surgery

IntroductionThe aim of the study was to evaluate preoperative factors associated with remission of diabetes and weight loss after laparoscopic gastric band surgery. Materials and methodsA retrospective cohort of 95 patients who had an adjustable gastric band placed were included. A preliminary descriptive study of prognostic factors was performed using the logistic regression model with SPSS 17.0. The independent variables were age, sex, body mass index (BMI), diabetes status, and degree of obesity; dependent variables were the proportion of weight loss, change in diabetes status score, and percent changes in fasting sugar and glycosylated haemoglobin. ResultsThe variables that were significantly associated with the percentage of changes in fasting blood sugar and glycated haemoglobin were: the degree of obesity in the first year; preoperative and diabetes status respectively. The analysis of the need for antidiabetic treatment using the modified diabetes status score showed preoperative BMI, age, and gender as significant predictors. ConclusionsIn patients undergoing gastric band surgery, weight loss is the fundamental mechanism by which insulin sensitivity increases. This improvement in glucose metabolism is influenced by factors such as sex, age, insulin treatment, duration of diabetes, and degree of preoperative obesity.

Factores predictores de resolución de la resistencia a la insulina con la cirugía de banda gástrica ajustable

IntroductionThe aim of the study was to evaluate preoperative factors associated with remission of diabetes and weight loss after laparoscopic gastric band surgery. Material and methodsA retrospective cohort of 95 patients who had an adjustable gastric band placed were included. A preliminary descriptive study of prognostic factors was performed using the logistic regression model with SPSS 17.0. The independent variables were age, sex, body mass index (BMI), diabetes status and degree of obesity; dependent variables were the proportion of weight loss, change in diabetes status score and percent changes in fasting sugar and glycosylated hemoglobin. ResultsThe variables that were significantly associated with the percentage of changes in fasting blood sugar and glycated hemoglobin were: the degree of obesity in the first year; preoperative and diabetes status respectively. The analysis of the need for antidiabetic treatment using the modified diabetes status score showed preoperative BMI, age and gender as significant predictors. ConclusionsIn patients undergoing gastric band surgery, weight loss is the fundamental mechanism by which insulin sensitivity increases. This improvement in glucose metabolism is influenced by factors such as sex, age, insulin treatment, duration of diabetes and degree of preoperative obesity.

Interrelationships of serum androgens, omental adipose tissue metabolism, and nonalcoholic fatty liver disease in obese premenopausal women.

The concept that androgens regulate multiple aspects of adipose tissue metabolism in women is based on studies of women with pathological androgen excess and in vitro studies generally using supraphysiological androgen concentrations. We investigated whether in women with normal-range serum testosterone, relationships exist between serum androgens and expression of proinflammatory (tumor necrosis factor-α, interleukin-6, CD68), anti-inflammatory (adiponectin), and lipid metabolic (lipoprotein lipase, hormone sensitive lipase) genes in omental adipose tissue, and severity of nonalcoholic fatty liver disease (NAFLD). We studied obese women undergoing laparoscopic gastric band surgery (premenopausal, regular menses, nondiabetic, serum testosterone <2.5 nmol/L, n=27). Gene expression was measured in omental adipose tissue. Liver biopsies were examined in 22 participants. Serum testosterone or androstanediol glucuronide (an indicator of peripheral androgen metabolism) were not related to markers of inflammation or lipid metabolism in omental adipose tissue. In women with NAFLD, there was a significant trend to higher serum free testosterone, serum insulin, and insulin resistance with increasing severity of liver pathology; however, markers of inflammation in omental adipose tissue did not differ. Omental lipoprotein lipase expression was significantly increased in women with nonalcoholic steatohepatitis (NASH). These primarily correlative data suggest that physiological-range androgen levels do not influence inflammation or lipid metabolism in omental adipose tissue of women, but further studies of direct androgen effects on adipose tissue are needed for confirmation. Androgens may still play a role in the pathogenesis of NAFLD in women, via mechanisms unrelated to omental adipose tissue metabolism.

Transversus abdominis plane infiltration for laparoscopic gastric banding: A pilot study

To estimate an effect size for the transversus abdominis plane (TAP) infiltration on quality of recovery in patients undergoing laparoscopic gastric band surgery. The pilot study was a randomized, double blinded, placebo controlled trial. Patients undergoing laparoscopic gastric band surgery were randomized to receive a bilateral TAP infiltration with 20 mL of 0.5% ropivacaine or saline. The evaluated outcomes included quality of recovery-40 (QoR-40) at 24 h, postoperative opioid consumption and pain. Data was examined using the Mann-Whitney U test. Nineteen subjects were recruited. There was a positive trend favoring the TAP infiltration group in global QoR-40 scores at 24 h after surgery, median [interquartile range (IQR)] of 175.5 (170-189) compared to 170 (160-175) in the control group (P = 0.06). There also a positive trend toward a lower cumulative opioid consumption in the TAP infiltration group, median (IQR) of 7.5 (2.5-11.5) mg iv morphine equivalents compared to 13 (7-21.5) in the control group (P = 0.07). Correlation analysis (Spearman's Rho) demonstrated an inverse relationship between 24 h cumulative opioid consumption and global QoR-40 scores, -0.49 (P = 0.03). The use of multimodal analgesic techniques to reduce opioid related side effects is particularly desirable in morbidly obese patients undergoing gastric reduction surgery. The TAP infiltration seems to have a clinically important effect in reducing postoperative opioid consumption and improve quality of recovery after laparoscopic gastric band surgery in morbid obese patients. Future studies to confirm the beneficial effects of the TAP infiltration in these patients are warranted.

Mycobacterium abscessus peritonitis associated with laparoscopic gastric banding

BackgroundMycobacterium abscessus is a rapidly growing Mycobacterium that is a common water contaminant in the environment. We report a case of M. abscessus infection with band erosion following laparoscopic gastric banding.Case presentationA 34-year-old woman developed insidiously progressing abdominal distension over a period of 1 year associated with abdominal pain, fatigue, night sweating and anorexia 4 years after laparoscopic gastric banding for obesity. Investigation revealed significant ascites with caseating granuloma in peritoneal biopsies from which M. abscessus was isolated. Band erosion with infection and multiple abdominal adhesions were confirmed during laparoscopic removal of the gastric band. To the best of our knowledge, this is the first reported case of M. abscessus infection after laparoscopic gastric banding surgery. We discuss the possible sources of infection, its indolent presentation, and therapeutic challenges.ConclusionIt is important to consider environmentally acquired infection in patients with signs and symptoms of infection in the presence of surgical prosthesis.

Effect of different positions during induction of anesthesia on lower esophageal pH and ease of intubation in morbidly obese patients

Background This randomized-controlled study was designed to assess the effect of a patient’s position on lower esophageal pH and ease of intubation during induction of anesthesia in morbidly obese patients. Methods Sixty-six morbidly obese patients undergoing laparoscopic gastric banding surgery were allocated according to the patient’s position before induction of anesthesia to one of three equal groups: group S (control), ‘sniff’ position with the patient supine, group R, ‘ramp’ position, and group RT 30π reverse-Trendelenburg position. The primary outcome measure was lower esophageal pH. The secondary outcome measures were ease of intubation, laryngoscopic view, and changes in heat rate, mean arterial blood pressure, and arterial oxygen saturation during induction. Results Lower esophageal acidity was significantly increased in group S compared with group RT and group R, P less than 0.001, with a significant increase in group R compared with group RT, P less than 0.001. Although the laryngoscopic view was the best in group R, there were no significant differences in intubation time and ease of intubation between group R and group RT, P =0.069. Heart rate was significantly increased in reverse-Trendelenburg 30π (group RT) after induction of anesthesia compared with before induction P less than 0.001. There were statistically significant reductions in the mean arterial blood pressure after induction of anesthesia in group RT and group R compared with before induction, P =0.001 and 0.020, respectively, but it was not clinically significant. Oxygen saturation was significantly higher in group RT and group R compared with group S, P =0.001. Conclusion During induction of anesthesia in morbidly obese patients, the reverse-Trendelenburg 30π position is the best as it increases the lower esophageal pH, allows easy laryngoscopy, and provides an adequate laryngoscopic view.

Resolution of an esophageal leak and posterior gastric wall necrosis with esophageal self-expandable metal stents

The use of weight reduction surgeries has increased over the years with a higher proportion of these surgeries being sleeve gastrectomies, this has been associated with some complications including staple line leaks. We report a 32-year-old male who had undergone a laparoscopic gastric band surgery and subsequently a laparoscopic sleeve gastrectomy, this was complicated by both an staple line leak at the gastroesophageal junction as well as a large (> 4 cm) posterior gastric wall defect due to gastric wall necrosis. We used two co-axially inserted self-expandable stents (SEMS) in the management of this patient, 5 stents were used over repeated endoscopy sessions and 20 wk. Both defects had resolved without the need for surgical intervention.This is the first reported case were SEMS are used for both a staple line leak as well as a gastric wall defect. We also review the literature on the use of SEMS in the management of leaks post weight reduction surgeries.

Comparison of Different Anesthetic Regimens in Patients Undergoing Laparoscopic Adjustable Gastric Banding Operations: A Prospective Randomized Trial

Obesity is a multisystem disorder, particularly involving the respiratory and cardiovascular systems; therefore, a multidisciplinary approach is required. In spite of widespread performance of weight reduction (bariatric) surgeries, information regarding the anesthetic care of morbidly obese patients is scarce. The aim of this study was to compare the impact of fentanyl and remifentanil on the time of recovery, breathing parameters, and postoperative pain in morbidly obese patients undergoing laparoscopic adjustable gastric banding operations. In this prospective randomized study, 66 morbidly obese patients (BMI>35 kg/m(2)), aged between 24 and 70 years, scheduled for a laparoscopic adjustable gastric banding operation were divided into 2 groups based on the opioid used for anesthesia: group 1 whose who received remifentanil; and group 2, fentanyl). The following parameters were recorded: peripheral blood oxygenation (SpO2) while breathing room air at baseline and 5 minutes after preoxygenation (100%); end-tidal carbon dioxide pressure at designated time points during the procedure; time to extubation; SpO2 in the postanesthesia care unit; and pain intensity (using the visual analogue scale); and the presence of nausea and vomiting. The time to extubation was shorter in the remifentanil group, but there was no significant difference in the time to discharge from the postanesthesia care unit. The recovery of respiratory parameters to the baseline values was better and faster in the remifentanil group. The intensity of postoperative pain was similar in both groups (VAS, <3) CONCLUSIONS: Remifentanil showed good analgesic properties during laparoscopic gastric banding surgery. Postanesthesia recovery and return of respiratory parameters to the baseline values was faster when remifentanil was used. Postoperative pain and the rate of opioid-induced side effects after analgesia with remifentanil were similar as after anesthesia with a longer acting opioid, fentanyl. Despite the problem widely discussed in literature about remifentanil-induced hyperalgesia, no cases of analgesic overconsumption were registered in our study.

PMO-049 Pre-operative weight loss in patients undergoing laparoscopic gastric bypass or band

IntroductionTo evaluate the number of patients that achieved loss of at least 10% of their excess body weight prior to undergoing laparoscopic gastric bypass or gastric band surgery.MethodsForty consecutive patients...

Intraoperative Resident Education for Robotic Laparoscopic Gastric Banding Surgery: A Pilot Study on the Safety of Stepwise Education

Incorporation of robotic surgery into resident education poses questions regarding intraoperative teaching and patient care. This study aimed to evaluate the impact of gradually increasing resident console responsibility on resident competency and patient safety, in the presence of a proctor and bedside surgeon, for robotic laparoscopic-assisted gastric banding (R-LAGB) compared with the classical training model (CTM) of residents as first assistant. Eight clinical year 4 (CY4) residents completed 60 R-LAGB using a one-to-one proctored training model (PTM). R-LAGB was distilled into 7 key steps: gastroesophageal-junction dissection, gastrohepatic ligament dissection, retrogastric space creation, band placement, band closure, gastrogastric suturing, and port placement. Residents performed more complex steps after each case to gain competency in all aspects of the operation. Patient demographics, comorbidities, operative complications, operating times, and clinical outcomes were compared with a control group of 287 R-LAGB cases completed using the CTM (n = 15 CY4 residents). All residents using the PTM were able to successfully complete an R-LAGB as primary surgeon after a median of 8 operations (range 5 to 11); no residents in the CTM completed an R-LAGB as primary surgeon. Mean operative time was statistically greater in the PTM group (99.3 ± 22.1 minutes) vs CTM (91.5 ± 21.1 minutes) (p = 0.001). There were no intraoperative complications in either group; incidence of postoperative complications was similar between groups. All residents in the proctored setting claimed competence and have persistent console experience without significantly increasing procedure complications. PTM, otherwise known as stepwise education, is a safe, standardized method to train surgical residents in R-LAGB.

Intraoperative resident education for robotic laparoscopic gastric banding surgery

Introduction The incorporation of robotic surgery into resident education poses questions regarding the impact on intra-operative teaching and patient care. The aim of this study was to evaluate the impact of gradually increasing resident console responsibility in the presence of an expert proctor and bedside surgeon for robotic adjustable gastric banding (R-LAGB) on resident proficiency and patient safety compared to the classical training mode (CTM) of residents as first assistant. Methods After successful completion of a six-skill inanimate robotic simulation program, eight PGY-4 residents completed 60 R-LAGB using a one-to-one proctored setting (PTM). R-LAGB was distilled into 7 key steps: GE-junction dissection, gastrohepatic ligament dissection, retrogastric space creation, band placement, band closure, gastrogastric suturing, and port placement. Residents performed more complex steps after each case to gain competence in all aspects of the operation. Patient demographics, operative complications, operating times, and clinical outcomes were examined and compared to a control group of 287 R-LAGB completed using the CTM. Unpaired t-test were used for analysis (P=0.05). Results While residents using the proctored training mode (PTM) were able to successfully complete a R-LAGB as primary surgeon after a median of 8 operations (range: 4-11), none of the residents in the CTM completed a R-LAGB as primary surgeon. Mean operative time, patient demographics, intraoperative complications were similar between groups (Table).DemographicProctored training mode (n=60)Classical training mode (n=287)p ValueProcedure length (min, mean ± SD)99.3±22.191.5±21.1NSIntra-operative Complications, n (%)0(0%)0(0%)NSLength of stay (days, mean ± SD)1.3±0.71.3±0.6NSBMI (mean ± SD)42.4±4.445.4±5.5NSPatient age (mean ± SD)46.3±1145±11NS Conclusions Using a PTM for R-LAGB, residents reach competence after a median of 8 cases. All residents in the proctored setting claimed competence and have persistent console experience without significantly increasing procedure length or complications.

P-97 Early postoperative effects of long-term using anorexiants before laparoscopic gastric banding surgery for weight loss

Many morbidly obese patients have experienced various anorexiants before bariatric surgery. The long-term use of anorexiants can emotionally distort hunger sensation for those who have drug dependency or for those whom the drugs no longer have affect. This study was to evaluate the effects of long-term use of anorexiants for change of hunger sensation and weight loss after laparoscopic (LAGB).