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Canadian Surgery Forum 2014 Vol. 57 (4 Suppl 1) August/août 2014 canjsurg.ca DOI: 10.1503/cjs.009414 Canadian Surgery Forum canadien de Forum chirurgie Abstracts of presentations to the Résumés des communications Annual Meetings of the présentées aux congrès annuels de Canadian Association l’Association canadienne of Bariatric Physicians des médecins et chirurgiens and Surgeons bariatriques Canadian Association Association canadienne of General Surgeons des chirurgiens généraux Canadian Association l’Association canadienne of Thoracic Surgeons des chirurgiens thoraciques Canadian Hepato-Pancreato- Canadian Hepato-Pancreato- Biliary Association Biliary Association Canadian Society of la Société canadienne Surgical Oncology d’oncologie chirurgicale Canadian Society la Société canadienne des of Colon and chirurgiens du côlon Rectal Surgeons et du rectum Vancouver, BC Vancouver (C-B) Sept. 17–21, 2013 du 17 au 21 sept., 2013 Abstracts • Résumés FORUM CANADIEN DE CHIRURGIE 2014 Canadian Association of Bariatric Physicians and Surgeons Association canadienne des médecins et chirurgiens bariatriques 1 This retrospective study evaluated the short-term outcomes of (CJS Editors' Choice Award) Weight loss and obesity- our first 162 laparoscopic sleeve gastrectomies. related outcomes of gastric bypass, sleeve gastrectomy Between August 2010 and February 2013, 212 patients under- and gastric banding in patients enrolled in a population- went LSG as a sole bariatric operation. A retrospective review of based bariatric program: prospective cohort study. a prospectively collected database was performed. Postoperative R.S. Gill, S. Apte, S. Majumdar, C. Agborsangaya, complications and weight loss at 12 months were examined. C. Rueda-Clausen, D. Birch, S. Karmali, S. Klarenbach, Quality of life (using IWQOL-lite and EQ-5D) and diabetes reso- A. Sharma, R.S. Padwal. From the University of Alberta, lution were also examined. Data were analyzed using a Student t Edmonton, Alta. test or χ2 test where appropriate. Thus far, data hava been collected on 162 patients with average Bariatric care is increasingly being delivered in Canada within follow-up of 138 days (SD 113). The mean age was 43.9 (SD 9.6) publicly funded regional programs. The optimal bariatric surgi- and there were 131 females. Mean initial body weight (kg) and cal procedure for severely obese individuals receiving bariatric BMI were 134.6 (SD 52.6) and 48.5 (SD 6.8). The majority of care is currently unknown. The objective of this population- these patients 106 (73.2%) had 4 or more comorbidities. based prospective cohort study was to compare the effectiveness Median length of hospital stay was 2 days. There were no con- of laparoscopic Roux-en-Y gastric bypass (LRYGB), laparo- versions to open surgery. scopic sleeve gastrectomy (LSG), and laparoscopic adjustable In terms of complications, there were 3 staple line leaks gastric banding (LAGB) in severely obese patients. (1.85%; 1 required early reoperation and the other 2 presented A total of 150 consecutive patients (51 LRYGB; 51 LSG; 10 days later with small intra-abdominal collections that resolved 48 LAGB) from the population-representative, publicly funded with conservative measures), 1 gastric volvulus that required early Weight Wise bariatric program were examined. The primary out- reoperation, and 2 patients experienced a pulmonary embolus come was weight change (kg). Between-group changes were analyzed (1.23%). One patient required a blood transfusion in the early using multivariable regression adjusted for age, sex, and baseline postoperative period. There were 2 superficial wound infections weight. Last-observation-carried-forward imputation was used for (1.23%). Two patients developed postoperative dysphagia missing data. (1.85%) requiring endoscopic dilation. At baseline, mean age was 43.5 ± 9.5 years, 87.3% were females and At 12 months, there were 67 patients with a mean body weight overall preoperative BMI was 46.2 ± 7.4 kg/m2. Absolute (kg) and relative (kg) BMI of 93.4 (SD 15.9; p < 0.0001) and 34.4 (SD 4.8; p < (% of baseline) mean weight losses were 36.6 ± 19.5 kg (26.1% ± 12.2%) 0.0001). Of the 56 patients with type 2 diabetes, 35 (62.5%) for LRYGB, 21.4 ± 16.0 kg (16.4% ± 11.6%) in for LSG, and 7.0 ± achieved remission within 12 months and this occurred most fre- 9.7 kg (5.8% ± 7.9%) for LAGB (p < 0.0001 for between-group compari- quently within 3 months 23 (41.1%). At 12-month follow-up, sons) at 2 years. Change in BMI was significantly greater in the LRYGB only 23.5% of this group was taking antidiabetic medication. All (–13.0 ± 6.6 kg/m2) group compared with both the LSG (–7.6 ± 5.7 34 pre-diabetics achieved remission within 6 months. In terms of kg/m2) and the LAGB (–2.6 ± 3.5 kg/m2) groups (p < 0.0001 for between- quality of life, the mean EQ-5D VAS score improved from 59.62 group comparisons). In addition, change in BMI was significantly greater to 82.92 (p < 0.05) and the mean IWQOL-lite score improved in the LSG group compared with the LAGB group (p < 0.05). Hyperten- from 44 to 86 (p < 0.05). sion, diabetes, and dyslipidemia prevalence’s decreased to a significantly Laparoscopic sleeve gastrectomy is a safe and effective bariatric greater degree with LRYGB compared with LAGB (p < 0.05). procedure. Resolution of comorbidity and improvement in qual- In a publicly funded bariatric surgery program providing ity of life in our small, rural program is comparable with that population-based bariatric care to severely obese individuals, reported in the literature. LRYGB and LSG demonstrated greater weight loss than LAGB. LRYGB was more effective than LAGB in improving obesity- 3 related comorbidities. Is early discharge of patients post-laparoscopic Roux-en-Y gastric bypass safe? A. Bazzarelli, R. Wu, 2 F. Haggar, A. Neville, J. Yelle, I. Raiche, J. Mamazza. From Early outcomes of a small, rural bariatric surgery the Ottawa Hospital, Ottawa, Ont. program. D. Pace, L. Twells, C. Smith, D. Boone, K. Manning, K. Lester, C. Dillon, W. Midozi, R. Murphy, Bariatric surgery cases have risen significantly in order to combat L. Bartlett, D. Gregory. From Memorial University, St. the obesity epidemic. The timing and related safety of early dis- John’s, Nlfd. charge after laparoscopic Roux-en-Y gastric bypass (LRYGB) is S86 J can chir, Vol. 57 (4 Suppl 1) août 2014 — Résumés © 2014 Association médicale canadienne CANADIAN SURGERY FORUM 2014 still debated, and the safety of early discharge (< 24 h) after sur- decreased by over 20 minutes as experience with LRYGB gery remains unclear. The objective of this study was to examine increased (153.9 v. 133.3 min; p < 0.001). Similarly, unexpected the impact of early discharge on surgery related readmission fol- return to the operating room decreased following the first 150 lowing LRYGB. cases (5.3% unexpected return v. 2.6%; p = 0.08). A retrospective review of patients undergoing LRYGB from Laparoscopic Roux-en-Y gastric bypass is a technically September 2009 to March 2011 at the Ottawa Hospital was per- demanding procedure with an appreciable learning curve. Results formed. Discharge readiness was determined by adequate PO anal- from this single-centre retrospective cohort study demonstrate gesia, tolerating fluids, voiding well, ambulating without assistance that as experience with this advanced laparoscopic procedure and absence of tachycardia. Fisher exact tests or χ2 tests were used increases, operative time among surgeons decreases. Unexpected for categorical variables and student t tests for continuous variables return to the operating room, on the other hand, does not appear to compare differences between patients discharged on postopera- to be affected by experience. Additional studies encompassing tive day (POD) 1 (< 24 h) and those discharged on POD 2 or 3. more specific short-term outcomes are required to fully elucidate A total of 638 patients were included. Thirty-four patients this learning curve. were discharged on POD 1 (early DC) and 604 patients were dis- charged on POD 2 or 3 (standard DC). The 30-day readmission 5 rates were not different between early DC and standard DC (p = Bariatric surgery in patients with renal disease: Is it safe 1.0). There were 2 readmissions in the early DC group (5.88%) and is there an optimal approach? F. Saleh. From the Uni- as compared with 47 readmissions in the standard DC group versity of Toronto, Toronto, Ont. (7.78%). The 2 groups (early DC v. standard DC) were compara- ble in terms of mean age (44.38 v. 45.72 yr, p = 0.49), sex (77% Obesity rates among patients with chronic kidney disease (CKD) female v. 82%, p = 0.36), mean BMI (48.21 v. 59.44, p = 0.28), and end-stage renal disease (ESRD) mirror that of the general perioperative risks as indicated by the American Society of Anes- population. With growing interest to offer bariatric surgery to thesiologists (ASA) score (71% v. 79% ASA 3, p = 0.05), and total these patients, concerns remain regarding safety. number of concurrent intraoperative procedures (11.8% v. The American College of Surgeons National Surgery Quality 10.6%, p = 0.83). Improvement Program was used to collect on selected laparo- Early discharge from hospital within 24 hours after LRYGB scopic bariatric procedures between 2005 and 2011. Estimated appears to be safe and does not adversely affect readmission. Fast glomerular filtration rate (GFR) was calculated for each patient tracking patients following surgery may result in significant hos- and grouped according to their respective stages of CKD. Uni- pital cost savings and a reduction waiting lists. variate and multivariate analyses were used to compare complica- tion rates across stages of GFR for the Roux-en-Y gastric bypass 4 (RYGB), laparoscopic adjustable gastric band (LAGB), and longi- Defining the learning curve: early experience of laparo- tudinal sleeve gastrectomy (LSG) separately.
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