Authors: Christopher Schneider William Cobb John Scott Alfredo Carbonell Katie Myers Eric Bour
Publish Date: 2010/11/12
Volume: 25, Issue: 5, Pages: 1594-1598
Abstract
Internal hernia IH is one of the more acute and potentially devastating complications after laparoscopic gastric bypass LGB Currently there is no way to predict which patients will develop IH We propose that patients who undergo periods of rapid excess weight loss EWL following LGB are more likely to develop IHA retrospective review of a prospectively collected laparoscopic gastric bypass database from our bariatric center was performed Patient data between 2002 and 2009 was reviewed Demographics initial body mass index BMI detailed weight loss curves and morbidity specifically IH were reviewed Statistical analysis was performed Logistic regression analysis was used to obtain an adjusted odds ratio for rapid weight loss and hernia developmentWe reviewed all 934 LGB procedures performed The average initial BMI was 491 kg/m2 range = 34–91 kg/m2 EWL based on our current averages at 1 3 6 9 and 12 months postoperatively were 20 40 60 75 and 85 We statistically defined rapid EWL as greater than the 90th percentile for weight loss Rapid EWL was noted in 332 310/934 of patients Fiftyeight 62 patients were identified with IH Of these 27465 had periods of rapid EWL odds ratio OR = 183 95 CI = 107 302 Bivariate analysis of patient factors that led to rapid EWL identified initial BMI 493 vs 466 kg/m2 and rapid EWL as increasing the likelihood of developing IH p = 0026 A multivariate logistic model for IH identified only rapid EWL as a predictive factor Locations of IH were the jejunojejunostomy 24 Pedersen’s defect 23 adhesions 9 and colonic mesentery 1 There were five patients with combined JJ and Pederson’s herniasWilliam Cobb receives educational support is a consultant for and is on the speaker’s bureau for WL Gore He is on the speaker’s bureau at Ethicon Inc and receives educational support from and is a consultant for Ethicon EndoSurgery He is also on the speaker’s bureau and is a consultant for Covidien John Scott is an advisor for WL Gore and receives grant support from Ethicon EndoSurgery Alfredo Carbonell is a speaker and consultant for and receives grant support from WL Gore is a consultant and advisory board member for Ethicon Inc receives grant support from Ethicon EndoSurgery and is a consultant for Kensey Nash Eric Bour receives fellowship funding from and is a speaker for Ethicon Endosurgery and is a speaker for WL Gore Christopher Schneider and Katie Myers have no conflicts of interest or financial ties to disclose
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