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2010 Annual Meeting Abstracts

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Outcomes of Laparoscopic Roux-en-Y Gastric Bypass as a Primary Versus Revisional Bariatric Surgery
*Balaji Jangam1, *Kristine O' Hara2, *Bruce Bernstein2, *Andrea Cronin2, *Ravi Chhatrala2, *Ioannis Raftopoulos1
1Bariatric Center at Saint Francis Hospital and Medical Center, University of Connecticut, Hartford, CT;2Bariatric Center at Saint Francis Hospital and Medical Center, Hartford, CT

OBJECTIVE: To compare the outcomes of laparoscopic Roux-en-Y gastric bypass (LRYGB) as a primary (CG) versus revisional bariatric surgery (RBS). DESIGN: Prospective case-control study. SETTING: Institutional practice. PATIENTS: 585 consecutive patients between August 2004 and February 2010 as primary (n=547) or RBS (n=38). MAIN OUTCOME MEASURES: patient demographics, peri-operative details, % excess weight loss (%EWL), status of associated Co-morbidities, as well as assessment of Quality of life (QoL). RESULTS: The CG and RBS groups differed in relation to BMI (46.9 vs. 39.8 Kg/m2, p<.001). RBS patients had significantly longer OT (338.0 vs. 223.0 min, p <0.001) and LOS (3.7 vs. 1.9 days, p <0.001). The conversion rate was 17.6% in RBS and none in the CG. Although early major morbidity was higher in RBS patients (21.1% vs. 3.6%, p<.001), late major complications were almost similar (2.6% RBS vs. 4.3% CG, p=0.513). %EWL at 1 year was greater for the CG (71.6% vs. 52.1%, p=.003). Percentage improvement of HTN (91.7% vs. 88.1%), DM (88.9% vs. 95.3%), OSA (66.7% vs. 84.6%) and dyslipidemia (50% vs. 62.4%) was similar in RBS and CG respectively, whereas GERD improvement was reported more frequently in the CG (100% vs. 84.6%, p<.001). At 6-month follow-up RBS patients reported lower SF-36 QoL scores for the physical component (45.7 vs. 51.4, p=.010), whereas QoL scores for the mental component were similar in both groups (51.5 vs. 53.1, p=.952). CONCLUSIONS: RBS carries higher peri-operative risks, but long-term risks are similar to the CG. Long term improvement of pre-operative symptoms related to original bariatric surgery and associated co-morbidities is very likely. Laparoscopic approach is feasible in more than eighty percent of patients.

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