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Summary of Selected Presentations of ASMBS Meeting Part 2

Posted On : August 17, 2010

Is Weight Loss Better Sustained With Long Limb Gastric Bypass in the Super Obese?

Columbia University at Harlem Hospital Center, New York, NY

Gastric bypass with Roux limb length of 150 cm has shown better weight loss in patients with a BMI greater than 50, but the ideal length of the Roux limb is not yet agreed upon. This study was conducted to compare long-term weight loss and weight regain of standard limb length (SLL) and long limb length (LLL). 120 patients with a BMI greater than 50 went through the SLL or LLL gastric bypass. The weight regain and the rate of complications were followed up for years 1, 2, and 3 after surgery. The authors concluded, there was no apparent difference in demographics, preoperative BMI measurements, or comorbidities. In comparing SLL to LLL preoperative BMI was around 56 and there was no difference in percentage weight regain. Also, typical complications such as bleeding and leakage were also parallel. Hence, there is no apparent distinction between SLL and LLL gastric bypass operations, with regards to the percentage weight regain.

Editorial: There were a few studies presented at the meeting that looked at the distal gastric bypass operation. There has been a resurgence of this operation recently. I would suggest that the standard gastric bypass has a high failure rate and conversion to distal bypass appears to be an easy solution. This study demonstrated that there was not a significant difference between the long limb or the short limb gastric bypass. There does however undisputed increase in the metabolic complications of the distal gastric bypass.
Ara Keshishian, MD

Area Laparoscopic Bariatric Procedures Safe in Super Obese Patients? A NSQIP Data Analysis

Department of Surgery, New York Hospital Queens, Flushing, NY

This study was conducted to test the safety of the Laparoscopic Bariatric Procedure in super obese patients. 29,300 patients who underwent LBP were separated into two groups having a BMI greater than 50 and less than 50. Patients who underwent Laparoscopic Gastric Bypass (LGB) and Laparoscopic Adjustable Gastric Band (LAGB) were used as the basis for the study. As a result, in the BMI >50 Kg/ m2 group there were more males, younger patients, and higher occurrences of HTN and Dyspnea. In both procedures the group of people whose BMI was greater than 50 had an elevation in complications. As a result, patients with a BMI of less than 50 have less chance of complications and mortality when compared to super obese patients.

Primary and Revisional Laparoscopic Adjustable Gastric Band Placement in Patients with Hiatal Hernia Surgery

University of Nebraska Medical Center, Omaha, NE

In this case study the regularity of hiatal hernia and the safety of restoring and revising LAGB was assessed. Many physicians restore a hiatal hernia at the time of the Laparoscopic Adjustable Gastric Band (LAGB) placement. Data from the CDB/RM (Clinical Data Base/ Resource Manager) was used for LAGB with and without hiatal hernia during a three year time span to conduct this experiment. In LAGB operations 19% of patients had a hiatal hernia compared to 26% in the repair surgery group. As a result, hiatal hernia repair was carried out with LAGB in 12% of the patients. Mortality, length of stay, and morbidity was about the same in cases undergoing hiatal hernia restoration with initial LAGB versus non hiatal hernia repair patients. Statistics show, that morbidity was quite less when hiatal hernia was renovated in the primary operation in comparison to adjustment surgery. Occurrence of a hiatal hernia is linked with an increased rate of revisional surgery and a rise of morbidity following LAGB. All in all, hiatal hernias are best mended with primary LAGB.

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