Laparoscopic Gastric Bypass Patients Research Articles

Gastric Bypass Versus Sleeve Gastrectomy: Comparison of Patient Outcomes, Satisfaction, and Quality of Life in a Single-Center Experience.

Background: Laparoscopic sleeve gastrectomy (LSG) is the most common primary bariatric operation performed in the United States. Its relative technical ease, combined with a decreased risk for anatomic and malabsorptive complications make LSG an attractive option compared to laparoscopic gastric bypass (LGB) for many patients and surgeons. However, emerging evidence for progressive gastroesophageal reflux disease (GERD) after LSG, and the inferior weight loss in many studies, suggests that the enthusiasm for LSG requires reassessment. We hypothesized that patient satisfaction and quality of life (QoL) may be lower after LSG compared to LGB because of these differences. Methods: We distributed a survey querying weight-loss outcomes, complications, foregut symptoms, QoL, and overall satisfaction to patients who underwent bariatric operations at our institution between 2000 and 2020 and who had electronic mail contact information available. Mean follow-up was 2.75 ± 2.41 years for LGB patients and 3.37 ± 2.18 (P = .021) years for LSG patients. We compared these groups for weight-loss outcomes, changes in foregut symptoms, gastrointestinal QoL, postbariatric QoL, and overall satisfaction using appropriate statistical tests. Results: Among 323 respondents, 126 underwent LGB and 197 underwent LSG. LGB patients had larger body mass index (BMI) reduction than LSG patients (-17.16 ± 9.07 kg/m2 versus -14.87 ± 7.4 kg/m2, P = .023). LGB patients reported less reflux (P = .003), with decreased heartburn (P < .0001) and regurgitation (P = .0027). However, a greater proportion of LGB patients reported at least one complication (P = .025). Despite this, more LGB patients reported satisfaction (92.86%) than LSG patients (73.6%). Conclusion: LGB patients are significantly more likely to be satisfied than LSG patients. Factors contributing to the higher level of satisfaction include less GERD and better BMI decrease.

Seeking an Initial-Weight-Independent Metric in a Mediterranean Cohort of Gastric Bypass Patients: the %AWL Revisited.

Most relative weight-loss metrics follow the formula "Weight loss(%) = 100 · (Initial BMI - Final BMI) / (Initial BMI-a)," where a is the reference point that defines the metric. The percentage of total weight loss (%TWL, a = 0) and percentage of excess weight loss (%EWL, a = 25) are influenced by a patient's initial weight. Recently, the percentage of alterable weight loss metric (%AWL, a = 13) has been reported to produce initial-weight-independent outcomes. This study aimed to replicate the methodology used for %AWL determination in a Mediterranean cohort of bariatric patients. Multicenter study in 10 large hospitals in Spain. Two large prospective databases were retrospectively searched for all primary laparoscopic gastric bypass patients with 2years of follow-up. Outcomes at nadir were expressed and analyzed with 26 different metrics (a from 0 to 25), looking for the metric whose outcomes produced (1) the lowest coefficient of variation, (2) no differences between initially lighter and heavier patients, and (3) no correlation with patients' initial BMI. A cohort of 1793 patients was stratified into 4 gender-age groups: younger women (YW, n = 733), older women (OW, n = 674), younger men (YM, n = 197), and older men (OM, n = 189). The calculations suggested an optimal reference point of 18kg/m2, defining a new metric (percentage of Mediterranean alterable weight loss, %MAWL). When %TWL, %EWL, %AWL, and %MAWL were tested on the whole sample, only %MAWL produced initial-weight-independent results. In our Mediterranean cohort of patients, a reference point of 18 (and not 13) yielded initial-weight-independent outcomes.

Internal Hernia After Laparoscopic Gastric Bypass Without Preventive Closure of Mesenteric Defects: a Single Institution’s Experience

BackgroundInternal herniation (IH) is a well-known complication after laparoscopic gastric bypass (LGB). Diagnosing and managing IH can be challenging. This retrospective cohort study aimed to achieve a greater understanding of symptomatology, diagnostic tools, complications, risk of IH recurrence, and symptom relief in IH patients. MethodsWe included patients who underwent LGB surgery at our institution between 2011 and 2015. Mesenteric defects were not preventively closed during LGB. We focused on LGB patients who underwent surgical intervention(s) for suspected IH during a 7-year study period. We studied patient characteristics, (predictive) symptoms and signs, abdominal imaging, operative findings, post-operative course, and risk of (recurrent) IH. ResultsA total of 1588 patients were included. In total, 243 patients underwent IH-related diagnostic laparoscopy. Radiating pain to the back (OR 2.45, p = .03), post-prandial pain (OR 3.23, p = .00), and leukocytosis (OR 15.53, p = .01) were identified as predictors of IH. The estimated risk of IH-related diagnostic laparoscopy was 16% at 3 years post-LGB, and the risk of confirmed IH was 12%. The estimated risk of diagnostic laparoscopy for suspected recurrent IH was 10% at 5 years post-LGB. In patients who underwent secondary mesenteric defects closure, post-operative symptom relief was reported in 84%. ConclusionThis study demonstrates a considerable risk of developing IH after LGB without preventive closure of the mesenteric defects. We emphasize the value of diagnostic laparoscopy to achieve symptom relief in patients with suspicion of IH. Preoperative diagnosis of IH can be improved by being watchful of specific symptoms and signs which can predict the intra-operative presence of IH.

Community hospital decreases narcotic usage in postoperative bariatric patients.

Opioids have long been used as an effective form of analgesia for pain in the postoperative setting; however, their addictive potential and associated complications have become a detriment. There has been an increasing movement to decrease opioid prescribing. The aim of this study was to look at common bariatric surgery procedures at a single institution and compare opioid usage before and after the implementation of a multimodal pain regimen. Community program, hospital-employed, and private practice, United States. Six hundred twelve laparoscopic gastric bypass and laparoscopic sleeve gastrectomy patients were included in this single-institution retrospective cohort study. Data were obtained from chart review. Comparison was made between patients from 2016 and patients from a 3-month period in 2017 when the new pain management protocol had been instituted. The postoperative opioid usage of 516 patients from 2016 was compared with that of 96 patients from a 3-month period in 2017 after initiating the new pain management protocol. The mean intravenous hydromorphone usage of the control group, 16.0 ± 14.6 morphine milligram equivalent (or 4.0 mg ± .2), over the postoperative inpatient stay decreased to 7.3 ± 6.7 morphine milligram equivalent (or 1.8 mg ± .2) in the study group. This represents a 55% decrease. The study group did show less 30-day postoperative complications compared with the control, 1.04% and 2.13%, respectively, although this was not statistically significant. A multimodal pain regimen is an effective way to cut opioid usage with no statisticaldifference in overall 30-day complications.

PSU4 COMPARISON OF OBESITY CLASSIFICATIONS AT 1, 3, AND 5 YEARS AFTER GASTRIC BYPASS AND GASTRIC SLEEVE SURGERY USING A FEDERATED ELECTRONIC MEDICAL RECORD (EMR) NETWORK

Few published studies have reported body mass index (BMI) following different bariatric surgical procedures. This real-world study compared the rates of obesity and severe obesity at multiple time points following laparoscopic gastric bypass (LGB) or laparoscopic gastric sleeve (LGS) procedures. This retrospective study utilized the TriNetX EMR Research Data Network and Platform. Patients ≥20 years old undergoing LGB or LGS between January 2009 and March 2018 were identified and then excluded if they ever underwent any alternative surgical treatment for obesity. Demographic and clinical characteristics one-year pre-surgery were used for 1:1 propensity-score matching. Outcomes at 1, 3, and 5 years post-surgery included BMI <30 (non-obese) and <40 (non-super obese), using the most recent measurement or diagnosis code, were compared using standard bivariate statistics. Initially 14,482 LGB and 20,890 LGS patients of similar mean age (46±12 years), proportion female (79%) and mean BMI (45±9) met the study criteria. LGB patients had significantly higher rates of comorbidity but lower rates of select medication use. Post-match (n=13,450 each) standardized differences were all <10%. At each time point significantly greater rates of LGB compared to LGS patients attained BMIs <30 (Year 1: 21.6% vs 11.6%; Year 3: 32.2% vs 16.0%; Year 5: 34.0% vs 16.7%) and <40 (Year 1: 57.2% vs 49.3%; Year 3: 66.3% vs 54.6%; Year 5: 68.6% vs 55.7%), all P<0.001. The 5-year odds ratios were BMI<40: 2.50 (CI 2.44, 2.74) and BMI<30: 1.70 (1.66, 1.83). In this real-world setting, LGB patients were more likely than LGS patients to not be obese or severely obese up to 5 years following surgery. While more than half the patients in each cohort could not be classified as severely obese by year 1, the proportion of the LGB cohort to not be obese was 2-fold greater at each time point post-surgery.

An Expanded Retrospective Review of Trocar Site Hernias in Laparoscopic Gastric Bypass Patients.

Trocar site hernias (TSH) are reported in 0.3% to 5.4% of laparoscopic cases, depending on diameter and type. Most occur with trocars over 10 mm in diameter. Some recommend routine fascial closure, but this requires time, costs, pain, and increased infection rates. All prior series are based on clinical presentation alone. We examined the possibly underreported prevalence of asymptomatic TSH on postoperative computed tomography (CT) scans in a series of laparoscopic gastric bypass (LGBP) patients with unclosed port site fascia. After Institutional Review Board (IRB) approval, a retrospective review of all patients undergoing LGBP at our center from 2005 to 2014 was performed. All procedures were performed using dilating optical trocars up to 12 mm diameter, placed above the arcuate line. No fascial closures were performed. Any patients undergoing abdominal CT scanning for any reason in the study period were included; patients who had undergone a separate laparoscopic operation after LGBP but before CT were excluded. One thousand ninety-five patients were included; of these, 244 (22.3%) met study criteria, providing 732 port sites of 11 or 12 mm diameter to study. Only two fascial defects (0.27%), one in an 11-mm site and one in a 12-mm site, each in different patients, were identified. Both were nonpalpable, asymptomatic, and plugged with fat. Incisional hernias in dilating or optical access trocar sites are extremely rare in LGBP patients using trocars up to 12 mm, above the arcuate line. When found, they tend to be asymptomatic and at low risk for bowel strangulation. Routine closure of such fascial sites is likely unnecessary.

Impact of Intragastric Balloon Before Laparoscopic Gastric Bypass on Patients with Super Obesity: a Randomized Multicenter Study.

Super obese patients are recommended to lose weight before bariatric surgery. The effect of intragastric balloon (IGB)-induced weight loss before laparoscopic gastric bypass (LGBP) has not been reported. The aim of this prospective randomized multicenter study was to compare the impact of preoperative 6-month IGB with standard medical care (SMC) in LGBP patients. Patients with BMI >45kg/m2 selected for LGBP were included and randomized to receive either SMC or IGB. After 6months (M6), the IGB was removed and LGBP was performed in both groups. Postoperative follow-up period was 6months (M12). The primary endpoint was the proportion of patients requiring ICU stay >24h; secondary criteria were weight changes, operative time, hospitalization stay, and perioperative complications. Only 115 patients were included (BMI 54.3±8.7kg/m2), of which 55 underwent IGB insertion. The proportion of patients who stayed in ICU >24h was similar in both groups (P=0.87). At M6, weight loss was significantly greater in the IGB group than in the SMC group (P<0.0001). Three severe complications occurred during IGB removal. Mean operative time for LGBP was similar in both groups (P=0.49). Five patients had 1 or more surgical complications, all in the IGB group (P=0.02). Both groups had similar hospitalization stay (P=0.59) and weight loss at M12 (P=0.31). IGB insertion before LGBP induced weight loss but did not improve the perioperative outcomes or affect postoperative weight loss.

A5070 - Safety And Efficacy of Stand-Alone Optical Trocar Access In Laparoscopic Gastric Bypass Patients With Multiple Prior Abdominal Operations

A5070 - Safety And Efficacy of Stand-Alone Optical Trocar Access In Laparoscopic Gastric Bypass Patients With Multiple Prior Abdominal Operations

Weight loss outcomes and complications from bariatric surgery in the super super obese

Bariatric surgery has been established as the most effective long-term treatment for morbid obesity. We performed a retrospective review of SSO patients treated at our institute between 2008 and 2013 who underwent a laparoscopic gastric bypass (LGBP) or sleeve gastrectomy (LSG). The primary end point for this study was excess weight loss (EWL) at 1, 3, 6, and 12months. Secondary end points included procedure length (PL), length of stay (LOS), diabetes management and postoperative complications. We identified 135 SSO patients who underwent bariatric surgery (93 LGBP, 42 LSG) at our institute from 2008 to 2013 with a median follow-up of 49months. The incidence of EWL>30% for patients in the LGBP group was 3.9, 29.0, 72.2 and 94.6% at 1, 3, 6 and 12months, respectively, while the incidence of EWL>30% in patients in the LSG group was 4.2, 25.0, 59.1 and 100% at 1, 3, 6 and 12months, respectively. PL was 124±49min for the LGBP group and 98+51min for the LSG group (p<0.005). LOS was on average 3.0days (range 1-21) for the LGBP group and 3.4days (range 1-13) for the LSG group (p=0.41). Patients experienced a decrease in their hemoglobin A1C level by 10% for the LGBP group and 9% for the LSG group at 1year (p=0.89). Postoperative complications were seen in 15.1% of LGBP patients and 4.8% of LSG patients. Bariatric surgery is feasible in the SSO patients with comparable EWL outcomes and postoperative complications to historical non-SSO patients.

Pre-Operative Psychological Characteristics of Gastric Band and Gastric Bypass Patients

Weight loss outcomes vary among different bariatric procedures, and may be partially due to differences in patient characteristics that are present preoperatively. In an observational study, laparoscopic adjustable gastric band (LAGB) and Roux-En-Y laparoscopic or open gastric bypass (RYGB) patients were compared on pre-op dimensions of depression, anxiety, and disordered eating. Results indicated that depression scores were in the mild range, and anxiety scores were in the mild range only for RYGB patients. In comparison to adults with eating disorders, scores on disordered eating scales were low. Cognitive-affective depression symptoms and several eating disorder subscale scores were higher in RYGB than in LAGB patients. This suggests that surgical candidates who choose RYGB surgery may differ psychologically from those who choose LAGB, although other factors impact choice of procedure also. Future research should delineate the decision-making process leading to the selection of a surgery type as well as the match of the patients to the demands of the post-op regimen.

Changes in postprandial gut hormones after metabolic surgery: a comparison of gastric bypass and sleeve gastrectomy

Background Laparoscopic gastric bypass (GB) is reportedly more effective than laparoscopic sleeve gastrectomy (SG) in the treatment of patients with a low body mass index and type 2 diabetes mellitus. However, the mechanism remains speculative. We compared the postprandial gut hormone patterns between patients undergoing laparoscopic GB and laparoscopic SG at 2 years after surgery in a hospital-based, prospective study. Methods A total of 16 laparoscopic GB and 16 laparoscopic SG patients were followed up and appraised for glucose homeostasis. Two years after surgery, the mixed meal test and gut hormones were evaluated in 13 laparoscopic GB and 13 laparoscopic SG patients who had been included in the previous randomized trial. Results The preoperative characteristics, such as body mass index, body weight, waist circumference, and duration of T2DM were comparable between the 2 groups. T2DM remission was achieved in 13 (81%) laparoscopic GB and 3 (19%) laparoscopic SG patients ( P < .05) 2 years after surgery. The laparoscopic GB patients had lost more weight and had a smaller waist circumference and lower levels of glucose and hemoglobin A1c, and lower insulin resistance than the SG patients. Significant differences were found in acyl ghrelin, des-acyl ghrelin, cholecystokinin, and resistin between the 2 groups, but none in obestatin, gastric inhibitory peptide, glucagon-like peptide-1, and leptin. Conclusions Both laparoscopic GB and laparoscopic SG have strong hindgut effects after surgery, but GB has a significant duodenal exclusion effect on cholecystokinin. The laparoscopic SG group had lower acyl ghrelin and des-acyl ghrelin levels but greater concentrations of resistin than the laparoscopic GB group.

P-54 Do laparoscopic gastric bypass patients with BMI35 kg/m 2?

P-54 Do laparoscopic gastric bypass patients with BMI<35 kg/m 2 have similar outcomes as patients with BMI>35 kg/m 2?

Insurance-mandated medical programs before bariatric surgery: do good things come to those who wait?

Background Insurance companies often require a mandated medical program (MMP) before bariatric surgery. It is unknown whether MMPs improve weight loss before and after surgery. The purpose of our study was to determine whether MMPs improve pre- and postoperative weight loss at a tertiary care, U.S. academic teaching hospital. Methods After institutional review board approval, data were collected prospectively from consecutive patients undergoing nonrevisional laparoscopic gastric bypass or adjustable gastric banding from August 2006 to 2010 by a single surgeon (T.S.K.). The patients were divided into 2 groups: those undergoing a MMP and those who did not. The MMP patients underwent a standardized program of ≥6 months' duration under the direction of our medical bariatricians and nutritionists. The data from the laparoscopic gastric bypass and laparoscopic adjustable gastric banding patients were analyzed separately. The primary outcome data included the interval to surgery and the percentage of excess weight loss before surgery and at 6 and 12 months after surgery. Results A total of 440 patients (327 laparoscopic gastric bypass and 113 laparoscopic adjustable gastric banding) were included in the present study. No significant difference was found in the preoperative percentage of excess weight loss or the percentage of excess weight loss at 6 and 12 months after surgery between the MMP and non-MMP patients. The MMP patients had a significantly longer wait time to surgery. Conclusion Patients who underwent a standardized MMP had a significant delay in their time to surgery and did not experience significant benefit in their preoperative or postoperative weight loss. Insurance companies should abandon the policy of mandating preoperative medical weight loss programs.

Do Patients Seeking Laparoscopic Adjustable Gastric Banding Surgery Differ from Those Seeking Gastric Bypass Surgery? A Comparison of Psychological Profiles Across Ethnic Groups

Understanding presurgical psychological functioning is important in determining whether patients may benefit from psychological support before or after undergoing bariatric surgery. However, few studies have directly explored whether presurgical psychosocial profiles differ for patients presenting for different bariatric surgeries and what, if any, impact ethnic background might have. The present study compared presurgical depressive symptomatology, binge eating symptoms, and psychopathology in Caucasian and African American laparoscopic adjustable gastric banding (LAGB) and gastric bypass (RYGB) patients. Patients (n=272) presenting for either LAGB or RYGB surgery completed self-report measures of depressive symptomatology (BDI), binge eating symptoms (BES), and psychopathology/personality (PAI) as part of the presurgical psychological evaluation. RYGB patients endorsed more depressive symptomatology, binge eating symptoms, somatic complaints, and antisocial features than LAGB patients, though higher BMI in the RYGB patients accounted for differences in binge eating symptoms. When the sample was examined by ethnic group, LAGB-RYGB differences were found only in African American, and not Caucasian, patients. Psychosocial profiles appear to differ for African American patients presenting for LAGB and RYGB surgeries; however, some of these differences are accounted for by differences in presurgical BMI. Gaining a better understanding of the initial psychological characteristics of bariatric surgery candidates may improve clinicians' abilities to identify and address specific areas of concern for these patients.

Evaluation of Clinical Outcomes for Gastric Bypass Surgery: Results from a Comprehensive Follow-up Study

Laparoscopic gastric bypass (LGB) surgery markedly increases percent excess weight loss (%EWL) and obesity-related co-morbidities. However, poor study quality and minimal exploration of clinical, behavioral, and psychosocial mechanisms of weight loss have characterized research to date. We conducted a comprehensive assessment of n = 100 LGB patients surveyed 2-3 years following surgery using standardized measures. Mean %EWL at follow-up was 59.1 ± 17.2%. This high level of weight loss was associated with a low rate of metabolic syndrome (10.6%), although medications were commonly used to achieve control. Mean adherence to daily vitamin and mineral supplements important to the management of LGB was only 57.6%, and suboptimal blood chemistry levels were found for ferritin (32% of patients), hematocrit (27%), thiamine (25%), and vitamin D (19%). Aerobic exercise level (R (2) = 0.08) and pre-surgical weight (R (2) = 0.04) were significantly associated with %EWL, but recommended eating style, fluid intake, clinic follow-up, and support group attendance were not. Psychosocial adjustment results showed an absence of symptomatic depression (0%), common use of antidepressant medications (32.0%), low emotional distress related to the post-surgical lifestyle (19.8 ± 14.0; scale range 0-100), a high level of perceived benefit from weight loss in terms of functioning and emotional well-being (82.7 ± 17.9; scale range 0-100), and a change in marital status for 26% of patients. At 2-3 years following LGB surgery aerobic exercise, but not diet, fluid intake, or attendance at clinic visits or support groups, is associated with %EWL. Depression is symptomatically controlled by medications, lifestyle related distress is low, and marital status is significantly impacted.

Survey of the Effective Exercise Habits of the Formerly Obese

Patients must subscribe to behavioral and lifestyle modifications for continued success after weight loss surgery (WLS). Few data exist about the ideal type, duration, and intensity of exercise for WLS patients. After surgery, should we mandate that patients exercise like a young, lean individual does? To reconcile this, we compared the exercise habits of successful bariatric surgery patients with physically fit controls. One hundred individuals were enrolled. The operative group (OG) included 50 laparoscopic Roux-Y gastric bypass patients (LRYGB) who achieved excess weight loss of at least 80% one year after the surgery. The control group (CG) included 50 individuals of normal BMI who exercised regularly and did not undergo LRYGB. The exercise habits were compared using Fisher's exact and Mantel-Haenszel chi square tests. The 2 groups had equivalent BMIs (24.7 vs. 23.4 kg/m(2)). The OG was older (39.5 years) than the CG (26.2 years). There was a statistically significant difference between the groups regarding cardiovascular exercise, 80% walking (OG) vs. 60% running (CG). OG patients exercised longer and with similar frequency as CG did. A high proportion of CG lifted weights (86%) vs. OG (44%). Sixty percent of CG performed recreational sports compared with 34% of OG. Regular exercise is of utmost importance in maximizing and maintaining weight loss after WLS. Although patients who undergo WLS are older than the typical exercise enthusiast, they can achieve excellent weight loss and sustain a normal BMI with regular exercise habits that are quite distinct from younger individuals whose bodies were never undermined by obesity.

Effects of Obesity Surgery on Type 2 Diabetes Mellitus Asian Patients

Obesity is a major risk factor for the development of type 2 diabetes mellitus (T2DM). Surgery is the most effective treatment for morbid obesity, and it has been shown to lead to dramatic improvement in type T2DM. However, data concerning obese Asian patients have not been reported, and the mechanism of improving T2DM after bariatric surgery in this population remains speculative. From April 1997 to March 2006, 1,375 patients undergoing obesity surgery were recruited for our study of the effects of weight loss surgery on type 2 diabetes mellitus (T2DM). Laparoscopic vertical banded gastric partition (LVBG) was performed in 552 patients (40.1%), laparoscopic gastric bypass in 660 patients (48.0%), and laparoscopic adjustable gastric banding (LAGB) in 140 patients (10.2%). Another 23 patients (1.7%) received open or revision surgery. We evaluated the clinical data and effect of obesity surgery on T2DM, impaired fasting glucose (IFG) and compared the changes with those with normal fasting glucose. Among all the patients, 166 (12.1%) had impaired fasting glucose (IFG) and 247 (18.0%) had T2DM. Patients with IFG or DM were significantly older, more central obese, and they had higher insulin resistance and a higher HbA1C level than those with normal fasting glucose. The mean total weight loss for the population was 28.6%, 29.1%, 28.5%, 23.8%, and 24.4% (at 1, 2, 3, 5, and 7 years after surgery). There was no increase of surgical risk in T2DM or IFG patients. One year after operation, fasting plasma glucose returned to normal in 78.5% of T2DM patients and 94.7% of IFG patients. The HbA1C level returned to under 7.0 in 81.5% of T2DM and in 100% of IFG patients. Laparoscopic gastric bypass patients had a greater weight loss and a higher rate of glucose normalization (93.1%) than the LVBG patients (85.3%) and LAGB patients (73.9%), but no difference in HbA1C normalization. Obesity surgery resulted in significant and sustained weight loss with a cure rate of T2DM up to 80% in morbidly obese Asian patients. Gastric bypass surgery had a better result in T2DM cure rate than LVBG and LAGB because of better weight reduction.

Comparing Outcomes of Laparoscopic Versus Open Bariatric Surgery

The objective of this study was to use nationally representative data to compare outcomes of open gastric bypass (OGB) versus laparoscopic gastric bypass (LGB) surgery. The number of bariatric procedures continues to grow. Increasingly, these surgeries are being performed laparoscopically. However, few population-based studies have examined differences in outcomes between LGB and OGB surgeries. Population-based studies can provide further insight into differences in outcomes between open and laparoscopic bariatric procedures. Using the Nationwide Inpatient Sample, we identified adults undergoing LGB or OGB surgery during 2005 (n = 19,156). Following preliminary descriptive statistics, multiple logistic and linear regressions were used to obtain risk-adjusted outcomes, including postoperative in-hospital complications, reoperation, length of stay, and total charges. The majority of patients in the study sample (74.5%) underwent laparoscopic bypass surgery in 2005. After adjusting for patient and hospital level factors, patients undergoing OGB surgery were more likely to experience reoperation as well as the following complications: pulmonary (odds ratio [OR] = 1.92 (1.54-2.38), P < 0.001); cardiovascular (OR = 1.54 [1.07-2.23], P = 0.02); procedural (OR = 1.29 [1.06-1.57], P < 0.01); sepsis (OR = 2.18 [1.50-3.16], P < 0.001); and anastomotic leak (OR = 1.32 [1.02-1.71], P = 0.03). After risk adjustment, LGB was associated with a shorter length of stay but higher total charges. Overall, LGB patients are less likely to experience reoperation and postoperative complications in the hospital and have a shorter length of stay but incur higher total charges than OGB patients.

Use of critical care resources after laparoscopic gastric bypass: effect on respiratory complications

Background Before 2005, all subjects undergoing laparoscopic gastric bypass with a body mass index >50 kg/m 2, age >40 years, and documented obstructive sleep apnea (OSA) were admitted to the intensive care unit (ICU) in our institution. Starting in January 2005, only patients with a body mass index >60 kg/m 2 and severe OSA were admitted. This study assessed the incidence of respiratory complications in patients undergoing laparoscopic gastric bypass before and after implementation of the new ICU admission criteria. Methods The records of the laparoscopic gastric bypass patients who had undergone laparoscopic gastric bypass from January 2004 to December 2005 were reviewed regarding demographic data (age, sex, body mass index, American Society of Anesthesiologists classification); OSA; use of home continuous positive airway pressure; length of stay in postanesthesia care unit, ICU, and hospital; postoperative ventilation and hypoxemia (oxygen saturation <90%), and unplanned ICU admission. Results A total of 250 charts were analyzed (122 from 2004 and 128 from 2005). The demographic data were comparable between the 2 groups. Although OSA was more frequent in the 2004 than in the 2005 cohort ( P = .02), the incidence of OSA requiring home continuous positive airway pressure was comparable ( P = .47). The length of hospital stay was greater in 2004 than in 2005 ( P = .003). More patients were admitted to the ICU in 2004 ( P <.001). All unplanned ICU admissions were because of surgical anastomotic/staple line leaks (7 patients in 2004 versus 0 in 2005; P = .006). Overall, the incidence of postoperative respiratory complications was low (6% in 2004 and 4% in 2005) and comparable in both groups. Conclusion Limiting ICU admission after laparoscopic gastric bypass to patients with a body mass index >60 kg/m 2 and severe OSA did not increase the overall incidence of postoperative respiratory complications or hospital stay.

P75: Impact of a multidisciplinary perioperative dexmedetomidine protocol on the management of patients undergoing laparoscopic gastric bypass

Background: Our group has previously demonstrated perioperative dexmedetomidine (DEX) administration to be safe in patients undergoing laparoscopic gastric bypass (LGB). We have since implemented a multidisciplinary perioperative DEX protocol designed to maximize perioperative analgesia while minimizing sedation. Methods: Prospective analysis of a single surgeon’s experience with a perioperative DEX protocol in patients undergoing LGB during a three month period. Patients were evaluated for perioperative pain scores, periand postoperative narcotic requirements, time to ambulation (TTA), length of stay (LOS) and respiratory complications. DEX patients were compared to a matched historical control group. Student’s t-test and non-parametric analyses were used for statistical evaluation. Narcotic requirements were converted to morphene equivalents (MEQ). Results: Twenty-three consecutive patients were enrolled in the DEX protocol with a mean age of 44.3 years and a mean BMI of 42. When compared to the matched historical control group (n 21, mean age 43.4 years, mean BMI 43.4), DEX patients had significantly reduced narcotic requirements in the OR (14.6 MEQ vs 28.1 MEQ, p 0.05) and during their hospital stay (106.4 MEQ vs 134.6 MEQ, p 0.05). DEX patients also had shorter PACU times (121.2 mins vs. 191.7 mins, p 0.05), earlier ambulation (121. mins vs 191.7 mins, p 0.05) and a trend towards shorter LOS (3.1 days vs 3.5 days). There were no adverse respiratory events in the DEX group. Conclusion: The use of a standardized multidisciplinary DEX protocol for perioperative pain management in LGB patients reduces both perioperative and overall narcotic requirements. This allows for less perioperative sedation, shorter PACU times and earlier postoperative ambulation. PII: S1550-7289(08)00248-7