P17.

LAPAROSCOPIC VERTICAL BANDED GASTROPLASTYWITH SLEEVE GASTRECTOMY: TWO-YEARFOLLOW-UP STUDYTimothy R. Lapham, M.D., Oscar Chan, M.D.,Hazem A. Elariny, M.D., Ph.D., Advanced Laparoscopic andGeneral Surgery Associates, Vienna, VA.

Purpose: Vertical banded gastroplasty (VBG), formerly the mostcommonly performed bariatric procedure, has lost popularity dueto a higher incidence of failure and complications. 40% of patientsfail to loose adequate weight and a third require revision for failureor acid reflux. We report our results with a modification of VBGprocedure that adds sleeve gastrectomy (VBG�SG).Methods: From June 2002 to October 2004, 180 patients under-went VBG�SG. Highly motivated, non–sweet-addicted patientswere selected. Data was collected retrospectively. The surgicalprocedure involves a standard laparoscopic VBG with addition ofsleeve (lateral) gastrectomy.Results: Operative time averaged 80 minutes. Most patients weredischarged the following day. No staple line leaks, no hernias, nowound infections, no erosions and no deaths occurred. Patientsreport a high level of satisfaction, with only 12% of patientsexperiencing short-term (�3 weeks) postoperative nausea with noincrease in GERD symptoms. One patient required band removalfor stricture and three patients required endoscopic dilation forstricture. Percent EBWL one and two years postoperatively re-mains in excess of 70%.Conclusions: Laparoscopic vertical banded gastroplasty withsleeve gastrectomy can be safely and rapidly performed for thetreatment of morbid obesity. Significant weight loss can be ob-served from this procedure. Candidates for this surgery must behighly motivated and compliant. Results are comparable to Roux-en-Y gastric bypass, while avoiding dumping syndrome, B12 de-ficiency, iron malabsorption and small bowel and anastomoticcomplications. Further follow-up is necessary to assess the long-term outcome of these patients.

PII: S1550-7289(05)00205-4

P18.

PROSPECTIVE, SINGLE-INSTITUTION COMPARISONOF LAPAROSCOPIC ADJUSTABLE GASTRIC BANDINGVS. LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASSManish S. Parikh, M.D., George A. Fielding, M.D.,Christine J. Ren, M.D., Department of Surgery, New York Uni-versity School of Medicine, New York, NY.

Purpose: Laparoscopic adjustable gastric banding (LAGB) andlaparoscopic Roux-en-Y gastric bypass (RYGB) are two commonprocedures offered to the morbidly obese in the US. There are nosingle-center studies comparing outcomes between procedures.Methods: Data was prospectively collected on all LAGB andRYGB operations performed at our institution from July 2000through November 2004. Preoperative age, body mass index(BMI), operative time (OR time), length of stay (LOS), and %excess weight loss (EWL) at 1, 2, and 3 years were evaluated.Student’s t tests, chi-square test, and Fisher’s exact tests were usedfor statistical analysis, where appropriate.

Results: Over the 53-month period, 870 primary LAGB and277 primary RYGB were performed. Mean age for LAGB andRYGB was 42.1 years vs. 42.0 years (p � NS), respectively,and mean preoperative BMI was 45.9 kg/m2 vs. 47.6 kg/m2

(p � 0.14), respectively. Operative time (57 minutes vs. 131minutes, p �0.001) and median length of stay (24 hrs vs. 72 hrs,p �0.001) were significantly lower for LAGB. 7 (0.8%)bands were removed. %EWL and the proportion of RYGBpatients achieving �50%EWL were significantly higher forRYGB at each year (see table). LAGB failure rate (�25%EWL)was significantly higher than RYGB at 1 year but not at 2 or 3years.

1 Year Lap-Band Lap-Bypass p-value

% follow-up 82% 67%mean %EWL � SEM 44 � 17

[8-93]66 � 18[14-111]

�0.001

�25% EWL 13% 2% �0.001�50% EWL 35% 86% �0.001

2 Year Lap-Band Lap-Bypass p-value

% follow-up 67% 31%mean %EWL � SEM 53 � 19

[10-99]69 � 18[34-107]

�0.001

�25% EWL 5% 0% p � 0.12�50% EWL 54% 84% �0.001

3 Year Lap-Band Lap-Bypass p-value

% follow-up 55% 42%mean %EWL � SEM 47 � 12

[22-64]62 � 14[34-89]

�0.001

�25% EWL 6% 0 p � .32�50% EWL 44% 79% p � .01

Conclusions: LAGB and RYGB both result in significant weightloss. Compared with LAGB, RYGB requires a longer operativetime and a longer length of stay, but results in greater %EWL withno difference in failure rate at 3 years. Patient follow-up remainsa challenge to data collection.

PII: S1550-7289(05)00206-6

P19.

TO DETERMINE THE EXCESS BODY WEIGHT LOSSIN 470 PATIENTS WHO UNDERWENT THE DUODENALSWITCH PROCEDURE AS SURGICAL TREATMENT OFMORBID OBESITYShar Hashemi, M.D., Jeffrey Nicastro, M.D.,Heather McMullen, M.D., Gene Coppa, M.D., Staten IslandUniversity Hospital, Staten Island, NY.

Purpose: The duodenal switch procedure results in a restrictedcaloric intake and diversion of bile and pancreatic secretionsto induce fat malabsorption. Broad acceptance of this pro-cedure has been impeded because of concerns that the malab-sorptive component may produce serious nutritional complica-tions.Methods: BMI and EBW data collected postoperatively everythree months from all patients who underwent duodenal switchas the primary surgical treatment of morbid obesity at a singleinstitution during the 5-year period beginning January 2000.Sequential measurements of weight were obtained to assessexcess body weight loss.Results: The average body mass index (BMI) was 52.8 (range,34 –95). Perioperative mortality was 1.4%, and morbidity(including leaks, wound dehiscence, splenectomy, and post-

252 Abstracts: Plenary Session/Surgery for Obesity and Related Diseases / 1 (2005) 222–283