<figure><img src="image_39.png" /></figure>

landmarks, lymph node dissection of left side of Aorta, both hilum, infrabifurcation of trachea is more easily performed in laparoscopically than conventional open surgery. The peripheral of the right bronchial artery, the first branch of left bronchial artery, and pulmonary branches of both vagal nerves are preserved as much as possible. Careful points; Ultrasonic coagulating system and diathermy are not used around the both recurrent laryngeal nerves. This makes incidence of palsy of the nerves lower. Bleeding from the root of left bronchial artery derived from the Aorta is difficult to complete hemostasis, so we especially take care of dissection around the artery. Conclusion; Once you get used to procedure of thoracoscopic esophagotomy, it takes up to 5 hours for completion. This procedure does not take considerable long time at all comparing to conventional open surgery and rather likely to do more curative lymph node dissection under magnification of the thoracoscopic view. We concluded that this operation would become an option of standard operation for esophageal cancer.

## V060

### THORACOSCOPIC THYMECTOMY FOR NON-THYMOMA-TOUS MYASTHENIA GRAVIS, Arvind Kumar MD, Dileep K Pawar MD, All India Institute of Medical Sciences, New Delhi, India

Thymectomy is the standard surgical procedure offered to patients with myasthenia gravis and provides relief to a significant number of patients. Sternotomy has been the traditional approach to perform this procedure. Though it provides excellent exposure, the sternotomy has its own morbidity. Throacoscopy has become a popular approach for thymectomy due to avoidance of sternotomy. It provides an opportunity for complete removal of thymus without the morbidity of sternotomy. It can be performed from the right chest, left chest or bilaterally. The use of a sternal lift device is also popular as it increases the retrosternal space, making the upper pole dissection easier. The benefits of bilateral approach include complete removal of pericardial fat bilaterally as well as clearance of aorto-caval groove and A-P window under vision. These are known sites for ectopic thymic tissue.

The steps of bilateral thoracoscopic thymectomy are same on both the sides. These consist of: complete removal of pericardial fat, division of the mediastinal pleura, dissection of the entire thymic tissue contained in the pleural envelope anterior to the phrenic nerve starting from the lower pole of the thymus on the pericardium, careful dissection of the thymus from the left innominate vein including clipping of the thymic veins and finally dissection of both upper poles upto the thyro-thymic ligament to remove the thymus completely. The mobilized gland is then put in a plastic bag and retrieved through the lowermost port on the right side. Between October 2000 and September 2006, we have performed this procedure on 102 patients with conversion required in three- two because of excessive mediastinal fat and one due to accidental injury to the phrenic nerve during dissection, which required thoracotomy for performing nerve repair under operating microscope. All the patients were extubated on the table and none required post-operative ventilation or ICU stay.

The main advantage of bilateral approach is complete clearance achieved under vision in all the critical areas. Use of sternal lift helps in the dissection in the area of innominate veins.

The video demonstrates the critical steps of the procedure.

## V061

### LAPAROSCOPIC TOTAL EXTRAPERITONEAL REPAIR OF RECURRENT BILATERAL INGUINAL HERNIAS, Brian P Jacob MD, Brian Katz MD, Anthony Vine MD, Mark Reiner MD, Mount Sinai Medical Center, New York City

The optimal surgical option for repairing recurrent inguinal hernias by using either a traditional open or a laparoscopic technique remains a controversial topic. Despite randomized trials showing that the laparoscopic techniques result in a less painful postoperative period and provide a quicker return to normal daily activities, few surgical groups have adopted the laparoscopic inguinal hernia repair as the standard operation for recurrences. Between January 2000 and July 2006, our group performed 125 consecutive laparoscopic recurrent inguinal hernia repairs with mesh (105 cases using the total extraperitoneal approach and 20 cases using the transabdominal preperitoneal approach).

In this video, we describe the details of our standard technique for a bilateral laparoscopic recurrent inguinal hernia repair. This case is based on a 30 year old male who had early bilateral recurrences following a laparoscopic transabdominal preperitoneal repair at an outside institution. By standardizing the operative technique, laparoscopic recurrent inguinal hernia repairs can continue to result in a rapid recovery period, few post-operative morbidities, and long term durability.

## V062

### LAPAROSCOPIC KASAI PORTOENTEROSTOMY WITH EXTRACORPOREAL ROUX LIMB CONSTRUCTION, Deepika Nehra BS, Samuel Rice-Townsend BA, Sanjeev Dutta MD, Lucile Packard Children's Hospital, Stanford University Medical Center

Biliary atresia can result in liver failure, and is potentially curable with Roux-en-Y portoenterostomy (Kasai procedure). We present a 10-week old infant with persistent jaundice and preliminary workup concerning for biliary atresia. In the operating room, the patient is positioned supine at the foot of the bed. A port is placed in the umbilicus for the camera and in the far left upper quadrant for the liver retractor. Two additional working ports are placed. The diagnosis of biliary atresia is first confirmed. This is done by passing a transabdominal spinal needle through the abdominal wall and into the lumen of the gallbladder. Aspiration of white bile or absence of lumen confirms the diagnosis of biliary atresia. In the case of bilious aspirate, an intraoperative cholangiogram is performed to assess biliary anatomy. The first phase of the procedure involves mobilization and removal of the atretic gallbladder. The cystic duct is then dissected proximally to expose the atretic common bile and common hepatic duct. The hepatic artery and portal vein are carefully exposed and preserved. The atretic duct is followed proximally toward the portal plate, which is then dissected away from the portal bifurcation. Small branches of the portal vein extending into the portal plate are transsected. The portal plate is clearly identified and delineated left to right and anterior to posterior. The portal plate is excised leaving a thin white membrane on the liver that contains the biliary ductules. Once adequate exposure of the portal plate is achieved, attention is turned to creation of the Roux-limb. A region of bowel 10 cm distal to the ligament of Treitz is identified and 2 orienting sutures are placed. The bowel is exteriorized through a slightly enlarged umbilicus and a 40 cm Roux-limb is constructed. The bowel is then returned to the abdomen, and laparoscopy resumed. The Roux-limb is brought antecolic to the area of portal dissection and it is tacked to the liver to reduce tension on the anastomosis. A small enterotomy is made at its tip and a portoenterostomy is sutured intracorporeally using interrupted stitches, starting with the back wall and finishing with the front wall. All ports are removed, pneumoperitoneum reduced and all incisions are closed.
V063

THORACOSCOPIC REPAIR OF A TYPE D TRACHEO-E
SOPHAGEAL FISTULA, Samuel E Rice-Townsend

BA,Deepika Nehra BS,Sanjeev Dutta MD, Lucile Packard
Children's Hospital, Stanford University Medical Center

Type D esophageal atresia (EA) is the rarest form of this
anomaly, comprising 1% of all cases, and is indicated by the
presence of both proximal and distal tracheoesophageal fis-
tulas (TEF). This video depicts what we believe is the first
description of thoracoscopic repair of a Type D lesion. A full-
term newborn with complex congenital heart disease is
diagnosed with EA. She is taken to the operating room for
thoracoscopic repair of her EA and ligation of the suspected
TEF. The patient is positioned semi-prone at a 40-degree
angle with the right side up. The right arm is elevated and
secured above the head. Three trocars are placed: mid chest
in the posterior axillary line, high up in the axilla at the mid-
axillary line and lower in the chest at the mid-axillary line.

The first step is identification and division of the azygous
vein which aids visualization and manipulation of the
esophageal limbs and trachea. Blunt dissection in the region
of the distal esophageal pouch identifies the fistula connect-

ing the distal pouch to the trachea. This fistula is suture lig-
ated intracorporeally and divided. The proximal esophageal
pouch is then dissected. In this unusual case, a second tra-
cheoesophageal fistula appears to originate at the distal end
of the proximal esophageal pouch. This fistula is divided
and the tracheal defect closed. Excellent mobilization of the
proximal esophageal pouch is achieved with the "spaghetti"
maneuver. Pressure on a naso-esophageal tube brings the
proximal pouch near the distal pouch. The two ends are
attached with a single interrupted stitch placed medially.
The distal end of the proximal pouch is then opened after
which interrupted sutures tied intracorporeally are placed to
complete the back wall of the anastomosis. A feeding tube
is inserted through the nares and directed from the proximal
pouch into the distal pouch. The front wall of the anastomo-
sis is completed. A pleural flap is created to protect the
anastomosis. The lung is reinsufflated and all incisions are
closed. Total operative time is typically 2.5 hours. Post-oper-
atively, continuous feeds are instituted immediately and a
swallow study is performed on post-operative day 5 to eval-
uate the integrity of the anastomosis. The feeding tube is
removed and the patient fed orally.

<figure><img src="image_40.png" /></figure>
<figure><img src="image_41.png" /></figure>

# SAGES POSTER LISTING

## Posters of Distinction

**P001 BAUER, KARL** "VIDEO-ASSISTED THORACIC SURGERY (VATS) FOR THE RESECTION OF METASTATIC ADENOCARCINOMA AS AN ACCEPTABLE ALTERNATIVE"

**P002 BELL, AUDREY** "DYNAMITE SKILL ASSESSMENT SYSTEM: INITIAL EVALUATION"

**P003 BOCHKAREV, VICTOR** "SHORT ESOPHAGUS: HOW MUCH LENGTH CAN WE GET?"

**P004 CHING, SIOK** "LAPAROSCOPIC VENTRAL HERNIA REPAIR: IS IT FEASIBLE FOR OBESE PATIENTS?"

**P005 DE PAULA, AUREO** "HORMONAL EVALUATION OF PATIENTS WITH BMI BELOW 35 SUBMITTED TO THE LAPAROSCOPIC TREATMENT OF TYPE 2 DIABETES MELLITUS"

**P006 EISENBERG, DAN** "PREOPERATIVE WEIGHT LOSS DOES NOT PREDICT SUCCESSFUL OUTCOME AFTER LAPAROSCOPIC ROUX-Y GASTRIC BYPASS"

**P007 FRANCO, ELIZABETH** "PERCUTANEOUS ENDOSCOPIC GASTROSTOMY: A SAFE TECHNIQUE IN PATIENTS RECEIVING CORTICOSTEROIDS"

**P008 GASPER, WARREN** "FOREGUT SURGERY IN LUNG TRANSPLANT PATIENTS"

**P009 GOETZE, THORSTEN** "INCIDENTAL GALLBLADDER CANCER AFTER LAPAROSCOPIC CHOLECYSTECTOMY AND THE PROBLEM OF A PRACTICAL CLASSIFICATION"

**P010 GREENSTEIN, ALEXANDER** "RECURRENCE AFTER LAPAROSCOPIC VENTRAL HERNIA REPAIR: A PROSPECTIVE COMPARISON OF SUTURES VERSUS TACKS"

**P011 HAMAHATA, YUKIHORO** "A NEW TECHNIQUE FOR COLONOSCOPY"

**P012 IQBAL, ATIF** "STUDY OF INTRA-GASTRIC AND INTRA-BLADDER PRESSURE CHANGES DURING REST, COUGHING, WEIGHT LIFTING, RETCHING AND VOMITING"

**P013 JOBANPUTRA, SANJAY** "LAPAROSCOPIC SIGMOID COLECTOMY FOR DIVERTICULITIS AFTER PERCUTANEOUS DRAINAGE"

**P014 KENDRICK, MICHAEL** "LAPAROSCOPIC DISTAL PANCREATECTOMY FOR PANCREATIC NEOPLASIA"

**P015 LAU, JAMES** "IS THERE A DIFFERENCE IN ANASTOMOTIC COMPLICATIONS BETWEEN DIFFERENT GASTROJEJENUAL TECHNIQUES FOR GASTRIC BYPASS?"

**P016 MAHOMED, ANIES** "LYMPHATIC SPARING SURGERY FOR VARICOCELE IN ADOLESCENTS IS EFFECTIVE IN CONTROLLING HYDROCOELE DEVELOPMENT"

**P017 MCCLUNEY, A** "LAPAROSCOPIC CANNULATION: USE OF THE SAGES LEARNING CENTER TO VALIDATE A POTENTIALLY NEW FLS TASK"

**P018 MCGEE, MICHAEL** "FEASIBILY OF TRANSRECTAL NATURAL ORIFICE TRANSLUMENAL ENDOSCOPIC SURGERY (NOTES) IN THE PORCINE MODEL"

**P019 NAZARI, SHAHRAM** "INTRAOPERATIVE CHOLANGIOGRAPHY IN PERFORMANCE OF LAPAROSCOPIC CHOLECYSTECTOMY. SELECTIVE OR ROUTINE? OUR EXPERIENCES."

**P020 ONDERS, RAYMOND** "SAFE COMBINED PLACEMENT OF THE LAPAROSCOPIC DIAPHRAGM PACING STIMULATION SYSTEMS(DPS) AND PERCUTANEOUS ENDOSCOPIC GASTROTOMY(PEG) TUBES: RESULTS OF A PHASE ONE STUDY IN AMYOTROPHIC LATERAL SCLEROSIS(ALS)"

**P021 OVERBY, DAVID** "PROPHYLACTIC PLACEMENT OF REMOVABLE INFERIOR VENA CAVA FILTERS IN PATIENTS UNDERGOING GASTRIC BYPASS FOR MORBID OBESITY."

**P022 PIERCE, RICHARD** "FUNDAMENTALS OF LAPAROSCOPIC SURGERY (FLS) SKILLS TRAINING IS APPROPRIATE FOR SENIOR MEDICAL STUDENTS ENTERING SURGICAL RESIDENCY"

**P023 POLYHRONOPOULOS, GERRY** "EFFECT OF CARBON DIOXIDE PNEUMOPERITONEUM ON HEPATIC TISSUE PERFUSION"

**P024 RASHID, QAMMAR** "TRANSAXILLARY ENDOSCOPIC THYRODECTOMY FOR MULTINODULAR GOITER: A NEW APPROACH TO AN OLD DISEASE"

**P025 SEO, CHRISTINA** "CONVERSION RATES IN LAPAROSCOPIC COLECTOMY AFTER PREOPERATIVE ENDOSCOPIC TATTOOING."

**P026 SERENO, STEFANO** "PREVALENCE OF INTERNAL HERNIAS AFTER LAPAROSCOPIC COLORECTAL RESECTION"

**P027 SHAH, SOHAIL** "EVALUATING THE IMPACT OF A MINIMALLY INVASIVE PEDIATRIC SURGEON ON HOSPITAL PRACTICE AND RESIDENT TRAINING"

**P028 SINGER, S** "LAPAROSCOPIC VERSUS OPEN EMERGENCY APPENDICECTOMY- LENGTH OF HOSPITAL STAY IN ENGLAND 2000-2004"

**P029 SOON, YUEN** "THE USE OF EPIDURAL ANALGESIA IN LAPAROSCOPIC COLORECTAL SURGERY"

**P030 TOMIOKA, H** "EFFECT OF PREVIOUS ABDOMINAL SURGERY ON LAPAROSCOPIC COLORECTAL SURGERY"

**P031 UDE, AKUEZUNKPA** "EFFECT OF VIRTUAL REALITY TRAINING BY NOVICES ON LAPAROSCOPIC CHOLECYSTECTOMY IN A PORCINE MODEL"

**P032 VELANOVICH, VIC** "HOW MANY ESOPHAGEAL CANCERS NEED TO BE PREVENTED TO MAKE ABLATION OF BARRETT'S ESOPHAGUS COST-EFFECTIVE?"

**P033 VOLCKMANN, ERIC** "PATIENT PERCEPTIONS OF NATURAL ORIFICE TRANSLUMINAL SURGERY (NOTES)"

**P034 WORKU, DAWIT** "DYNAMIC DECISION MAKING RESEARCH IN LAPAROSCOPIC CHOLECYSTECTOMY"

**P035 YOUSSEF, YASSAR** "LAPARO-ENDOSCOPIC BOWEL RESECTION: A HYBRID PROCEDURE FOR FUTURE TRANSGASTRIC SURGERIES"

## Bariatric Surgery

**P036 AHMED, AHMED** "ROUX LIMB OBSTRUCTION SECONDARY TO CONSTRICTION AT TRANSVERSE MESOCOLON AFTER LAPAROSCOPIC RETROCOLIC ROUX-EN-Y GASTRIC BYPASS (LRYGB)."

**P037 AHMED, AHMED** "CHOLECYSTECTOMY DURING LAPAROSCOPIC GASTRIC BYPASS HAS NO EFFECT ON DURATION OF HOSPITAL STAY"

**P038 AHMED, AHMED** "TRENDS IN INTERNAL HERNIA INCIDENCE AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS (LRYGB)"
SAGES POSTER LISTING

**P039 AHMED, AHMED** "THE EFFECT OF STAPLE LINE REINFORCEMENT SLEEVES (SEAMGUARD) ON INTERNAL HERNIA INCIDENCE AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS (LRYGB)."

**P040 ALASFAR, FAHAD** "REDUCTION OF CIRCULAR STAPLER RELATED WOUND INFECTION IN PATIENTS UNDERGOING LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS"

**P041 BALDUF, LISA** "IMPACT OF SOCIOECONOMIC FACTORS ON PATIENT PREPARATION FOR BARIATRIC SURGERY"

**P042 BENNETT, JOHN** "MRI ASSESSMENT OF GASTRIC FUNCTION AFTER LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING - A PILOT STUDY."

**P043 BENNETT, JOHN** "THE EFFECT OF FOLLOW UP ON THE OUTCOME OF LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING IN THE TREATMENT OF MORBID OBESITY."

**P044 BODAVULA, VENKATA** "PAIN MANAGEMENT IN LAPAROSCOPIC GASTRIC BYPASS SURGERY"

**P045 BOKOBZA, BERNARD** "INTRAGASTRIC MIGRATION OF A GASTRIC BANDING: ABOUT 13 CASES"

**P046 BONHEUR, JAMES** "LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS: AN INSTITUTION'S REVIEW OF WEIGHT LOSS IN BOTH EXTENDED AND SHORT ROUX LIMBS"

**P047 BONHEUR, JAMES** "LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS VERSUS LAPAROSCOPIC GASTRIC BANDING: AN INSTITUTION'S COMPARISON OF WEIGHT LOSS"

**P048 BOSS, THAD** "LAPAROSCOPIC TRUNCAL VAGOTOMY FOR WEIGHT-LOSS: INITIAL EXPERIENCE IN 15 PATIENTS FROM A PROSPECTIVE, MULTI-CENTER STUDY"

**P049 CAMPOS, GUILHERME** "SPECTRUM AND PREDICTORS OF COMPLICATIONS AFTER GASTRIC BYPASS."

**P050 CHOWBEY, PRADEEP** "BARIATRIC SURGERY - ASIAN PERSPECTIVE"

**P051 CLAPP, BENJAMIN** "LAPAROSCOPIC SPLEEN PRESERVING DISTAL PANCREATECTOMY AFTER GASTRIC BYPASS FOR NESIDIOBLASTOSIS"

**P052 COTTAM, DANIEL** "IS IT TIME TO ABANDON THE 21MM STAPLER FOR GASTROJEJUNOSTOMY IN LAPAROSCOPIC RNY GASTRIC BYPASS?"

**P053 DE LA CRUZ-MUNOZ, NESTOR** "PATIENTS CAN BE SAFELY DISCHARGED AFTER 24 HOURS FOR A LAPAROSCOPIC GASTRIC BYPASS"

**P054 DE LA CRUZ-MUNOZ, NESTOR** "GASTRIC BYPASS IN PATIENTS >60 YEARS OLD"

**P055 DE LA CRUZ-MUNOZ, NESTOR** "CT SCANNING IS NOT SENSITIVE FOR FINDING INTERNAL HERNIAS AFTER GASTRIC BYPASS"

**P056 DE LA CRUZ-MUNOZ, NESTOR** "GASTRIC BYPASS IS SAFE IN PATIENTS WITH BMI>50"

**P057 DICKIE, B** "DOES MENTAL HEALTH ILLNESS AFFECT THE ASSESMENT AND OUTCOME OF BARIATRIC SURGERY?"

**P058 EARLE, KRISTEN** "LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING WITH TRUNCAL VAGOTOMY: DOES THIS AUGMENT WEIGHT LOSS?"

**P059 ECKHAUSER, AARON** "CHANGES IN BODY TISSUE COMPOSITION IN MORBIDLY OBESE PATIENTS FOLLOWING BARIATRIC SURGERY."

**P060 ESCALANTE-TATTERSFIELD, TOMAS** "ROLE OF COLOR DOPPLER SONOGRAPHY IN THE DIAGNOSIS OF DEEP VEIN THROMBOSIS IN MORBIDLY OBESE PATIENTS UNDERGOING LAPAROSCOPIC GASTRIC BYPASS"

**P061 ESCALONA, ALEX** "RISK FACTORS FOR MORBIDITY FOLLOWING LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS"

**P062 FAZYLOV, RAFAEL** "EFFECT OF ADVANCED AGE ON OUTCOMES AFTER LAPAROSCOPIC GASTRIC BYPASS"

**P063 FONG, DEREK** "ENDOSCOPIC TREATMENT OF JEJUNOJEJUNAL OBSTRUCTION AFTER ROUX-EN-Y GASTRIC BYPASS SURGERY"

**P064 FREZZA, ELDO** "RESTRICTIVE SLEEVE GASTRECTOMY"

**P065 FREZZA, ELDO** "THE IMPACT OF MORBID OBESITY ON THE REGIONAL ECONOMY"

**P066 FREZZA, ELDO** "LAPAROSCOPIC GASTRIC BANDING AND STOMACH REDUCTION (GBSR)"

**P067 FUSCO, MARK** "REOPERATIVE LAPAROSCOPIC ADJUSTABLE GASTRIC BAND (LAP-BANDÆ) SURGERY CAN BE SAFELY PERFORMED AT A FREE STANDING AMBULATORY SURGERY CENTER."

**P068 GALLO, ALBERTO** "EFFECT OF THE LAP BAND SYSTEM ON COMORBID CONDITIONS IN SEVERELY OBESE ADOLESCENTS: EARLY RESULTS."

**P069 GALVANI, CARLOS** "UNREVELING THE MYTH: SIZE DOES MATTER. THE VG BAND DECREASES THE INCIDENCE OF COMPLICATIONS AFTER LAP BAND SURGERY"

**P070 GANDSAS, ALEX** "POST-OPERATIVE ROBOTIC TELEPRESENCE REDUCES LENGTH OF STAY IN PATIENTS UNDERGOING NON-COMPLICATED LAPAROSCOPIC GASTRIC BYPASS FOR MORBID OBESITY."

**P071 GARAND, SUSAN** "WHAT IS THE OPTIMAL BOWEL PREP FOR PATIENTS WHO HAVE UNDERGONE GASTRIC BYPASS?"

**P072 GONG, KE** "FOLLOW-UP OF 121 MORBIDLY OBESE PATIENTS AFTER GASTRIC BYPASS SURGERY"

**P073 HAGEDORN, JUDITH** "NATURE VS NUTURE: IDENTICAL TWINS AND BARIATRIC SURGERY"

**P074 HAN, SOO HWA** "WEIGHT LOSS OUTCOMES UTILIZING A STANDARDIZED ROUX-LIMB LENGTH: A COMPARISON BETWEEN SUPER-OBESE AND NON-SUPER OBESE PATIENTS UNDERGOING LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS."

**P075 HAN, SANG-MOON** "IMPORTANCE OF CLINICAL INDICATORS IN DETECTING POSTOPERATIVE COMPLICATIONS FOLLOWING LAPAROSCOPIC SLEEVE GASTRECTOMY."

**P076 HANSEN, ERIK** "EARLY IMPROVEMENT IN GLUCOSE HOMEOSTASIS AFTER ROUX-EN-Y GASTRIC BYPASS IS WEIGHT-INDEPENDENT"

**P077 HARPER, JASON** "CANCER IN THE GASTRIC REMNANT PRESENTING EARLY AFTER GASTRIC BYPASS"

**P078 HARTIN, CHARLES** "PREOPERATIVE BARIATRIC SCREENING AND TREATMENT OF H. PYLORI"

**P079 HOFFMAN, AARON** "REVERSE ANGLE OF HIS DISSECTION: A NEW TECHNIQUE FOR LAP. BAND PLACEMENT"

<figure><img src="image_42.png" /></figure>
<figure><img src="image_43.png" /></figure>

SAGES POSTER LISTING

**P080 HONG, DENNIS** "UNCOMMON CAUSE OF CHRONIC NAUSEA, VOMITING AND REGURGITATION FOLLOWING LAPAROSCOPIC GASTRIC BYPASS: LONG JEJUNAL DIVERTICULUM SYNDROME"

**P081 HOPE, WILLIAM** "RECURRENCE OF MESENTERIC DEFECTS AFTER CLOSURE IN ROUX-EN-Y GASTRIC BYPASS"

**P082 HUYHN, QUOC** "A CANADIAN EXPERIENCE COMPARING LAPAROSCOPIC GASTRIC BYPASS TO ADJUSTABLE GASTRIC BAND"

**P083 IRGAU, ISAIAS** "REMOVABLE IVC FILTERS IN HIGH RISK BARIATRIC PATIENTS"

**P084 JAN, JAY** "PREDISPOSING FACTORS FOR BAND SLIPPAGE IN LAP-BAND PATIENTS"

**P085 KARDYS, CLARK** "PREVENTION OF MORTALITY FROM PULMONARY EMBOLISM IN BARIATRIC PATIENTS THROUGH IVC FILTER PLACEMENT."

**P086 KASAMA, KAZUNORI** "LAPAROSCOPIC BARIATRIC SURGERY IN JAPAN:SINGLE SURGEON'S SERIAL EXPERIENCES"

**P087 KAUL, ASHUTOSH** "SUBCLINICAL DIABETIC GASTROPARESIS MAY CONTRIBUTE TO POOR OUTCOMES AFTER LAPAROSCOPIC GASTRIC BAND"

**P088 KAUL, ASHUTOSH** "BARIATRIC SURGERY IN PATIENTS OVER 65 YEARS IS SAFE WITH ACCEPTABLE MORBIDITY"

**P089 KENNEDY, COLLEEN** "THE USE OF RETRIEVABLE VENAL CAVAL FILTERS IN BARIATRIC PATIENTS"

**P090 KETCHUM, ERIC** "AGE RELATED RESOLUTION OF CARDIOVASCULAR COMORBIDITIES IN BARIATRIC SURGERY PATIENTS"

**P091 KIM, EUNG** "INCISIONLESS ACCESS PORT INSERTION METHOD DURING LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING"

**P092 KOLDER, DAN** "LAPAROSCOPIC GASTRIC BYPASS SURGERY IN AN OBESE SLOW PROGRESSIVE INSULIN DEPENDENT DIABETIC PATIENT"

**P093 KURESHI, IKRAM** "A COMPARISON OF LAPAROSCOPIC AND OPEN REVISIONS OF ROUX-EN-Y GASTRIC BYPASS"

**P094 LAHMANN, BRIAN** "USE OF 3MÔ TEGADERMÔ ABSORBENT CLEAR ACRYLIC DRESSING ON SURGICAL WOUNDS"

**P095 LAPHAM, TIMOTHY** "USE OF A BLADED OPTICAL PERITONEAL ACCESS TROCAR IN THE UNINSUFFLATED ABDOMEN; A FIVE-YEAR EXPERIENCE"

**P096 LEE, HONGCHAN** "EFFECT OF BARIATRIC SURGERY ON WEIGHT LOSS IN PATIENTS WITH TYPE 2 DIABETES"

**P097 LINOS, DIMITRIOS** "LAPAROSCOPIC SLEEVE GASTRECTOMY AS AN ALTERNATIVE OPTION IN LOW BMI PATIENTS: INITIAL RESULTS"

**P098 MATEI, EMIL** "EARLY RESULTS OF REMNANT GASTRECTOMY FOR GASTRO GASTRIC FISTULAE AFTER DIVIDED ROUX Y GASTRIC BYPASS FOR MORBID OBESITY"

**P099 MCCLOSKEY, C** "HORMONAL VALIDATION OF THE ROLE OF WEIGHT LOSS SURGERY IN THE TREATMENT OF POLYCYSTIC OVARIAN SYNDROME"

**P100 MEDINA, SANDRA G.** "INCIDENCE AND MANAGEMENT OF GASTROJEJUNAL ANASTOMOTIC STENOSIS AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS USING A HAND-SEWN TECHNIQUE"

**P101 MITTERMAIR, REINHARD** "A 10-YEAR EXPERIENCE WITH LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING FOR MORBID OBESITY"

**P102 MÇLLER, MARKUS** "MATCHED PAIR ANALYSIS OF PROXIMAL VS. DISTAL LAPAROSCOPIC GASTRIC BYPASS WITH 4 YEARS FOLLOW-UP"

**P103 Withdrawn**

**P104 MU—OZ, RODRIGO** "ENDOSCOPIC FINDINGS IN MORBID OBESE PATIENTS UNDERGOING BARIATRIC SURGERY"

**P105 NAHMIAS, NISSIN** "DRAINS AND UPPER GIS AFTER GASTRIC BYPASS SURGERY- ARE THEY NECESSARY?"

**P106 NALAMATI, SURYA PRASAD** "COMPARISON OF THREE DIFFERENT GASTROJEJUNOSTOMY ANASTOMOSIS TECHNIQUES IN LAPAROSCOPIC ROUX EN Y GASTRIC BYPASS (LRYGBP) SURGERY"

**P107 NGUYEN, RICHARD** "A NOVEL TREATMENT APPROACH FOR POSTPRANDIAL HYPOGLYCEMIA AFTER ROUX-EN-Y GASTRIC BYPASS"

**P108 PENDER, JOHN** "WOUND PROTECTOR DEVICE DECREASES PORT SITE INFECTION AFTER LAPAROSCOPIC ROUX EN Y GASTRIC BYPASS."

**P109 PURI, V** "BARIATRIC SURGERY IN THE PRESENCE OF INTESTINAL MALROTATION: EXPERIENCE WITH THE DUODENAL SWITCH.."

**P110 QUILICI, PHILIPPE** "THROMBO-EMBOLIC RISKS OF MORBIDLY OBESE PATIENTS UNDERGOING A LAPAROSCOPIC GASTRIC BYPASS WITH ROUX Y LIMB"

**P111 RASMUSSEN, JASON** "THE UTILITY OF ROUTINE POSTOPERATIVE UPPER GI SERIES FOLLOWING GASTRIC BYPASS"

**P112 RASMUSSEN, JASON** "MARGINAL ULCERATION AFTER LAPAROSCOPIC GASTRIC BYPASS: AN ANALYSIS OF PREDISPOSING FACTORS IN 260 PATIENTS."

**P113 RENTON, D** "INTERNAL HERNIAS AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS ARE PREVENTED WITH BIOABSORBABLE SEAMGUARDÆ MATERIAL"

**P114 ROWAN, BREA** "ANTI-XA LEVELS OF TWO PROPHYLACTIC DOSING REGIMENS OF LOW MOLECULAR WEIGHT HEPARIN DURING LAPAROSCOPIC BARIATRIC SURGERY"

**P115 SALIMATH, JAYARAJ** "LONG TERM OUTCOME OF LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING IN PATIENTS WITH ESOPHAGEAL DYSMOTILITY"

**P116 SALLET, JOS...** "UTILIZATION OF THE INTRAGASTRIC BALLOON (BIB) IN PRE-OPERATIVE PREPARATION FOR SUPER OBESE PATIENTS WITH HIGH SURGICAL RISK COMPARING WITH TWO STEPS SURGERY"

**P117 SALLET, JOS...** "LAPAROSCOPIC ROUX-EN-Y GASTRIC BY PASS WITH DISTAL JEJUNUN-ILEAL DIVERSION – TECHNIQUE AND RESULTS"

**P118 SHERWINTER, DANNY** "THROMBOSIS OF THE LAP-BAND SYSTEM"

**P119 SILECCHIA, GIANFRANCO** "TWO STEPS LAPAROSCOPIC BILIO-PANCREATIC DIVERSION WITH DUODENAL SWITCH AS TREATMENT OF HIGH-RISK SUPER OBESE PATIENTS: ANALYSIS OF COMPLICATIONS"
SAGES POSTER LISTING

P120 SORIANO, IAN "MANAGEMENT OF RETAINED AND SECONDARY COMMON BILE DUCT STONES AFTER ROUX-EN-Y GASTRIC BYPASS SURGERY: CASE REPORT & REVIEW OF THE LITERATURE"

P121 STEPHENS, D "BARIATRIC OPERATIONS: LOW MORTALITY IN A HIGH VOLUME BARIATRIC SURGERY CENTER"

P122 STRAUSS, STEPHANIE "DOES REQUIRING SMOKE CESSION PRIOR TO BARIATRIC SURGERY PRODUCE SUSTAINED SMOKING ABSTINENCE"

P123 SUWA, TATSUSHI "OUR PRACTICAL PROCEDURE FOR LAPAROSCOPY-ASSISTED DISTAL GASTRECTOMY WITH LYMPH NODES DISSECTION"

P124 TAGAYA, NOBUMI "THE FOLLOW-UP METHOD FOR REMNANT STOMACH AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS OF MORBID OBESITY- APPLICATION OF DOUBLE-BALLOON INTESTINAL ENDOSCOPY."

P125 TAKATA, MARK "FACTORS PREDICTING GASTROJEJUNOSTOMY STRICTURE AFTER GASTRIC BYPASS FOR MORBID OBESITY."

P126 TALLER, JANOS "WEIGHTLOSS SURGERY AFTER NISSEN FUNDOPERATION: CONSIDERATION FOR LAPAROSCOPIC SLEEVE GASTRECTOMY"

P127 TE RIELE, WOUTER "LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING (LAGB) IN SUPER-OBESITY PATIENTS, THE RIGHT CHOICE?"

P128 TILLOU, GREGORY "EVALUATION OF PERIOPERATIVE DEXMEDETOMIDINE ADMINISTRATION FOR LAPAROSCOPIC GASTRIC BYPASS"

P129 TOPART, PHILIPPE "MOVING TO LAPAROSCOPY FOR BILIOPANCREATIC DIVERSION WITH DUODENAL SWITCH WITHIN THE LEARNING CURVE: WHAT DIFFERENCE DOES IT MAKE?"

P130 TUCKER, OLGA "SINGLE-STAGE LAPAROSCOPIC SLEEVE GASTRECTOMY FOR WEIGHT LOSS IN MORBID OBESITY"

P131 TUCKER, OLGA "THE ROLE OF THE BARIATRIC SURGEON IN ENDOSCOPIC MANAGEMENT OF PATIENTS AFTER WEIGHT LOSS SURGERY"

P132 TUCKER, OLGA "IS CONCOMITANT CHOLECYSTECTOMY NECESSARY IN OBESITY PATIENTS UNDERGOING LAPAROSCOPIC GASTRIC BYPASS SURGERY?"

P133 UEDA, KAZUKI "COMPLICATIONS OF SLEEVE GASTRECTOMY WITH WRAPPING USING PTFE IN A PORCINE MODEL"

P134 YU, SHERMAN "STAPLE LINE REINFORCEMENT IN LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS: SEAMGUARD OR PERISTRIPS?"

P135 ZOGRAFAKIS, JOHN "BENEFIT OF PATIENT CONTROLLED LOCAL ANESTHETIC INFUSION DEVICE AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS (LRYGB)"

Basic Science (Cellular Bio, Physiology)

P136 AVITAL, SHMUEL "DIFFERENT PNEUMOPERITONEUM PRESSURES EFFECT THE PROPORTION OF CARBON DIOXIDE DIFFUSION THROUGH THE PERITONEUM AND THROUGH OPEN SMALL BOWEL AS REFLECTED BY END TIDAL CARBON DIOXIDE (ETCO2): OBSERVATION IN A SMALL ANIMAL MODEL"

P137 BELIZON, A "THE EFFECT OF SURGERY ON GRANULOCYTE GENE EXPRESSION; A MICROARRAY ANALYSIS."

P138 BENNETT, JOHN "EARLY RESULTS OF THE USE OF NOVEL PROTEOMIC AND METABOLOMIC ASSESSMENT TOOLS TO ASSESS METABOLIC RESPONSE TO WEIGHT-LOSS IN PRE AND POST-LAGB PATIENTS."

P139 CHIKUNGUWO, SILAS "LAPAROSCOPIC BARIATRIC SURGERY-INDUCED WEIGHT LOSS ENHANCES THE SPECIFIC IMMUNE SYSTEM."

P140 YAVUZ, YUNUS "EFFECT OF BLOOD GAS CORRECTION ON TISSUE BLOOD FLOW DURING CARBON DIOXIDE PNEUMOPERITONEUM"

Colorectal/Intestinal Surgery

P141 ARMON, YARON "LAPAROSCOPIC MANAGEMENT OF COMPLICATED CROHN'S DISEASE"

P142 AVERSA JR, JOHN "A COMPARISON OF HAND-ASSISTED LAPAROSCOPIC (HAL) AND LAPAROSCOPIC COLECTOMY FOR THE TREATMENT OF DIVERTICULAR DISEASE."

P143 BAEK, JEONG-HEUM "SHORT-TERM RESULTS OF LAPAROSCOPIC SURGERY VERSUS OPEN SURGERY FOR RADICAL TREATMENT OF PATIENTS WITH COLORECTAL CANCER"

P144 BALAGUE, CARMEN "OUTCOME OF LAPAROSCOPIC COLORECTAL SURGERY IN OCTOGENARIANS."

P145 BERLAND, TODD "INTRAOPERATIVE GAMMA PROBE LOCALIZATION OF THE URETERS: A NOVEL TECHNIQUE"

P146 BROZOVICH, MARC "LAPAROSCOPIC COLECTOMY FOR "BENIGN" COLORECTAL NEOPLASIA: A WORD OF CAUTION"

P147 CAMBRONERO, NEIL "ANAL PAP SMEAR IN HIGH RISK PATIENTS: A POOR SCREENING TOOL"

P148 CARILLI, SENOL "AN INFECTIOUS COMPLICATION OF LAPAROSCOPIC APPENDECTOMY: FIFTH DAY SYNDROME"

P149 CARLIN, ARTHUR "THE MANAGEMENT OF PERFORATED APPENDICITIS: LAPAROSCOPIC VERSUS OPEN APPENDECTOMY"

P150 CHAMPAGNE, BRADLEY "A RESIDENT'S EXPERIENCE WITH HAND-ASSISTED VS. STRAIGHT LAPAROSCOPY FOR LEFT COLECTOMY: IS THERE REALLY A DIFFERENCE?"

P151 CHOI, GS "LAPAROSCOPIC RESECTION FOR RECTAL CANCER: ONCOLOGIC OUTCOMES IN 139 CONSECUTIVE PATIENTS WITH A MINIMUM FOLLOW-UP OF 2 YEARS."

P152 CHOUILLARD, ...LIE "ELECTIVE LAPAROSCOPIC LEFT COLONIC RESECTION FOR NON COMPLICATED DIVERTICULITIS: WHEN IS IT BEST TO OPERATE?"

P153 DALVI, ABHAY "LAPAROSCOPIC TOTAL COLECTOMY FOR BENIGN COLONIC DISORDERS"

P154 D'AMBROSIO, GIANCARLO "MINIMALLY INVASIVE TREATMENT OF RECTOVAGINAL FISTULA"

P155 DOMAJNKO, BASTIAN "LAPAROSCOPIC-ASSISTED SIGMOID COLECTOMY FOR VOLVULUS"

P156 ERENLER KILIC, ILKNUR "LAPAROSCOPIC TREATMENT OF CROHN'S DISEASE: SINGLE SURGICAL TEAM EXPERIENCE"

P157 ERENLER KILIC, ILKNUR "SINGLE SURGICAL TEAM EXPERIENCE FROM TURKEY FOR ULCERATIVE COLITIS"

<figure><img src="image_44.png" /></figure>
<figure><img src="image_45.png" /></figure>

SAGES POSTER LISTING

**P158 ERENLER** KILIC, ILKNUR "LAPAROSCOPIC SURGERY IN COLORECTAL CANCERS: EXPERIENCE WITH 57 PATIENTS"

**P159 ETO, KEN** "VIRTUAL REALITY SURGERY SIMULATION SYSTEM FOR LAPAROSCOPIC ASSISTED COLORECTAL SURGERY WITH PATIENT-SPECIFIC ANATOMY"

**P160 FAKHRE, G. PETER** "PRESACRAL LYMPHANGIOMA: RARE CAUSE FOR CYSTIC PRESACRAL TUMOR"

**P161 FARESI, MARIANO** "LAPAPAROSCOPIC COLECTOMY FOR COLON CANCER. DOES CONVERSION AFFECT THE OUTCOME?"

**P162 FORGIONE, A.** "PROSPECTIVE EVALUATION OF FUNCTIONAL RESULTS AFTER LAPAROSCOPIC COLECTOMY FOR DIVERTICULAR DISEASE"

**P163 GARCIA-ORIA, MIGUEL** "ANOTHER WAY TO TREAT THE APPENDICEAL ROOT IN LAPAROSCOPIC APPENDECTOMY"

**P164 GARRETT, KELLY** "LAPAROSCOPIC TOTAL PROCTOCOLECTOMY AND LAPAROSCOPIC TOTAL ABDOMINAL COLECTOMY: SINGLE SURGEON EXPERIENCE"

**P165 GHOSHEH, B.** "LAPAROSCOPIC APPROACH TO ACUTE SMALL BOWEL OBSTRUCTION: REVIEW OF 1047 CASES."

**P166 HAHNLOSER, DIETER** "LAPAROSCOPIC MANAGEMENT OF SMALL BOWEL OBSTRUCTION: ANALYSIS OF THE SALTS DATABASE."

**P167 HAYASHI, SHIGEKI** "HAND-ASSISTED LAPAROSCOPIC TOTAL COLECTOMY FOR ULCERATIVE COLITIS WITH SIGMOID COLON CANCER"

**P168 HERMAN, ROMAN** "CHANGES IN ANORECTAL PHYSIOLOGY AFTER ANAL SPHINCTER RADIOFREQUENCY REMODELING (SECCA PROCEDURE)"

**P169 IKEDA, EIJI** "EVALUATION OF LAPAROSCOPE-ASSISTED COLECTOMY FOR THE PATIENTS WITH ACUTE ABDOMEN"

**P170 JAKOBLEFF, WILLIAM** "LAPAROSCOPIC EXCISION OF A MALIGNANT MESENTERIC CYST IN A 22 YEAR-OLD FEMALE"

**P171 JAYARAMAN, S** "STAPLED HEMORRHOIDOPEXY IS ASSOCIATED WITH A HIGHER RECURRENCE RATE OF INTERNAL HEMORRHOIDS COMPARED TO CONVENTIONAL EXCISION SURGERY: FOLLOW-UP TO A META-ANALYSIS"

**P172 JAZAERI, O** "OUTCOMES OF LOCAL EXCISION OF T1 RECTAL CANCERS: OPEN TRANSANAL VS ENDOSCOPIC MICROSURGICAL"

**P173 JOBANPUTRA, SANJAY** "LAPAROSCOPIC ASSISTED DIVERTICULAR RESECTION FOR SITUS INVERSUS TOTALIS."

**P174 JOSHI, AMIT** "A TECHNIQUE FOR LAPAROSCOPIC FEEDING JEJUNOSTOMY USING A BALLOON-TIP CATHETER"

**P175 KANAZAWA, AKIYOSHI** "OUTCOME OF LAPAROSCOPIC SURGERY IN LOWER RECTAL CANCER"

**P176 KANG, SUNG-BUM** "LAPAROSCOPIC RESECTION ALLOWS EARLIER CHEMOTHERAPY THAN OPEN RESECTION IN STAGE III COLORECTAL CANCER"

**P177 KANG, SUNG-BUM** "IS ROUTINE MOBILIZATION OF SPLENIC FLEXURE NECESSARY IN LAPAROSCOPIC RESECTION OF RECTOSIGMOID CANCER?"

**P178 KATSUNO, GOUTAROU** "USEFULLNESS OF LAPAROSCOPIC SURGERY FOR PERFORATED OR ABSCESS FORMING APPENDICITIS"

**P179 KIERNAN, F** "LAPAROSCOPIC RIGHT HEMICOLECTOMY FOR INTESTINAL INTUSSUCCEPTION"

**P180 KIM, JAE HWANG** "THE EFFECT OF ROTATABLE LAPAROSCOPIC VIDEO MONITOR ON THE CAPABILITY OF LAPAROSCOPIC PROCEDURE"

**P181 KIRBY, DR.RACHEL** "INFLAMMATORY BOWEL DISEASE: OPEN VERSUS LAPAROSCOPIC SUBTOTAL COLECTOMY."

**P182 KIRBY, RACHEL** "PERFORATED DIVERTICULAR DISEASE: LAPAROSCOPIC HARTMANN'S PROCEDURE AND SUBSEQUENT LAPAROSCOPIC REVERSAL."

**P183 KIRBY, DR.RACHEL** "ASSESSMENT OF A LAPAROSCOPIC APPROACH IN THE MODERN MANAGEMENT OF PERFORATED PEPTIC ULCER DISEASE."

**P184 KOKUBA, YUKIHITO** "THE PROBLEMS OF LAPAROSCOPIC LOW ANTERIOR RESECTION FOR RECTAL CANCER"

**P185 KUMARA, SHANTHA** "PLASMA TIMP-1 LEVELS ARE TRANSIENTLY INCREASED AFTER LAPAROSCOPIC-ASSISTED COLORECTAL RESECTION FOR BENIGN INDICATIONS"

**P186 KUMARA, SHANTHA** "COLORECTAL RESECTION, OPEN MORE SO THAN MINIMALLY INVASIVE, IN PATIENTS WITH BENIGN INDICATIONS IS ASSOCIATED WITH PROANGIOGENIC CHANGES IN THE PLASMA LEVELS OF ANGIPOIETIN 1 AND 2"

**P187 KY, ALEX** "USE OF TRANSANAL ENDOSCOPIC MICROSURGERY FOR EXCISION OF RECTAL LESIONS"

**P188 LAW, WAI LUN** "LAPAROSCOPIC RESECTION FOR STAGE IV COLORECTAL CANCER"

**P189 LEE, YS** "LAPAROSCOPIC SURGERY FOR SPLENIC FLEXURE COLON CANCER"

**P190 LEZOCHE, GIOVANNI** "NUCLEOTIDE-GUIDED MESORECTAL EXCISION IN LOCAL TREATMENT OF NON ADVANCED LOW RECTAL CANCER (NALRC) BY TEM"

**P191 LUDWIG, K.** "GI RECOVERY RESPONDER ANALYSIS: RESULTS OF PHASE III TRIALS OF ALVIMOPAN (ALV) 12 MG VERSUS PLACEBO (PLA) IN PTS UNDERGOING BR"

**P192 MALHOTRA, NITIN** "LAPAROSCOPIC TREATMENT OF INTRAABDOMINAL FISTULAS: SINGLE SURGEON EXPERIENCE"

**P193 MALONEY, NELL** "CONVERSION RATES IN LAPAROSCOPIC COLORECTAL SURGERY SINCE THE COST TRIAL"

**P194 MATSUOKA, H** "LAPAROSCOPIC ADHESIOLYSIS FOR BOWEL OBSTRUCTION: PREOPERATIVE USEFULNESS OF CINE MAGNETIC RESONANCE IMAGING"

**P195 MAZEH, HAGGI** "LAPAROSCOPIC AND OPEN REVERSAL OF HARTMAN'S PROCEDURE – A COMPARATIVE RETROSPECTIVE ANALYSIS"

**P196 MEIRELES, OZANAN** "USE OF OXIMETRY-CAPABLE INSTRUMENTS TO ENHANCE IDENTIFICATION OF ISCHEMIC BOWEL DURING SURGERY."

**P197 MISRA, SUBHASIS** "JEJUNAL DIVERTICULA – A SOURCE OF MASSIVE GASTROINTESTINAL BLEEDING"

**P198 MISRA, SUBHASIS** "SPECTACULAR COLOSTOMY - A NEW TECHNIQUE"
SAGES POSTER LISTING

P199 MOLOO, HUSEIN "THE ADOPTION OF LAPAROSCOPIC COLORECTAL SURGERY: A NATIONAL SURVEY OF GENERAL SURGEONS"

P200 NAIDU, MURALI "ENTERIC FISTULAS FROM CROHN'S DISEASE CAN BE TREATED SAFELY AND EFFECTIVELY WITH LAPAROSCOPIC SURGERY"

P201 NAKAJIMA, KIYOKAZU "MINIMALLY INVASIVE APPROACHES TO COMPLEX CROHN'S DISEASE: THE CURRENT ROLE OF HALS IN EXTENSIVE COLECTOMY"

P202 NELSON, THOMAS "RETROGRADE APPROACH TO LAPAROSCOPIC SIGMOID COLECTOMY FOR DIVERTICULITIS: A 6 YEAR SINGLE INSTITUTION SINGLE SURGEON EXPERIENCE OF A NOVEL TECHNIQUE"

P203 NISHIOKA, MASANORI "NEW PORTS DESIGN IN LAPAROSCOPIC CENTRAL LYMPH NODES DISSECTION WITH LEFT COLIC ARTERY PRESERVATION FOR COLON CANCER"

P204 NOVITSKY, YURI "HAND-ASSISTED LAPAROSCOPIC COLECTOMY: IS THERE AN ADVANTAGE OVER OPEN RESECTIONS?"

P205 DELANEY, CONOR "IMPACT OF AN EXPERIENCED LAPAROSCOPIC COLORECTAL SURGEON TO AN EXISTING TRADITIONAL COLORECTAL PRACTICE IN AN ACADEMIC MEDICAL CENTER."

P206 OGUMA, JUNYA "A CASE OF COLONIC INTUSSUSCEPTION RESULTING FROM LIPOMATOUS TUMOR TREATED BY LAPAROSCOPIC-ASSISTED SURGERY"

P207 PETROFSKI, JASON "HAND-ASSISTED LAPAROSCOPIC RIGHT HEMICOLECTOMY OFFERS ADVANTAGES OVER OPEN RIGHT HEMICOLECTOMY AND STANDARD LAPAROSCOPIC HEMICOLECTOMY IN PATIENTS WITH COLONIC NEOPLASIA"

P208 PHADKE, MADHAV "PREVENTION OF STOMAL COMPLICATIONS"

P209 RAMIREZ VALDERRAMA, ALEXANDER "NECROSIS INTESTINAL IN A 14-MONTH-OLD INFANT WITH AN INTESTINAL OBSTRUCCION BY ASCARIS"

P210 RAO, ARUN "BIOABSORBABLE GLYCOLIDE COPOLYMER STAPLE LINE REINFORCEMENT FOR LAPAROSCOPIC APPENDECTOMY"

P211 RAWLINGS, ARTHUR "LAPAROSCOPIC COLON SURGERY: AN EIGHT YEAR EXPERIENCE"

P212 READ, THOMAS "IPEEK PORTI: A NOVEL APPROACH TO AVOID CONVERSION UTILIZING HAND-ASSIST TECHNOLOGY"

P213 REYNOLDS, JR., HARRY "ALVIMOPAN, A PERIPHERALLY ACTING MU-OPIOID RECEPTOR (PAM-OR) ANTAGONIST, SIGNIFICANTLY ACCELERATED GASTROINTESTINAL RECOVERY AND HOSPITAL DISCHARGE IN PATIENTS RECEIVING INTRAVENOUS PATIENT-CONTROLLED OPIOIDS AFTER SMALL BOWEL RESECTION (SBR)"

P214 ROTHOLTZ, NICOLAS "LAPAROSCOPIC PROCTOCOLECTOMY USING COMPLETE INTRACORPOREAL DISSECTION"

P215 RUIZ, DAN "IS HAND ASSISTED SURGERY FOR DIVERTICULITIS BETTER THAN OPEN OR STANDARD LAPAROSCOPIC SURGERY?"

P216 SAIDA, YOSHIHISA "A COMPARISON OF ABDOMINAL CAVITY BACTERIAL CONTAMINATION IN LAPAROSCOPY AND LAPAROTOMY FOR COLORECTAL CANCER"

P217 SEBASTIAN, MOLLY "CHEMOPREVENTION AFTER SURGERY FOR CROHN'S DISEASE: IS IT NEEDED?"

P218 SHERIDAN, CAROL "LAPAROSCOPIC RIGHT COLON RESECTION IN THE LEARNING CURVE"

P219 SILVER, ANDREA "LAPAROSCOPIC-ASSISTED ENDOSCOPIC REMOVAL OF A COLONIC MASS"

P220 SINGH, RAVINDER "CAN COMMUNITY SURGEONS PERFORM LAPAROSCOPIC COLO-RECTAL SURGERY WITH OUTCOMES EQUIVALENT TO TERTIARY CARE CENTERS?"

P221 SOON, YUEN "LAPAROSCOPIC COLORECTAL SURGERY FOR STAGE IV ENDOMETRIOSIS"

P222 SOON, YUEN "LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER- 150 CONSECUTIVE CASES"

P223 SOON, YUEN "QUALITY OF LIFE FOLLOWING LAPAROSCOPIC AND OPEN COLORECTAL SURGERY"

P224 SPITLER, JENNIFER "OUTCOMES ANALYSIS OF LAPAROSCOPIC RESECTION FOR ISOLATED PATHOLOGY OF THE SMALL INTESTINE"

P225 STIPA, FRANCESCO "MANAGEMENT OF OBSTRUCTIVE COLORECTAL CANCER WITH ENDOSCOPIC STENTING FOLLOWED BY SINGLE STAGE SURGERY: OPEN OR LAPAROSCOPIC RESECTION?"

P226 TAKIGUCH, S "IS LADG TRULY MINIMALLY INVASIVE?-SINGLE BLIND RANDAMIZED TRIAL"

P227 TALLER, JANOS "TOTALLY LAPAROSCOPIC RIGHT COLECTOMY: DESCRIPTION OF TECHNIQUE AND REVIEW OF OUR FIRST FIVE PATIENTS."

P228 TARGARONA, EDUARDO "CLINICAL, ANATOMIC AND PATHOLOGIC PREDICTIVE FACTORS FOR INMEDIATE SURGICAL OUTCOME AFTER LAPAROSCOPIC APPROACH TO THE RECTUM"

P229 SHAYANI, VAFA "LAPAROSCOPIC EXTRA-PERITONEAL REPAIR OF INGUINAL HERNIA COMBINED WITH ELECTIVE RESECTION OF SIGMOID COLON"

P230 THEKKINKATTIL, DINESH "FUNCTIONAL OUTCOME OF LAPAROSCOPIC MESH SACROCOLPORECTOPEXY FOR COMBINED RECTAL AND VAGINAL PROLAPSE"

P231 TSUBAMOTO, MARI "LAPAROSCOPIC SURGERY IN CROHN'S DISEASE: MANAGEMENT OF BOWEL FISTULAS."

P232 UCHIKOSHI, FUMIHIRO "LYMPH NODE DISSECTION USING THE ELECTROTHERMAL BIPOLAR SEALER (LIGASURE V&#63722;) IN THE LAPAROSCOPIC SURGERY FOR COLON CANCER"

P233 ZACHARAKIS, EMMANOUIL "TRANSANAL ENDOSCOPIC MICROSURGERY FOR RECTAL TUMORS. THE ST MARY'S EXPERIENCE."

P234 ZAIDI, RAZA "LAPAROSCOPIC HARTMANN'S PROCEDURE: A VIABLE OPTION IN TREATING ACUTELY PERFORATED DIVERTICULTIS."

P235 ZDICHAVSKY, MARTY "LAPAROSCOPIC SIGMOID COLECTOMY AFTER DIVERTICULITIS: THE THREE TROCAR TECHNIQUE."

P236 ZDICHAVSKY, MARTY "PRELIMINARY RESULTS OF LAPAROSCOPIC SURGERY FOR ACUTE DIVERTICULITIS."

<figure><img src="image_46.png" /></figure>
<figure><img src="image_47.png" /></figure>

SAGES POSTER LISTING

Complications of Surgery

P237 ANDOH, HIDEAKI "PROCEDURE FOR USE THE SEPRAFILM ADHESION BARRIER IN LAPAROSCOPIC SURGERY"

P238 BOCCARDO, JUSTIN "LAPAROSCOPIC REPAIR OF DUCT OF LUSHKA INJURY."

P239 BOWERS, STEVEN "ENDOSCOPIC PERFORATION OF DUODENAL DIVERTICULUM: A REPORT OF TWO CLINICAL CASES"

P240 CALA, ZORAN "COMPLICATIONS OF ENDOSCOPIC IMPLANTATION OF PERITONEAL DIALYSIS CATHETER"

P241 CARVALHO, GUSTAVO "LAPAROSCOPIC TRANSMEDIASTINAL DRAINAGE - A SIMPLE AND EFFECTIVE PROCEDURE FOR THE TREATMENT OF ACCIDENTAL PNEUMOTHORAX IN LAPAROSCOPIC ANTI-REFLUX SURGERY"

P242 COX, DAVID "SAFETY AND EFFICACY OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN PATIENTS WITH PRIOR UPPER ABDOMINAL SURGERY"

P243 FINNELL, CHRISTOPHER "PERFORATED DUODENAL ULCER FOLLOWING LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS"

P244 GATMAITAN, PATRICK "INTESTINAL FAILURE: A RARE ERCP COMPLICATION"

P245 GOETZE, THORSTEN "THE PERFORATION OF THE GALLBLADDER IN CASES OF INCIDENTAL GALLBLADDER CANCER- AND THE DOUBTFUL PROTECTIVE EFFECT OF ISOLATION BAGS."

P246 HOSHINO, HIROMITSU "INTRAABDOMINAL ABSCESS AS A COMPLICATION OF LAPAROSCOPIC APPENDECTOMY: REPORT OF A CASE"

P247 KIRSHTEIN, BORIS "EARLY RE-LAPAROSCOPY FOR MANAGEMENT OF SUSPECTED POSTOPERATIVE COMPLICATIONS"

P248 MISRA, SUBHASIS "RETROPERITONEAL TROCAR INJURY IN LAPAROSCOPIC CHOLECYSTECTOMY"

P249 NIKICA, ANDROMAKO "BILE DUCT INJURIES AFTER OPEN AND LAPAROSCOPIC CHOLECYSTECTOMIES AT DEPARTMENT FOR ABDOMINAL SURGERY, MARIBOR, SLOVENIA"

P250 OMELANCZUK, PABLO "INTRAOPERATIVE COMPLICATIONS IN THE LAPAROSCOPIC TREATMENT OF ESOPHAGEAL DISEASES"

P251 PALSA, MEGAN "LAPAROSCOPIC REMOVAL OF SEVERED, PARTIALLY RETAINED JACKSON-PRATT DRAIN FOLLOWING OPEN SURGERY."

P252 SOON, YUEN "ASSESMENT OF ADHESIONS AT LAPAROSCOPY FOLLOWING OPEN AND LAPAROSCOPIC COLORECTAL SURGERY"

P253 TSUJINAKA, SHINGO "VISCERAL FAT AREA IS A USEFUL PREDICTOR OF SURGICAL OUTCOME FOLLOWING LAPAROSCOPIC COLECTOMY FOR COLON CANCER"

P254 WHITE, BRENT "LAPAROSCOPIC MANAGEMENT OF RETAINED GALLSTONES PRESENTING AS A HEPATIC MASS"

P255 WOLF, JOSEPH "INTRAOPERATIVE DIAGNOSIS AND REPAIR OF TRANSECTED RADIAL NERVE DURING ENDOSCOPIC RADIAL ARTERY HARVEST FOR CABG"

Education/Outcomes

P256 ADKINS, J "ACQUISITION OF LAPAROSCOPIC SKILLS: COMPARISON OF MEDICAL STUDENTS AND PA STUDENTS"

P257 AGGARWAL, R "THE DEVELOPMENT OF A PROFICIENCY-BASED TRAINING CURRICULUM ON THE LAPMENTOR VIRTUAL REALITY SIMULATOR"

P258 BREAUX, JASON "THE EFFECT OF NATURAL DISASTER ON ROUTINE SURGERY"

P259 CHANG, CK "LONG TERM FOLLOW UP FOR LAPAROSCOPIC CHOLECYSTECTOMY IN THE ELDERLY POPULATION"

P260 CULLEN, JOHN "MENTORING SURGICAL RESIDENTS ON LIVE ANIMAL MODELS IMPROVES THE SAFETY AND EFFICACY OF EGD"

P261 DUBROWSKI, ADAM "THE EFFECTS OF PRACTICE ORGANIZATION ON VISUO-MOTOR MISALIGNMENT ADAPTATION"

P262 DUNNICAN, WARD "STEREOSCOPIC VERSUS TRADITIONAL TWO-DIMENSIONAL VISUALIZATION FOR TRAINING MODULES."

P263 EDELMAN, D "LAPAROSCOPIC APPENDECTOMY, SAGES OUTCOMES STUDY"

P264 EDELMAN, DAVID "ON-Q PAIN MANAGEMENT SYSTEM DOES NOT REDUCE HOSPITAL LENGTH OF STAY IN VENTRAL HERNIA REPAIR"

P265 EDELMAN, DAVID "PANTOPRAZOLE UTILIZATION ANALYSIS"

P266 GEDEON, MAKRAM "A PROFICIENCY-BASED CURRICULUM FOR ROBOTIC TWO-LAYER HAND SEWN ANASTAMOSIS"

P267 GOULD, JON "THE CONSTRUCT VALIDITY OF COMPUTER-DERIVED PERFORMANCE METRICS FOR SELECTED SIMULATED LAPAROSCOPIC TASKS"

P268 HAGEDORN, JUDITH "INSURANCE VARIATIONS IN DEMOGRAPHICS AND OUTCOMES FOR GASTRIC BYPASS SURGERY"

P269 HAGGAR, FATIMA "A SYSTEMATIC REVIEW OF EDUCATIONAL INITIATIVES DESIGNED TO IMPROVE LAPAROSCOPIC SKILLS"

P270 HAHNLOSER, DIETER "COMPARISON AND VALIDATION OF TWO DIFFERENT SURGICAL SKILLS SIMULATORS"

P271 HARPER, JASON "GRADUATING LAPAROSCOPIC FELLOWS WOULD PERFORM MORE SOLID ORGAN AND BILIARY PROCEDURES IN THEIR IDEAL FELLOWSHIP THAN THEY ACTUALLY PERFORMED IN FELLOWSHIP TRAINING"

P272 HSU, MICHAEL "EXPERT PERFORMANCE CHARACTERISTICS OF A NEW VIRTUAL REALITY SURGICAL SIMULATOR"

P273 KAUL, ASHUTOSH "SHOULD HAND SUTURED GASTROJEJUNOSTOMY BE THE GOLD STANDARD? LESSONS LEARNT IN OVER 970 CONSECUTIVE LAPAROSCOPIC GASTRIC BYPASS CASESWITHOUT LEAK."

P274 KUNDHAL, PAVI "SYSTEMATIC REVIEW OF THE DATA PROVIDED FOR REGULATORY APPROVAL OF NOVEL ENDOLUMINAL GERD THERAPEUTICS."
SAGES POSTER LISTING

P275 KUROBE, MASASHI "IMPROVEMENT OF LAPAROSCOPIC SKILLS USING SIMULATORS FOR MEDICAL STUDENTS"

P276 LEE, TOMMY "MINIMALLY INVASIVE SURGERY FELLOWSHIP - A 6TH YEAR OF RESIDENCY?"

P277 MADAN, ATUL "PATIENT PERCEPTION OF MEDICARE FEE SCHEDULE OF LAPAROSCOPIC PROCEDURES"

P278 MATSUMOTO, SUMIO "ENDOSCOPIC SURGICAL SKILL QUALIFICATION FOR LAPAROSCOPIC CHOLECYSTECTOMY IN JAPAN"

P279 MCCLUNEY, ANTHONY "AUTOMATED PROMIS SIMULATOR METRICS PREDICT READINESS FOR FLS CERTIFICATION"

P280 MORI, TOSHIYUKI "INTER-RATER AGREEMENT IN ENDOSCOPIC SURGICAL SKILL QUALIFICATION SYSTEM IN JAPAN"

P281 PAIGE, J "SELF-REPORTED LEARNING PREFERENCE IS NOT RELATED TO GAINS IN SELF-CONFIDENCE LEVELS OF TRAINEES UNDERGOING BASIC SKILLS TRAINING IN MINIMALLY INVASIVE SURGERY WHEN COMPARED TO TEACHING METHOD EMPLOYED"

P282 PAIGE, J "SELF-REPORTED VIDEO GAME EXPERIENCE IS ASSOCIATED WITH INCREASED SELF-CONFIDENCE LEVELS OF TRAINEES PRIOR TO BEGINNING BASIC SKILLS TRAINING IN MINIMALLY INVASIVE SURGERY"

P283 PARARAS, NIKOLAOS "METASTATIC BREAST CARCINOMA INITIALLY PRESENTED AS ACUTE CHOLECYSTITIS. CASE REPORT AND REVIEW OF THE LITERATURE."

P284 PIMENTEL, ELISABETH "ABSTRACT VIRTUAL REALITY TRAINING DEVELOPS CORE LAPAROSCOPIC SKILLS COMPARABLE TO EXPERIENCED LAPAROSCOPIC SURGEONS: RESULTS OF A PROSPECTIVE RANDOMIZED TRIAL COMPARING TWO VIRTUAL REALITY TRAINERS"

P285 REHRIG, SCOTT "A SINGLE MASSED SKILLS COURSE FOR SURGERY TRAINEES DOES NOT CONVEY LONG TERM PERFORMANCE BENEFIT"

P286 SHIMADA, MITSUO "INSTITUTIONAL ACTIONS AND PROBLEMS FOR EDUCATION SYSTEM ESTABLISHMENT IN AN ENDOSCOPIC SURGERY DEVELOPING AREA IN JAPAN."

P287 SHIMIZU, SHUJI "ESTABLISHMENT OF HIGH-QUALITY INTERACTIVE TELESURGERY SYSTEM IN ASIA-PACIFIC AREA USING SUPERFAST INTERNET CONNECTIONS"

P288 SIDHU, RAMANDEEP "OBESITY AS A FACTOR IN LAPAROSCOPIC SURGERY"

P289 STEFANIDIS, DIMITRIOS "ROBOTIC SUTURING ON THE FLS MODEL POSSESSES CONSTRUCT VALIDITY, IS LESS PHYSICALLY DEMANDING AND IS FAVORED BY MORE SURGEONS COMPARED TO LAPAROSCOPY"

P290 TANOUE, KAZUO "TRAINING SEMINAR SPECIALIZED IN FUNDAMENTAL SKILLS OF ENDOSCOPIC SURGERY IN JAPAN"

P291 TICHANSKY, DAVID "POOR PREOPERATIVE JOB PERFORMANCE AND CAREER ADVANCEMENT SECONDARY TO OBESITY IS ASSOCIATED WITH GREATER WEIGHT LOSS FOLLOWING LAPAROSCOPIC GASTRIC BYPASS"

P292 UCHIDA, KAZUNORI "A SIMPLE AND EFFECTIVE SELF-TRAINING METHOD FOR LAPAROSCOPIC KNOT TYING"

P293 WILLIAMS, BRANDON "CLINICAL AND SEROLOGIC PREDICTORS OF GASTRIC BYPASS COMPLICATIONS"

P294 YEUNG, SHIRLEY "THE DEVELOPMENT OF A VIRTUAL REFERENCE MANUAL FOR PERI-OPERATIVE NURSES WORKING IN A MINIMALLY INVASIVE SURGICAL SUITE"

P295 YOSHIZAWA, JYOJI "95.5 % PRACTICING PHYSICIANS RECOGNIZE THE SIGNIFICANCE OF HANDS-ON COURSE FOR LAPAROSCOPIC SKILL IN PEDIATRIC SURGERY"

P296 ZHENG, BIN "MEASURING SURGICAL TEAM QUALITY USING A BENCH MODEL SIMULATION: CONSTRUCT VALIDITY OF LEGACY INANIMATE SYSTEM FOR ENDOSCOPIC TEAM TRAINING (LISETT)"

Endolumenal Therapies

P297 DIULUS, LEWIS "DIAGNOSTIC DILEMMA: ERCP STATUS POST ROUX-EN-Y GASTRIC BYPASS"

P298 HERNANDEZ, JONATHAN "SUCCESSFUL COMPLETION OF NEOADJUVANT CHEMORADIATION AND RO RESECTION AFTER MALIGNANT ESOPHAGEAL PERFORATION: A CASE FOR ENDOSCOPIC STENTING"

P299 SPINELLI, PASQUALE "TRANSANAL ENDOSCOPIC RESECTION OF CARPET-LIKE ADENOMAS OF THE RECTUM."

Ergonomics/Instrumentation

P300 ABTAHI, FATEMEH "BARBED SUTURE FOR CLOSURE OF MIDLINE ABDOMINAL INCISIONS: A PROSPECTIVE COMPARATIVE TRIAL"

P301 ADAMS, DANIELLE "A iONE SIZE FITS ALL" APPROACH IS NOT MEETING THE NEEDS OF A GROWING PERCENTAGE OF WOMEN SURGEONS WHO ARE USING DISPOSABLE LAPAROSCOPIC INSTRUMENTS"

P302 GATTA, PRAKASH "USE OF CAVITATION LESS ULTRASONIC SHEARS TO REDUCE AMOUNT OF INTRAOPERATIVE SCATTER"

P303 GLASS, KAREN "PROSPECTIVE ANALYSIS OF VISUAL CANNULA ENTRY IN LAPAROSCOPY: ENDOTIP."

P304 KULKARNI, JYOTSNA "A NEW AND SIMPLE " WRIST BAND " TECHNIQUE OF HAND ASSITED LAPAROSCOPIC SURGERY"

P305 LEE, GYUSUNG "ASSESSMENT OF TABLE HEIGHT CHANGE WITH LAPAROSCOPIC INSTRUMENT CHANGE"

P306 MEIRELES, OZANAN "USE OF OXIMETRY-CAPABLE INSTRUMENTS FOR THE DIFFERENTIATION OF VASCULAR AND NON-VASCULAR STRUCTURES DURING LAPAROSCOPY."

P307 NARULA, V "A COMPUTERIZED ANALYSIS OF STANDARD VERSUS HIGH DEXTERITY LAPAROSCOPIC INSTRUMENTATION IN TASK PERFORMANCE"

Esophageal/Gastric Surgery

P308 ANDERSON, CASANDRA "ROBOTIC-ASSISTED SURGERY FOR GASTRIC MALIGNANCIES: SHORT TERM RESULTS"

P309 AYAZI, SHAHIN "SINGLE CENTER REVIEW OF TREATMENT OF ZENKER'S DIVERTICULUM: OPEN VS. TRANSORAL"

P310 BALAJI, NS "DAY CASE LAPAROSCOPIC ANTIREFLUX SURGERY: A PROSPECTIVE STUDY"

P311 BALAJI, NS "THE INFLUENCE OF LAPAROSCOPIC ANTIREFLUX SURGERY ON DIETARY AND POSTURAL TRIGGERS OF GASTRO-OESOPHAGEAL REFLUX"

<figure><img src="image_48.png" /></figure>
<figure><img src="image_49.png" /></figure>

SAGES POSTER LISTING

**P312 BASKER, MURALIDHARAN** "RETROSPECTIVE REVIEW OF RESULTS OF LAPAROSCOPIC PARAESOPHAGEAL HERNIA IN 106 PATIENTS WITHIN A RURAL POPULATION OPERATED BY A SINGLE SURGEON"

**P313 CARVALHO, GUSTAVO** "EFFICIENT CLIPLESS MINILAPAROSCOPIC CHOLECYSTECTOMY- A STUDY OF 641 CASES"

**P314 CARVALHO, GUSTAVO** "NISSEN FUNDOPLICATION IS EFFECTIVE FOR THE TREATMENT OF THE NUTCRACKER ESOPHAGUS - PRELIMINARY DATA"

**P315 CHERUVU, CHANDRA** "ECONOMIC BENEFITS OF THE PROVISION OF DAY CASE LAPAROSCOPIC ANTI-REFLUX SURGERY"

**P316 CONWAY, WILLIAM** "EARLY EXPERIENCE WITH LAPAROSCOPIC GASTRIC RESECTION"

**P317 DE LA FUENTE, SEBASTIAN** "INCIDENCE OF FAMILIAL ACHALASIA OR ACHALASIA-TYPE SYMPTOMS AMONG RELATIVES OF PATIENTS UNDERGOING HELLER MYOTOMY WITH DOR FUNDOPLICATION"

**P318 DENK, PETER** "CLINICAL EXPERIENCE WITH PROPHYLACTIC STENTING OF HIGH RISK ESOPHAGEAL ANASTOMOSES"

**P319 ERENLER KILIC, ILKNUR** "ARE MANOMETRIC STUDIES AND CALIBRATION REALLY NECESSARY FOR THE PROCEDURE OF LAPAROSCOPIC FLOPPY NISSEN FUNDOPLICATION?"

**P320 FARAH, JOSE** "PARAESOPHAGEAL HERNIA AFTER LAPAROSCOPIC FUNDOPLICATION, COMPLICATIONS AND FOLLOW-UP"

**P321 FENTON-LEE, DOUGLAS** "LAPAROSCOPIC VERSUS OPEN D2 GASTRECTOMY FOR GASTRIC CARCINOMA"

**P322 FINAN, KELLY** "PREVENTION OF POSTOPERATIVE LEAKS FOLLOWING LAPAROSCOPIC HELLER MYOTOMY"

**P323 FURUTA, SHINPEI** "THORACOSCOPIC INTRATHORACIC ANASTOMOSIS USING SIDE-TO-SIDE (MODIFIED FROM ORRINGER) METHOD."

**P324 GU-J"NSD"TTIR, HILDUR** "LAPAROSCOPIC ANTIREFLUX RE-OPERATIONS IN ICELAND; OUTCOME AND ANALYSIS OF DATA FOR PREDICTABLE FACTORS FOR RE-OPERATIONS"

**P325 HARDY, RYAN** "REVISIONAL LAPAROSCOPIC ANTIREFLUX SURGERY IS SAFE AND EFFECTIVE IN PROPERLY SELECTED PATIENTS"

**P326 HAYASHI, HIDEKI** "CLINICAL EVALUATION OF A LAPAROSCOPICALLY ASSISTED DISTAL GASTRECTOMY WITH AN EXTRA-PEIRGASTRIC REGIONAL LYMPH NODE DISSECTION PRESERVING VAGAL NERVE BRANCHES FOR GASTRIC CANCER"

**P327 IIDA, ATSUSHI** "LAPAROSCOPIC SUTURING AND PERITONEAL LAVAGE FOR DUODENAL ULCER PERFORATION"

**P328 INOKUCHI, MIKITO** "HAND-ASSISTED LAPAROSCOPIC TOTAL GASTRECTOMY WITH SPLENECTOMY FOR ADVANCED GASTRIC CANCER"

**P329 ISOGAKI, JUN** "LAPAROSCOPIC RESECTION FOR GASTRIC REMNANT CANCER: REPORT OF 8 CASES."

**P330 IZUMI, YOSUKE** "NEW CONCEPT OF HYBRID ESOPHAGECTOMY TO ENHANCE ITS SAFETY AND RADICALITY FOR ESOPHAGEAL CANCER"

**P331 JEANSONNE, LOUIS** "TEN-YEAR FOLLOW-UP OF LAPAROSCOPIC HELLER MYOTOMY FOR ACHALASIA SHOWS DURABILITY"

**P332 J"HANNESD"TTIR, A-ALHEI-UR** "LAPAROSCOPIC ANTIREFLUX PROCEDURES; A SINGLE SURGEONS LONG-TERM RESULTS (5-10 YEARS)"

**P333 KAUTZMAN, LORI** "AERODIGESTIVE FUNCTIONAL OUTCOMES FOLLOWING MINIMALLY INVASIVE ESOPHAGECTOMY."

**P334 KAWAMURA, HIDEKI** "RESULTS OF D2 LYMPH NODES DISSECTION IN LAPAROSCOPY-ASSISTED DISTAL GASTRECTOMY"

**P335 KAZUYUKI, KOJIMA** "RESULTS OF ROUX-EN-Y RECONSTRUCTION AFTER LAPAROSCOPY ASSISTED DISTAL GASTRECTOMY COMPAIRED WITH CONVENTIONAL OPEN DISTAL GASTRECTOMY"

**P336 KILIC, ARMAN** "MINIMALLY INVASIVE MYOTOMY FOR ACHALASIA IN THE ELDERLY"

**P337 KILLICK, ROO** "THE ROLE OF LAPAROSCOPIC ANTI REFLUX SURGERY IN THE PREVENTION OF LUNG FAILURE DUE TO GASTRO OESOPHAGEAL REFLUX IN LUNG TRANSPLANT PATIENTS."

**P338 KIM, YOUNG-WOO** "INDICATION OF LAPAROSCOPY-ASSISTED DISTAL GASTRECTOMY FOR GASTRIC CANCER: AUDIT FOR THE INSTITUTIONAL GUIDELINE"

**P339 KIM, JIN JO** "TOTALLY LAPAROSCOPIC UNCUT ROUX-EN-Y GASTROJEJUNOSTOMY"

**P340 KITAHAMA, SEIICHI** "QUALITY OF LIFE AFTER LAPAROSCOPY-ASSISTED DISTAL GASTRECTOMY"

**P341 KURITA, NOBUHIRO** "PROBLEMS AND SOLUTIONS FOR INTRODUCTION OF LAPAROSCOPY-ASSISTED GASTRECTOMY FOR GASTRIC CANCER"

**P342 LEERS, JESSICA** "PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG) IN THE DIRECT PUNCTURE TECHNIQUE - AN ALTERNATIVE TO OPEN JEJUNAL FEEDING TUBE PLACEMENT?"

**P343 LIEW, VICTOR** "LAPAROSCOPIC GASTRIC RESECTION FOR BENIGN AND MALIGNANT CONDITIONS"

**P344 LIU, ROCKSON** "INITIAL EXPERIENCE WITH MINIMALLY INVASIVE IVOR LEWIS ESOPHAGECTOMY IN A COMMUNITY HOSPITAL"

**P345 LIU, RC** "DOES TREATMENT VOLUME INCREASE SURVIVAL IN PATIENTS WITH ESOPHAGEAL CANCER?"

**P346 NAGAI, EISHI** "LAPAROSCOPIC CARDIECTOMY (LC) FOR EARLY GASTRIC CANCER WITH PRESERVATION OF THE VAGUS NERVE"

**P347 NASON, KATIE** "A PROSPECTIVE STUDY OF THE IMPACT OF INDUCTION, CONCURRENT CHEMORADIATION ON PERIOPERATIVE MORBIDITY AND MORTALITY FOLLOWING AN ESOPHAGECTOMY"

**P348 NELSON, THOMAS** "REVISIONAL SURGERY AFTER HELLER MYOTOMY FOR TREATMENT OF ACHALASIA: A DESCRIPTIVE META-ANALYSIS FOCUSING ON OPERATIVE APPROACH."
SAGES POSTER LISTING

P349 OMELANCZUK, PABLO "HELLER LAPAROSCOPIC SURGERY AS TREATMENT FOR ACHALASIA"

P350 OMORI, T "LAPAROSCOPIC INTRAGASTRIC RESECTION OF GASTROINTESTINAL STROMAL TUMORS"

P351 OMORI, HIROAKI "LAPAROSCOPIC HIGHLY SELECTIVE VAGOTOMY FOR DUODENAL ULCER WITH OR WITHOUT GASTRIC OUTLET OBSTRUCTION"

P352 PERALTA, SOTERO "LAPAROSCOPIC MANAGEMENT OF MARGINAL ULCER PERFORATION AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS"

P353 PETELIN, JOSEPH "LAPAROSCOPIC HELLER MYOTOMY—TEN YEAR EXPERIENCE."

P354 PEYRE, CHRISTIAN "UTILITY OF TIMED BARIUM ESOPHAGRAM IN THE SURGICAL TREATMENT OF ACHALASIA"

P355 POULTSIDES, GEORGE "LAPAROSCOPIC GASTRIC RESECTION: TECHNIQUE AND OUTCOMES IN 25 PATIENTS."

P356 POULTSIDES, GEORGE "HAND-ASSISTED LAPAROSCOPIC TRANSDUODENAL RESECTION: INITIAL EXPERIENCE."

P357 RAWAT, S "LAPAROSCOPIC TRANSHIATAL ESOPHAGECTOMY (THE) WITH SELECTIVE LYMPHADENECTOMY FOR HIGH GRADE DYSPLASIA AND OESOPHAGEAL CANCER"

P358 ROLLER, JOSH "LAPAROSCOPIC HELLER MYOTOMY USING HOOK ELECTROCAUTERY: A SAFE, SIMPLE, AND INEXPENSIVE ALTERNATIVE"

P359 ROSS, SHARONA "GIANT HIATAL HERNIA DOES NOT ADVERSELY IMPACT OUTCOME AFTER LAPAROSCOPIC FUNDOPERATION FOR GERD"

P360 ROSSI, SAM "LAPAROSCOPIC WEDGE RESECTION OF A DUODENAL CARCINOID: A CASE REPORT"

P361 RYU, KEUN WON "LEARNING CURVE FOR LAPAROSCOPY-ASSISTED DISTAL GASTRECTOMY: CUSUM ANALYSIS FOR ONCOLOGICAL SURGERY"

P362 SATO, KAZUO "3-DEMENTION WRAPPING FOR ESOPHAGEAL ACHALASIA BY ENDOSCOPIC PROCEDURE"

P363 SMITH, KERRINGTON "LAPAROSCOPIC ANTRECTOMY: A DEFINITIVE TREATMENT FOR WATERMELON STOMACH"

P364 SUGA, HIROYASU "EVALUATION OF ENDOSCOPIC HEMOSTASIS BY LOCAL INJECTION OF A FIBRIN GLUE IN HEMORRHAGIC GASTRIC ULCER IN DOGS"

P365 TAGAYA, NOBUMI "LAPAROSCOPIC RESECTION OF GASTROINTESTINAL MESENCHYMAL TUMORS IN THE STOMACH"

P366 TALLER, JANOS "LAPAROSCOPIC RESECTION OF AN ESOPHAGEAL EPIPHRENIC DIVERTICULUM WITH LONG MYOTOMY: A CASE REPORT AND REVIEW OF THE LITERATURE."

P367 TAYLOR, MICHELLE "PREVENTION OF ESOPHAGEAL ANASTOMOTIC LEAK WITH TEMPORARY PLACEMENT OF AN EXPANDABLE POLYVINYL STENT IN A PORCINE MODEL."

P368 TSERETELI, ZURAB "LAPAROSCOPIC NISSEN FUNDOPERATION DOES NOT INCREASE DYSPHAGIA IN PATIENTS WITH ABNORMAL ESOPHAGEAL MOTILITY"

P369 TSUJITANI, SHUNICHI "LAPAROSCOPIC INTRAPERITONEAL CISPLATIN WITH REAL-TIME RT-PCR MONITORING OF FREE CANCER CELLS IN PATIENTS WITH SCIRRHOUS GASTRIC CANCER"

P370 UDDIN, SAMEENA "PREVALENCE OF BARRETT'S ESOPHAGUS IN PATIENTS WITH CHRONIC GERD REFERRED FOR SURGICAL OPINION"

P371 UECKER, NATHANIEL "ACHALASIA IN OBESE PATIENTS; A COMPARATIVE STUDY"

P372 VISWANATH, Y K S "ROLE OF ROUTINE INTRAOPERATIVE USAGE OF BOUGIE IN PREVENTING DYSPHAGIA FOLLOWING LAPAROSCOPIC NISSEN ROSSETTI'S FUNDOPERATION – A PROSPECTIVE COMPARATIVE STUDY"

P373 VISWANATH, Y K S "EFFECT OF BODY MASS INDEX (BMI) ON INTRA AND IMMEDIATE POSTOPERATIVE MORBIDITY FOLLOWING LAPAROSCOPIC NISSEN ROSSETTI'S FUNDOPERATION"

P374 WADA, NORIHITO "LAPAROSCOPY-ASSISTED PYLORUS PRESERVING GASTRECTOMY WITH TRIANGLE END-TO-END ANASTOMOSIS."

P375 WROBLEWSKI, ROBERT "GASTRIC PACEMAKER FOR MEDICALLY REFRACTORY GASTROPARESIS"

P376 YAMADA, HIDEO "CLINICAL EXPERIENCE WITH A SMALL OPENER (MULTI FLAP GATE) FOR LAPAROSCOPICALLY ASSISTED CANCER SURGERY"

Flexible Endoscopy

P377 AKCAKAYA, ADEM "COLORECTAL POLyps: LOCATION, SIZE, NUMBER, HISTOPATHOLOGY AND RISK OF CANCER"

P378 ELHASSAN, HISHAM "IDIOPATHIC DIFFUSE COLONIC VARICES: AN UNUSAUAL CAUSE OF ANEMIA"

P379 FRANCIS, WESLEY "ROUTINE PREOPERATIVE ENDOSCOPY PRIOR TO LAPAROSCOPIC ROUX-EN-Y BYPASS: IS IT NECESSARY?"

P380 GAYER, CHRISTOPHER "CLINICAL EVALUATION AND MANAGEMENT OF CAUSTIC INJURY IN THE UPPER GASTROINTESTINAL TRACT IN 92 ADULT PATIENTS IN AN URBAN MEDICAL CENTER"

P381 GEIGER, TIMOTHY "DECISION-MAKING PROCESS FOR SCREENING COLONOSCOPY"

P382 LOEWEN, MARK "SCREENING ENDOSCOPY BEFORE BARIATRIC SURGERY: A SERIES OF 452 PATIENTS"

P383 MEIRELES, OZANAN "TRANSABDOMINAL LESSER SAC FLEXIBLE PERITONEOSCOPY (LSFP): A NOVEL APPROACH FOR PANCREATIC BIOPSY"

P384 NIJHAWAN, S "ROLE OF FLEXIBLE ENDOSCOPY IN PENETRATING NECK TRAUMA"

P385 OISHI, HIDETO "ENDOSCOPIC PERCUTANEOUS TRANS-ESOPHAGEAL GASTRO-TUBING (E-PTEG) -FOR SIMPLER AND EASIER PROCEDURE-"

P386 ROTHOLTZ, NICOLAS "COLONOSCOPIC SURVEILLANCE AFTER POLIPECTOMY"

P387 SARMIENTO, RAY "TRANS CHOLEDOCHODUODENOSTOMY ENDOSCOPIC MANAGEMENT OF A STRICTURE ASSOCIATED 2.5 CM. LEFT INTRA-HEPATIC DUCT STONE: A CASE REPORT."

<figure><img src="image_50.png" /></figure>
<figure><img src="image_51.png" /></figure>

SAGES POSTER LISTING

P388 SINGH, RAVINDER "COLORECTAL CANCER SCREENING: A REVIEW OF A COLONOSCOPY-BASED SCREENING PROGRAM IN NORTHEASTERN ONTARIO"

P389 UDOMSAWAENGSUP, SUTHEP "DIAGNOSING THE CAUSE OF CHRONIC ABDOMINAL PAIN AFTER GASTRIC BYPASS: IS ENDOSCOPY USEFUL?"

P390 WANG, HAO "TITLE: THE TAILORING SIGMOIDOSCOPY SCREENING FOR COLORECTAL CANCER IN CHINESE PEOPLE (A RETROSPECTIVE STUDY ON 21 631 CASES)"

Hepatobiliary/Pancreatic Surgery

P391 ABE, AKIHITO "SCHEDULED LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS"

P392 AGARWAL, B "AVOIDING ANY ENERGY SOURCE FOR A SAFE & BETTER LAPAROSCOPIC CHOLECYSTECTOMY"

P393 AKCAKAYA, ADEM "A PROPOSAL FOR SCORING SYSTEM TO PREDICT THE DIFFICULTY IN TREATMENT OF BILIARY CALCULI BY ERCP"

P394 AKMAL, YASIR "INSULINOMA: IS LAPAROSCOPIC PANCREATECTOMY ONCOLOGICALLY SUPERIOR TO ROUTINE ENUCLEATION?"

P395 AMR, ZIAD "SINISTROPOSITION: LEFT-SIDED GALLBLADDER TREATED BY 2 MM LAPAROSCOPIC CHOLECYSTECTOMY. A REPORT OF TWO CASES"

P396 BAHIRAEI, FRU "THE ROLE OF PERITONEAL LAVAGE CYTOLOGY IN LOCALLY UNRESECTABLE PANCREATIC CANCER"

P397 BRONFINE, BORIS "THE ROLE OF LAPAROSCOPY WITH LAPAROSCOPIC ULTRASOUND FOR STAGING OF PANCREATIC CANCER IN THE ERA OF MODERN ADVANCED IMAGING."

P398 BUSTOS, SERGIO "COST-EFFICIENCY RATIO OF LAPAROSCOPIC CHOLEDOCOLITHOTOMY"

P399 CHEN, KUO-HSIN "LAPAROSCOPIC COMMON BILE DUCT EXPLORATION AFTER PREVIOUS BILIARY TREE SURGERY"

P400 CHIA, SHEA "EXPERIENCE WITH LAPAROSCOPIC DISTAL PANCREATECTOMY AT A TERTIARY CARE COMMUNITY TEACHING HOSPITAL"

P401 CHING, SIOK "RANDOMISED CLINICAL TRIAL OF LONGITUDINAL VERSUS TORSIONAL MODE ULTRASONIC SHEARS FOR LAPAROSCOPIC CHOLECYSTECTOMY"

P402 CLAPP, BENJAMIN "HAS THE MANAGEMENT OF GALLSTONE ILEUS CHANGED IN THE LAPAROSCOPIC ERA?"

P403 COHEN, MATTHEW "LAPAROSCOPIC RFA IN THE COMMUNITY SETTING."

P404 DEGANI, JASON "LCBDE LESS RISKY TO PANCREAS THAN ERCP"

P405 DIAZ, SERGIO "GALLBLADDER POLyps: IS ULTRASOUND VERSUS PATHOLOGY REPORT CORRELATION."

P406 EITAN, ARIEH "EVALUATION OF POSITIVE PRESSURE PNEUMOPERITONEUM EFFECT ON LIVER ENZYMES FOLLOWING.F ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY"

P407 EITAN, ARIEH "TRANSPERITONEAL VERSUS TRANSHEPATIC PERCUTANEOUS CHOLECYSTOSTOMY AS A NON-SURGICAL TREATMENT FOR ACUTE CHOLECYSTITIS"

P408 HSU, KATHYC/O: SHANNON A FRASER "CONVERSION IN LAPAROSCOPIC CHOLECYSTECTOMY AFTER GASTRIC RESECTION: A 15 YEAR REVIEW"

P409 FUJITA, FUMIHIKO "ONE HAND LIVER HANGING METHOD: AN EFFECTIVE TECHNIQUE TO CREATE A GOOD VISUAL FIELD IN THE LAPAROSCOPIC HEPATECTOMY"

P410 FUKUYAMA, SHOJI "THE PRESENT SITUATION OF LAPAROSCOPIC SURGERY FOR PANCREATIC DISEASE IN OUR INSTITUTION"

P411 FURUTA, K "LAPAROSCOPIC DISTAL PANCREATECTOMY"

P412 GAETANO, LA GRECA "IATROGENIC COMPLICATIONS DURING LAPAROSCOPIC CHOLECISTECTOMY AND SIMULTANEOUS ERCP: THE SAFETY OF THE RENDEZ-VOUS PROCEDURE IN 74 CONSECUTIVE CASES"

P413 GAMAGAMI, REZA "LAPAROSCOPIC CHOLECYSTECTOMY FOR SYMPTOMATIC BILIARY HYPERKINESIA"

P414 GELMINI, ROBERTA "LAPAROSCOPIC CHOLECYSTECTOMY USING HARMONIC: NOT ONLY CLIPLESS"

P415 GONG, KE "LAPAROSCOPIC CHOLECYSTECTOMY (LC) FOR THE PATIENTS WITH ACUTE BILIARY PANCREATITIS"

P416 HAN, HO-SEONG "LAPAROSCOPIC LIVER RESECTION FOR HEPATOCELLULAR CARCINOMA"

P417 HAN, HO-SEONG "LAPAROSCOPIC ROUX-EN-Y CHOLEDOCHOJEJUNOSTOMY IN BENIGN BILIARY DISEASE"

P418 HAN, HO-SEONG "LAPAROSCOPIC DISTAL PANCREATECTOMY WITH AN ATTEMPT TO PRESERVE SPLEEN AND ITS VESSELS"

P419 JORGE, IRVING "AN ALTERNATIVE RECONSTRUCTION AFTER PANCREATICODUODENECTOMY"

P420 KAKIHARA, MINORU "PREOPERATIVE EVALUATION OF THE CALOT TRIANGLE ANATOMY WITH THE 3-DIMENSIONAL CT IMAGE OF CHOLANGIOGRAM AND ANGIOGRAM COMPLEX (3D-DIC-CT-A) FOR THE SAFE LAPAROSCOPIC CHOLECYSTECTOMY."

P421 KHAN, JIM "URGENT CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS—SHOULD THIS BE PERFORMED BY SPECIALIST CENTRES ONLY?"

P422 KIM, KEE-HWAN "LAPAROSCOPIC SPLEEN-PRESERVING DISTAL PANCREATECTOMY FOR MUCINOUS CYSTIC NEOPLASM"

P423 KURANISHI, FUMITO "LAPAROSCOPIC CHOLECYSTECTOMY BY COMBINED METHOD"

P424 LAUERMAN, MARGARET "ENDOSCOPIC ULTRASOUND EVALUATION OF PERIAMPULLARY NEOPLASMS PREDICTS RESECTABILITY"

P425 MACOVIAK, JOHN "SAFETY AND OUTCOMES OF 2 MM LAPAROSCOPIC CHOLECYSTECTOMY IN 837 CASES; THE NEXT EVOLUTION IN LAPAROSCOPIC CHOLECYSTECTOMY"

P426 MILLER, JERAD "LAPAROSCOPIC ROUX-EN-Y CYSTOJEJUNOSTOMY USING A CIRCULAR STAPLER – A NOVEL TECHNIQUE"

P427 OJO, PETER "LEAKS FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY"
<figure><img src="image_52.png" /></figure>

## SAGES POSTER LISTING

**P428 PARK, C.H.** "LAPAROSCOPIC CBD EXPLORATION WITHOUT T-TUBE"

**P429 RAO, SONALI** "LAPAROSCOPIC CBD EXPLORATION WITH A LITTLE HELP FROM UROLOGISTS"

**P430 SALAMA, IBRAHIM** "LATERAL DISSECTION TECHNIQUE: TOWARDS SAFER LAPAROSCOPIC CHOLECYSTECTOMY"

**P431 SCHIPHORST, A.** "TIMING OF CHOLECYSTECTOMY AFTER ENDOSCOPIC SPHINCTEROTOMY FOR COMMON BILE DUCT STONES"

**P432 SCHRAIBMAN, VLADIMIR** "LAPAROSCOPIC TREATMENT OF PANCREATIC TUMORS: A SINGLE-CENTER EXPERIENCE IN BRAZIL"

**P433 TACHIBANA, MASASHI** "EXPERIENCE WITH NEEDLESCOPIC CHOLECYSTECTOMY IN 145 PATIENTS"

**P434 TAHA, SAFWAN** "INTERNAL BILIARY DRAINAGE; CHOLEDOCHODUODENOSTOMY OR SPHINCTEROPLASTY?"

**P435 TAKAORI, KYOICHI** "HAND-ASSISTED LAPAROSCOPIC SPLEEN-PRESERVING DISTAL PANCREATECTOMY"

**P436 TALLER, JANOS** "LAPAROSCOPIC SEGMENT III LIVER RESECTION FOR ISOLATED COLORECTAL METASTASIS: A DESCRIPTION OF TECHNIQUE"

**P437 TAYLOR, CRAIG** "PANCREATIC FISTULA FOLLOWING LAPAROSCOPIC DISTAL PANCREATECTOMY- ENDOSTAPLER VERSUS SUTURE +/- FIBRIN SEALANT"

**P438 VELANOVICH, VIC** "EFFICACY OF FIBRIN SEALANT WITH OMENTAL PATCH IN DECREASING PANCREATIC FISTULA AFTER LAPAROSCOPIC DISTAL PANCREATECTOMY"

**P439 VIRK, SATPAL** "INCOMPLETE LAPAROSCOPIC CHOLECYSTECTOMY - A CAUSE OF CONCERN"

**P440 WENNER, DONALD** "USE OF THE MULTIPLE INSTRUMENT GUIDE WITH 2.8 MM CHOLEDOCHOSCOPE TO REMEDiate BILE DUCT STONES"

**P441 WHITTAKER, VAUGHN** "THE RENDEZVOUS TECHNIQUE IN MANAGING CHOLEDOCHOLITHIASIS"

**P442 YOUNGWORTH, HOWARD** "SIGNIFICANCE OF SONOGRAPHIC GALLBLADDER WALL THICKENING IN CHRONIC CHOLECYSTITIS"

### Hernia Surgery

**P443 AGARWAL, B** "LAPAROSCOPIC TECHNIQUE OF MAYO'S REPAIR FOR VENTRAL HERNIA WITH MESHPLASTY"

**P444 ANGSTADT, JOHN** "PROCESS IMPROVEMENT REDUCES INFECTION IN LAPAROSCOPIC VENTRAL HERNIA REPAIR"

**P445 BHENDE, SIDDHARTH** "LAPAROSCOPIC LUMBAR HERNIA REPAIR"

**P446 CARILLI, SENOL** "DIFFERENCES IN RECOVERY TIME AND POSTOPERATIVE PAIN AMONG HERNIA PATIENTS: A COMPARISON OF KEYHOLE TYPES"

**P447 CHELALA, ELIE** "MESH OUTCOMES AND REDO SURGERY AFTER LAPAROSCOPIC TREATMENT OF VENTRAL AND INCISIONAL HERNIA. EXPERIENCE OF 57 SECOND LOOKS."

**P448 CHOWBEY, PRADEEP** "TEP REPAIR- SIR GANGA RAM HOSPITAL APPROACH"

**P449 EDELMAN, D** "LAPAROSCOPIC BIOLOGIC MESH REPAIR OR PROLENE MESH REPAIR"

**P450 GARDINER, BARRY** "ROBOTIC ASSISTED VENTRAL HERNIA REPAIR—A FEASIBILITY STUDY"

**P451 HUGUET, KEVIN** "LAPAROSCOPIC PARASTOMAL HERNIA REPAIR"

**P452 IDANI, HITOSHI** "LARGE HIATAL HERNIA WITH INCARCERATION OF THE OMENTUM MIMICKING A MEDIASTINAL TUMOR"

**P453 JIN, JUDY** "LAPAROSCOPIC LATERAL COMPONENT SEPARATION IN PATIENTS WITH INFECTED MESH"

**P454 MALLAT, ALI** "A NOVEL REPAIR OF RECURRENT PERINEAL HERNIA"

**P455 MAVANUR, ARUN** "OBTURATOR HERNIA; A MORE COMMON ENTITY IN THE LAPAROSCOPIC ERA?"

**P456 PERRY, KYLE** "A NOVEL APPROACH TO EXTRACTION OF INCARCERATED OMENTUM AND MESH INSERTION IN LAPAROSCOPIC VENTRAL HERNIA REPAIR"

**P457 RADOVANOVIC, BOJAN** "TEP IN INCISIONAL AND VENTRAL HERNIA REPAIR"

**P458 SAWYER, MICHAEL** "COMBINED LAPAROSCOPIC VENTRAL HERNIORRHAPHY WITH CHOLECYSTECTOMY USING ALLODERM TISSUE MATRIX"

**P459 SAWYER, MICHAEL** "LAPAROSCOPIC REPAIR OF FORAMEN OF MORGAGNI HERNIA IN A MORBIDLY OBESE PATIENT USING ALLODERM TISSUE MATRIX"

**P460 SCHMELZER, T** "CHANGES IN BLADDER PRESSURE IN MORBIDLY OBESE PATIENTS 1-YEAR AFTER GASTRIC BYPASS SURGERY"

**P461 SILVERMAN, ADAM** "THE NOVEL USE OF DIAGNOSTIC LAPAROSCOPY IN AN INCARCERATED FEMORAL HERNIA"

**P462 TERRY, NEBBIE** "IS EXPLANTATION OF INFECTED MESH AFTER LAPAROSCOPIC VENTRAL HERNIA REPAIR THE ONLY ASNWER?"

**P463 TSERETELI, ZURAB** "CHRONIC POSTERIOR SEROMA WITH NEOPERITONEUM FOLLOWING LAPAROSCOPIC VENTRAL HERNIA REPAIR: TREATMENT ALGORITHM"

**P464 VISWANATH, Y** "TRANS ABDOMINAL PRE-PERITONEAL MESH (TAPP) REINFORCEMENT OF POSTERIOR LOWER ABDOMINAL WALL IN-PATIENTS WITH SPORTSMAN'S GROIN; IS IT WORTHWHILE?"

**P465 WILLIAMS, CHRISTINA** "LAPAROSCOPIC VERSUS OPEN COMPONENT SEPARATION: A COMPARATIVE ANALYSIS IN A PORCINE MODEL"

### Minimally Invasive Other

**P466 AGARWAL, B** "VARICOCOELECTOMY BY ENDOSCOPIC EXTRAPERITONEAL ROUTE (VEER)"

**P467 AGARWALLA, RAMESH** "FLUOROSCOPY GUIDED LAPAROSCOPIC REMOVAL OF INGESTED FOREIGN BODY (SEWING NEEDLE) FROM THE ABDOMINAL CAVITY AFTER 9 YEARS AND TWO FAILED LAPAROTOMIES"

**P468 ANDERSON, JANNET** "LAPAROSCOPIC PD CATHETER INSERTIONS"

**P469 AYALON, AMRAM** "PRE OPERATIVE ANGIOGRAPHIC SPENIC ARTERY EMBOLIZATION BEFORE LAPAROSCOPIC SPLENECTOMY FOR GIANT SPEENS: IS IT OF ANY BENEFIT?"
<figure><img src="image_53.png" /></figure>

SAGES POSTER LISTING

**P470 BINENBAUM, STEVEN** "GALL STONE PANCREATITIS AFTER ROUX-EN-Y GASTRIC BYPASS: A TECHNIQUE OF LAP-ASSIST ERCP VIA THE GASTRIC REMNANT DURING LAPAROSCOPIC CHOLECYSTECTOMY"

**P471 BONI, LUIGI** "THE USE OF ELECTROTHERMAL BIPOLAR VESSEL SEALING SYSTEM (LIGASUREô) IN MINIMALLY INVASIVE VIDEOASSISTED THYROID SURGERY"

**P472 CHI, ESMOND** "TROCHARLESS LAPAROSCOPIC CAPD CATHETER PLACEMENT. A 2 YEAR REVIEW OF A NEW TECHNIQUE"

**P473 CHOKSHI, RAVI** "LAPAROSCOPIC REMOVAL OF A RETAINED LAPAROTOMY SPONGE - A CASE REPORT AND LITERATURE REVIEW"

**P474 GROTH, SHAWN** "DIAPHRAGMATIC HERNIAS FOLLOWING SEQUENTIAL VENTRICULAR ASSIST DEVICE EXPLANTATION AND ORTHOTOPIC HEART TRANSPLANTATION: EARLY RESULTS OF LAPAROSCOPIC REPAIR WITH PTFE"

**P475 GUTIERREZ, JESSICA** "EARLY RETURN TO PERITONEAL DIALYSIS FOLLOWING LAPAROSCOPIC REVISION OF MALFUNCTIONING CATHETERS"

**P476 HAGIWARA, KEN** "LAPAROSCOPIC SURGERY FOR PERSONS OF ADVANCED AGE"

**P477 HIRATA, YUZO** "LAPAROSCOPIC APPENDECTOMY PERFORMED IN OUR INSTITUTION"

**P478 ISHII, K** "A CASE OF KAPAROSCOPIC PERSISTENT URACHAL RESECTION"

**P479 KEMP, JASON** "GEOGRAPHIC VARIATION IN ADOPTION OF LAPAROSCOPIC CHOLECYSTECTOMY"

**P480 KIERNAN, F** "TITLE: LAPAROSCOPIC PLACEMENT OF AN ABSORBABLE MESH TO PROTECT SMALL BOWEL DURING PELVIC RADIOOTHERAPY."

**P481 LA GRECA, GAETANO** "A ìREVIVEDî TESTICLE DURING LAPAROSCOPIC INGUINAL HERNIA REPAIR: A DIFFICULT INTRAOPERATIVE DECISION !"

**P482 LALOR, PETER** "FAREWELL TO MCBURNEY'S INCISION: SHOULD LAPAROSCOPIC APPENDECTOMY BE THE GOLD STANDARD FOR APPENDICITIS?"

**P483 LEE, SUKHYUNG** "MANAGEMENT OF CHOLEDOCHOLITHIASIS AMONG THE UNITED STATES ARMY GENERAL SURGEONS"

**P484 LIU, ROCKSON** "IS COMPLETING A LAPAROSCOPIC FELLOWSHIP AFTER RESIDENCY WORTHWHILE?"

**P485 MANASNAYAKORN, SOPARK** "LAPAROSCOPIC MECKEL'S DIVERTICULECTOMY IN PATIENT WITH MECKEL'S DIVERTICULUM COMPLICATED BY SMALL BOWEL OBSTRUCTION: A CASE REPORT"

**P486 MARTEL, GUILLAUME** "HIRING PRACTICES IN MINIMALLY INVASIVE SURGERY: A NATIONAL SURVEY OF SURGICAL CHAIRS"

**P487 MATHAVAN, VINEY** "SEROMASCOPY: NON-ANATOMIC SPACE EXPLORATION WITH LAPAROSCOPE"

**P488 MCFARLIN, KELLIE** "LAPAROSCOPIC ASSISTED VENTRICULOPERITONEAL SHUNT EXPERIENCE IN URBAN CENTER"

**P489 METZ, MATTHEW** "A NOVEL TECHNIQUE FOR BILATERAL LAPAROSCOPIC ADRENALECTOMY"

**P490 NAZARI, SHAHRAM** "FUNDUS-FIRST LAPAROSCOPIC CHOLECYSTECTOMY IS SAFE AND REDUCES THE CONVERSION RATE."

**P491 NEALE, GARY** "LAPAROSCOPIC RESECTION OF GIST, WHEN MIGHT IT NOT BE APPROPRIATE?"

**P492 PARARAS, NIKOLAOS** "BILATERAL PNEUMOTHORACES FOLLOWING ERCP AND SPHINCTEROTOMY"

**P493 RATKAJEC, VALENTINA** "LAPAROSCOPIC APPROACH OF MATURE SOLID TERATOMA OF FALLOPIAN TUBE: CASE REPORT"

**P494 SAWYER, MICHAEL** "LAPAROSCOPIC PLACEMENT OF VENTRICULOPERITONEAL SHUNT CATHETERS USING MODIFIED SELDINGER TECHNIQUE"

**P495 SHIN, SUSANNA** "UNINSURED PATIENTS ARE OFFERED LAPAROSCOPIC HERNIA REPAIR LESS OFTEN"

**P496 STA.ANA, ENRIQUE** "PARTIAL CHOLECYSTECTOMY FOR MIRIZZI SYNDROME: A MINIMALLY INVASIVE APPROACH"

**P497 STONE, BENJAMIN** "A CASE PRESENTATION: PNEUMATOSIS INTESTINALIS"

**P498 SWAFFORD, CRAIG** "LAPAROSCOPIC CYST EXCISION AND SPLENOPEXY FOR HEMORRHAGIC SPLENIC PSEUDOCYST AND WANDERING SPLEEN"

**P499 TANTIA, OM** "BILIARY INJURIES IN LAPAROSCOPIC CHOLECYSTECTOMY - AN EXPERIENCE OF 13305 OPERATIONS"

**P500 TAVAKKOLIZADEH, ALI** "LAPAROSCOPIC VERSUS OPEN APPENDECTOMY IN PREGNANCY: INFLUENCE ON MATERNAL AND FETAL OUTCOMES"

**P501 WOOL, DANIEL** "MODIFIED OPEN TECHNIQUE FOR MINIMALLY INVASIVE ENDOSCOPIC SURGERY"

NOTES (Natural Orifice Transluminal Endoscopic Su

**P502 BINGENER, JULIANE** "THE PHYSIOLOGIC EFFECTS OF NOTES IN A PORCINE MODEL: COMPARISON WITH STANDARD LAPAROSCOPY"

**P503 FUKUMOTO, ROYD** "PERCUTANEOUS ENDOSCOPIC ASSISTED SURGERY: A FEASIBILITY STUDY OF NOVEL APPROACHES TO GERD AND WEIGHT LOSS"

**P504 JAGANATHAN, ASHOK** "MAGNETOCOLONOSCOPY"

**P505 MATTHES, KAI** "FEASIBILITY OF ENDOSCOPIC TRANSGASTRIC DISTAL PANCREATECTOMY (ETDP)"

**P506 OSBORNE, ERIC** "A SURVEY OF ATTITUDES TOWARDS ìNOTESî PROCEDURES AMONG POTENTIAL BARIATRIC PATIENTS"

**P507 PORTILLO, GUILLERMO** "ENDOSCOPY-ASSISTED LAPAROSCOPIC TRANSLUMINAL RESECTION OF A GE JUNCTION TUMOR: A CASE REPORT"

**P508 ROMANELLI, JOHN** "EARLY EXPERIENCE WITH VISCERAL CLOSURE IN NOTES PROCEDURES IN A PORCINE MODEL"

**P509 RYOU, MARVIN** "TRANSGASTRIC VENTRAL HERNIA MESH REPAIR IN A PORCINE MODEL USING A NEW ENDOSURGICAL OPERATING SYSTEM"
SAGES POSTER LISTING

**P510 SARMIENTO, RAY** "NATURAL ORIFICE TRANSLUMINAL ENDOSCOPIC SURGERY (NOTES) AND LAPAROSCOPY: A DOCUMENTATION ON ENDOSCOPE ORIENTATION, MANIPULATION AND NSTRUMENTATION IN A PORCINE MODEL: A LABORATORY WORK BY AN INDEPENDENT ENDOSCOPIC AND LAPAROSCOPY CENTER"

**P511 SCOTT, DANIEL** "TRANSGASTRIC, TRANSCOLONIC, AND TRANSVAGINAL CHOLECYSTECTOMY USING MAGNETICALLY ANCHORED INSTRUMENTS"

**P512 SHINOHARA, KAZUHIKO** "INVESTIGATION OF TECHNICAL PROBLEMS FOR THE DEVELOPMENT OF NOTES ASSISTING SYSTEM"

Pediatrics

**P513 HANLY, ERIC** "LAPAROSCOPY-MEDIATED ATTENUATION OF BETA-FIBRINOGEN EXPRESSION IS LOST WITH AGE"

**P514 SORENSEN, G. BRENT** "LAPAROSCOPIC REPAIR OF A BOCHDALEK'S HERNIA IN AN INFANT"

**P515 SUH, SUNG OCK** "CALCULOUS CHOLECYSTITIS AFTER LIVER TRAUMA IN A CHILD: A CASE REPORT"

**P516 TSAO, KUOJEN** "THORACOSCOPY FOR MALIGNANCY IN CHILDREN"

Robotics

**P517 ASTUDILLO, J ANDRES** "GASTRIC STIMULATOR PLACEMENT FOR GASTROPARESIS: OUR EXPERIENCE WITH THE DA VINCI ROBOT."

**P518 DUNNICAN, WARD** "ROBOTIC PARAESOPHAGEAL HERNIA REPAIR COMPARES FAVORABLY TO LAPAROSCOPIC PARAESOPHAGEAL HERNIA REPAIR"

**P519 HAGEN, MONIKA** "COMPARISON OF DEXTERITY BETWEEN BEGINNERS WITHOUT LAPAROSCOPIC EXPERIENCE AND LAPAROSCOPIC SURGEONS IN THEIR FIRST USE OF THE DA VINCI ROBOT"

**P520 OKADA, KAZUYUKI** "DEVELOPMENT OF A NEW ROBOTIC ASSISTANT SYSTEM FOR LAPAROSCOPIC SURGERY"

**P521 SHAH, KETUL** "TWO CASES OF GASTROINTESTINAL STROMAL TUMORS DIAGNOSED BY TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY: TREATMENT COURSE AND REVIEW OF LITERATURE"

Solid Organ Removal

**P522 BARLOCO, SEVERN** "LAPAROSCOPIC SPLENECTOMY: DOES GENDER PREDICT OUTCOME?"

**P523 DONNELLY, PATRICIO** "LAPAROSCOPIC ADrenalectomy for the treatment of adrenaL tumors"

**P524 EDWARDS, ERIC** "LAPAROSCOPIC NEPHRECTOMY EXPERIENCE AT A COMMUNITY TEACHING HOSPITAL"

**P525 KOBAYASHI, MICHIYA** "HAND-ASSISTED LAPAROSCOPIC SPLENECTOMY FOR HCV POSITIVE PATIENTS WITH THROMBOCYTOPENIA"

**P526 MORI, MISUZU** "EXPERIENCE WITH TRANSPERITONEAL LAPAROSCOPIC ADrenalectomy"

**P527 NELSON, THOMAS** "LAPAROSCOPIC ADrenalectomy: A 6 YEAR NON-TERtiARY CARE SiNGLE CEntER RETROSPECTIVE STUDY."

**P528 NOVOTNY, NATHAN** "HAND-ASSISTED LAPAROSCOPIC SPLENECTOMY: WHEN SHOULD IT BE OFFERED?"

**P529 PITT, TRACY** "OBESITY DOES NOT ADVERSELY AFFECT OUTCOMES AFTER LAPAROSCOPIC SPLENECTOMY"

**P530 REISSMAN, PETACHIA** "LAPAROSCOPIC HAND-ASSISTED SPLENECTOMY FOR MASSIVE SPLENOMEGALY"

**P531 TARGARONA, EDUARDO** "CLINICAL, ANATOMIC AND PATHOLOGIC PREDICTIVE FACTORS FOR INMEDIATE SURGICAL OUTCOME AFTER LAPAROSCOPIC SPLENECTOMY IN CASE OF SPLENOMEGALY"

**P532 TESSIER, D** "LAPAROSCOPIC SPLENECTOMY FOR SPLENIC MASSES"

Thoracoscopy

**P533 HERNANDEZ GUTIERREZ, JOSE MANUEL** "THORACOSCOPIC SURGERY. OUR EXPERIENCE."

**P534 LANTSBERG, LEONID** "EVALUATION OF COMPENSATORY SWEATING AFTER BILATERAL THORASCOPIC SYMPATHECTOMY FOR PALMAR HYPERHIDROSIS."

**P535 MURASUGI, MASAHIDE** "THORACOSCOPIC RESECTION OF THE ECTOPIC MEDIASTINAL PARATHYROID ADENOMA"

**P536 OKAJIMA, MASAZUMI** "DEVELOPMENT OF NON-CONTACT SENSING SYSTEM DURING VIDEO-ASSISTED THORACIC SURGERY (VATS)"

**P537 THARAVEJ, CHADIN** "THORACOSCOPIC ENUCLEATION OF GIANT SUBMUCOSAL TUMOR OF THE ESOPHAGUS: A CASE REPORT"

<figure><img src="image_54.png" /></figure>
<figure><img src="image_55.png" /></figure>

SAGES POSTER ABSTRACTS

## Posters of Distinction – P001

VIDEO-ASSISTED THORACIC SURGERY (VATS) FOR THE RESECTION OF METASTATIC ADENOCARCINOMA AS AN ACCEPTABLE ALTERNATIVE, Karl B Bauer BS, Mary S Maish MD, Dawn E Jaroszewski MD, Amy Yetasook BS, Robert Cameron MD, E. Carmack Holmes MD, University of California, Los Angeles Division of Thoracic Surgery, David Geffen School of Medicine

Adenocarcinomas commonly metastasize to the lungs and can be resected using open thoracotomy or Video-Assisted Thoracic Surgery (VATS). VATS remains controversial, but is a minimally invasive alternative to major open thoracotomy. This study reviews our metastatic resections in primary adenocarcinoma patients, using both thoracotomy and VATS. We aim to compare long-term prognoses to test the efficacy and viability of VATS.

**Methods:** A retrospective review of primary adenocarcinoma patients who underwent resection of pulmonary metastases from 1991-2006.

**Results:** A total of 41 (15 M, 26 F; median age 53) primary adenocarcinoma patients underwent pulmonary metastatic resection. VATS was performed in 20 patients (49%, 6 M, 14 F; median age 52) and open resection in 21 (51%, 9 M, 12 F; median age 54). Primaries included: 24 colorectal (59%), 11 breast (27%), 2 salivary (5%), and 1 liver, ovary, pancreas, and cervix (2% each). Six VATS (30%) and 9 open patients (43%) showed metastasis in non-thoracic locations. Two VATS (10%) and 5 open patients (24%) had local recurrences of their original cancer. VATS post-op follow was 427 days (median; range: 14-2436), and 1150 days (3-5835) after open resection. Primary diagnosis to first thoracic occurrence of VATS patients was 679 days (31-5057), and 1192 days (27-7002) for open patients. Total disease interval from original diagnosis to latest follow-up of VATS was 1562 days (87-6040), and 2948 days (30-10493) for open. Second thoracic recurrences were noted in 5 VATS patients (median Dfi: 173 days): 3 had VATS initially, then treated non-surgically (median Dfi: 84 days), and 2 had VATS initially, then thoracotomy (median Dfi: 576 days). Of initial open resection, a second recurrence was noted in 7 patients (median Dfi: 681 days): 6 had open resections (median Dfi: 695 days) and 1 was treated with chemotherapy (Dfi: 655 days). A third recurrence was noted in 1 VATS patient (Dfi: 569 days), who underwent an open procedure for the second recurrence, and then another VATS, and in 2 open patients (median Dfi: 1502 days), both of who had another open. No further recurrences were seen.

Ergo, VATS has become a viable alternative to thoracotomy regarding excision of pulmonary metastases. In the cases of primary adenocarcinoma, VATS shows no increase in the number of thoracic recurrences. VATS patients, however, have not been followed as long as open resection, as noted in the post-op follow-up and total disease intervals.

## Posters of Distinction – P002

DYNAMITE SKILL ASSESSMENT SYSTEM: INITIAL EVALUATION, Audrey K Bell BS, Jacqueline T Johanas BS, Caroline G Cao PhD, Steven D Schwaitzberg MD, Tufts University Department of Mechanical Engineering and Cambridge Health Alliance

Skill assessment in the training of surgical residents has not been perfected. Most virtual trainers in minimally invasive surgery lack dynamic task elements rendering them unrealistic simulations for pure skill assessment. Previous studies have indicated that some novices are able to achieve excellent scores on pure motor skill tasks despite no previous experience. In addition, the scoring methodology on many skill and assessment systems is labor-intensive. There is a need to develop a psychomotor skill assessment system that is able to discriminate between levels of experience and can automate the scoring. A dynamic skill assessment system was developed to accomplish these goals. The unique feature of this platform is the multidimensional movement of the task fixture. The fixture can be moved at a variety of directions and speeds and requires the subject to make accurate contact with a specified target in a physical training

box environment. 15 subjects (5 novice, 5 PG 2, 5 expert) were evaluated using five conditions at varying speeds and paths of the target fixture (static, horizontal, vertical, slow hourglass, fast hourglass). Time to complete the task, errors, path length, smoothness, and target misses were measured. Analysis of variance was used to analyze the performance. Results: Time to complete the task was significantly different across all conditions and experience levels. Target misses were statistically significant across experience levels in all conditions except horizontal target trajectory. Smoothness and path length were significantly different for static and horizontal task conditions as a function of experience. These pilot results indicate that a self scoring dynamic skill assessment system has the potential to differentiate pure skill acquisition and groups of varying experience.

<figure><img src="image_56.png" /></figure>

## Posters of Distinction – P003

SHORT ESOPHAGUS: HOW MUCH LENGTH CAN WE GET?, Victor Bochkarev MD, Yong Kwon Lee MD, Atif Iqbal MD, Michel Vitamvas RN, Dmitry Oleynikov MD, University of Nebraska Medical Center

**Background:** Laparoscopic antireflux surgery requires an adequate length of intra abdominal esophagus. Short esophagus can cause wrap slippage and affect clinical outcomes. The aim of the study is to measure maximum length of esophageal elongation with transhiatal mediastinal dissection.

**Methods:** This is a prospective study performed in the tertiary referral center between 2002-2006. One hundred and six patients with gastroesophageal reflux disease and suspected short esophagus on barium swallow were studied. Patients underwent antireflux surgery with extended tranhiatal mediastinal dissection to elongate short esophagus. Routine measurement of intra abdominal esophageal segment length with intraoperative esophagogastroscopy and laparoscopy was utilized to define the GE junction in order to quantify total intra-abdominal esophageal length. Postoperative 24 hours pH-manometry, UGI series and symptom scores were recorded to document the clinical outcomes.

**Results:** Total esophageal elongation was achieved by a mean of 2.65 (range 3-18) cm. Resultant intra-abdominal esophageal length was measured at a mean of 3.15 (range of 3 to 5) cm. None of the preoperative "short esophagus" required Collis' gastroplasty post extended mediastinal dissection. All preoperative symptom scores showed significant improvements with mean follow up of 18 (9-36) months. Mean distal esophageal acid exposure normalized in all patients studied postoperatively.

**Conclusions:** Short esophagus can be safely elongated with extended mediastinal esophageal dissection. This technique can negate the need for Collis' gastroplasty and improve overall outcome after antireflux surgery. We recommended that extended tranhiatal mediastinal dissection be performed to establish 3 cm. of intra abdominal esophagus at the time

## Posters of Distinction – P004

LAPAROSCOPIC VENTRAL HERNIA REPAIR: IS IT FEASIBLE FOR OBESE PATIENTS?, Siok S Ching MD, Abeezar I Sarela MS, Michael J McMahon PhD, Department of Surgery, Leeds General Infirmary, Leeds, United Kingdom.

**Introduction:** Treatment of ventral hernias can be particularly problematic in obese individuals. This study compared the feasibility and safety of laparoscopic ventral hernia repair in obese and non-obese patients.

**Methods:** Case notes were reviewed for 82 patients who
underwent laparoscopic ventral hernia repair during April 2003 to July 2006. Data on age, body mass index, size of mesh, operating time, in-patient stay and complications were analysed using Mann-Whitney U Test and Fisher's Exact Test.

**Results:** There were 39 men and 43 women, median age 55 years (range 24-92). Hernias were incisional in 63 patients (77%), of whom, 19 had recurrent incisional hernias following previous open repairs. In the remainder 19 patients, the hernias were mostly paraumbilical. Forty-seven patients (57%) were obese (BMI >30 kg/sq m) and 11 of these were morbidly obese (BMI >40 kg/sq m). The two heaviest patients (BMI 55 and 58 kg/sq m) had Roux-en-Y gastric bypass procedure concomitantly with the hernia repair. The hernia repair was converted to open in 2 non-obese patients (due to difficult adhesiolysis or a very wide fascial defect). There was no significant difference between non-obese and obese patients in defect size (median 4 vs. 5 cm, p = 0.80), size of mesh (median 280 vs. 225 sq cm, p = 0.80) or operating time (median 90 vs. 87 min, p = 0.97). An obese patient sustained colonic injury during adhesiolysis and this was laparoscopically repaired. The median in-patient stay was 2 days in both groups. Postoperatively, there was no missed enteric injury or early postoperative mesh infection. Seven patients had seromas (3 non-obese vs. 4 obese, p = 1.00), 8 patients had chronic postoperative pain (5 non-obese vs. 3 obese, p = 0.28) and 7 patients had recurrence (2 non-obese vs. 5 obese, p = 0.69). Two non-obese patients developed skin ulceration over a polypropylene + ePTFE composite mesh, 18 and 28 months after operation, and needed subsequent removal of mesh.

**Conclusion:** In obese individuals, laparoscopic repair of ventral hernia is associated with similar intraoperative and early postoperative features as compared with non-obese individuals. Ventral hernias in obese patients may be safely repaired by the laparoscopic technique with acceptable outcome.

## Posters of Distinction – P005

### HORMONAL EVALUATION OF PATIENTS WITH BMI BELOW 35 SUBMITTED TO THE LAPAROSCOPIC TREATMENT OF TYPE 2 DIABETES MELLITUS, Aureo L De Paula

PhD, Antonio L Macedo MD, Nelson Rassi MD, Alfredo Halpern MD, Cesar A Machado MD, Vladimir Schraibman MD, Hospital de Especialidades, Goiania, Brazil

**Introduction:** The objective of this study is to evaluate the pre and postoperative hormonal assays of patients with BMI below 35 kg/m2 submitted to the laparoscopic transposition of a segment of ileum to the jejunum in order to treat Type 2 Diabetes Mellitus (T2DM).

**Methods:** The hormonal assays evaluation was done in 18 patients operated between April 2005 and Jan 2006. 8 were female and 10 male. Mean age was 52.1 years (40-66). Mean BMI was 29.3 (24.2734.8). All patients had the diagnosis of T2DM for at least 3 years and evidence of stable treatment with oral hypoglycemic agents and or insulin for at least 12 months. Mean duration of T2DM was 7.3 years (3-15). Three techniques were performed, consisting in different combinations of ileal interposition (II) in the proximal jejunum and a sleeve gastrectomy. The following hormones were assayed in the pre and postoperative period at the baseline and following specific food stimulation (30-60-120min): GLP-1, GIP, Insulin, CCK, PPP, Somatostatin, PYY, Ghrelin, Adiponectin, Resistin, Leptin and IL-6.

**Results:** 6 patients had the II, 6 had the association of an II to a sleeve gastrectomy (II-SG) and 6 had an II with a diverted sleeve gastrectomy (II-DSG). Ghrelin had an important rise following the 3 operations, especially after the II (p<0.001). GLP-1 did the same, especially after the II-SG (p<0.001). GIP also had an important rise, with the II-SG and II-DSG been equally effective (p<0.001). CCK measurements were not affected by the II-DSG. The PPP was also slightly altered by the II-DSG. PYY had an important increase with all three operations (p<0.001). Somatostatin and IL-6 were not affected by all three operations (p=0.632). Both Leptin and Resistin blood levels decreased following the 3 operations, especially after the II-SG and II-DSG. Adiponectin was

not altered by the II and had a slight increase after the II-SG and II-DSG. Mean post-operative follow-up was 10.4 months. Both the II-SG and the II-DSG were effective in achieving an adequate glycemic control (91.7%). Following the II, 50% had an adequate glycemic control.

**Conclusions:** The incretin hormones (GLP-1, GIP) blood levels were substantially increased following the laparoscopic ileal interposition and may explain the promising good results associated to these operations for the treatment of T2DM.

## Posters of Distinction – P006

### PREOPERATIVE WEIGHT LOSS DOES NOT PREDICT SUCCESSFUL OUTCOME AFTER LAPAROSCOPIC ROUX-Y GASTRIC BYPASS, Dan Eisenberg MD, Alain Ramirez BS, Andrew J Duffy MD, Kurt E Roberts MD, Joshua IHRabosky PhD, Robert L Bell MD, Yale University School of Medicine

**Objectives:** Successful weight loss after laparoscopic Roux-Y gastric bypass (LRYGB) is dependent on the patient's continued compliance with dietary and exercise regimens. As a test of patient compliance, some institutions require preoperative weight loss as a prerequisite to surgery. Conversely, at our institution, we make no such preoperative demands. The goal of this study is to determine the relationship between preoperative weight loss and successful postoperative weight loss in patients undergoing LRYGB.

**Methods and Procedures:** Between August 2002 and September 2005, 354 LRYGB were performed. Patient demographics were entered into a longitudinal, prospective database. Patient weight was first measured six to eight weeks prior to surgery and a repeat weight was obtained immediately before surgery. Linear multiple regression analyses and one-way ANOVA were performed comparing body mass index (BMI) loss before surgery to percent BMI loss at 12 months after surgery.

**Results:** 256 patients were available one year after surgery and included in the study. Ages ranged from 17 to 64 years and preoperative BMI ranged from 36.1 to 90.5 kg/m2 (mean 51.4 kg/m2). For all patients, mean percentage excess weight loss and percentage BMI loss was 62% and 34.5%, at one year, respectively. Patients were grouped according to pre-operative weight change: 125 patients lost weight (M = -1.7 kg/m2, SD = 2.8) prior to surgery, while 131 did not lose weight or gained weight (M = +1.2 kg/m2, SD = 1.2) prior to surgery. At one year's follow-up, the percentage of body mass index loss of patient's who lost weight prior to surgery (M = -34.6, SD = 8.0) was statistically indistinguishable from those who did not lose weight prior to surgery (M = -34.5, SD = 7.6), F(1, 254) = .03, n.s. A multiple regression analysis also revealed that percent change in BMI from initial visit to surgery did not predict percent change in postoperative BMI at one year's follow-up, F(1, 254) = .09, n.s.

**Conclusions:** In this series, there was no correlation between preoperative and postoperative weight loss. In addition, preoperative weight gain does not portend less weight loss after surgery. Thus, preoperative weight loss is neither an adequate indicator of patient compliance nor a predictor of a patient's ability to lose weight in the first postoperative year.

## Posters of Distinction – P007

### PERCUTANEOUS ENDOSCOPIC GASTROSTOMY: A SAFE TECHNIQUE IN PATIENTS RECEIVING CORTICOSTEROIDS,

Elizabeth Franco MD, Habeeba Park BS, Stephen M Kavic MD, Patricia Turner MD, Bruce Greenwald MD, Adrian E Park MD, J. Scott Roth MD, University of Maryland School of Medicine

Percutaneous endoscopic gastrostomy (PEG) is a well-established technique of enteral access. However, there is a concern that PEG placement may lead to an unacceptable rate of complications in certain patient populations, such as those patients receiving corticosteroids. We examined data on PEG placement from a single institution to determine whether patients receiving steroid therapy are at increased risk of procedural complications. We conducted a retrospective review on 483 consecutive successful PEG placements
<figure><img src="image_57.png" /></figure>

SAGES POSTER ABSTRACTS

performed between January 2002 and June 2005. Of these, 32 patients (6.6%) were receiving corticosteroids; 17 were on acute steroids, and 15 were on chronic steroid treatment. For all patients, the mean age was 62 years (range 18-97 years), and 62% were male. Complications were defined as hemorrhage, wound infection, tube dislodgement, abdominal complaint, inability to tolerate gastric feeding, hypoxia and hypovolemia, and death. The overall rate of complications was 8.3%: hemorrhage (1.7%), wound infection (2.3%), tube dislodgement (0.8%), abdominal complaint (2.5%), inability to tolerate gastric feeding (0.4%), hypoxia and hypovolemia (0.2%). There was one death, in a patient who was not receiving steroids. The complication rate among patients taking steroids was 12.5%, and the complication rate was 8% for the steroid-free group. Chi-square analysis failed to demonstrate a statistically significant difference between these two rates of complications (p=0.48). There was no difference in rates of complications between acute or chronic steroid therapy patients. In this large series of PEG placements, we were not able to show a difference in patients receiving acute or chronic steroid therapy versus those not on steroids. Thus, PEG may be considered as a safe technique in patients regardless of steroid status.

## Posters of Distinction – P008

**FOREGUT SURGERY IN LUNG TRANSPLANT PATIENTS,**
Matthew P Sweet MD,Rasa Zarnegar MD,Ian Nipomnick BS,Charles Hoopes MD,Jeffrey A Golden MD,Steven R Hays MD,Lorriana E Leard MD,Marco G Patti MD, University of California San Francisco Departments of Surgery and Medicine, San Francisco, California, USA

**Background:** Gastroesophageal reflux disease (GERD) is prevalent among patients with end-stage lung disease (ESLD). GERD can lead to microaspiration and may be a risk factor for lung damage before and after lung transplantation. A fundoplication is the best way to stop reflux, but little is known about the safety of elective foregut surgery in patients with ESLD. The aims of this study were to report the safety of a laparoscopic fundoplication and/or pyloroplasty in patients with ESLD and GERD before or after lung transplantation.

**Methods:** Between January 1997 and July 2006, 286 patients were listed for lung transplantation. One hundred and seventy-three patients went on to lung transplantation. A total of 27 laparoscopic fundoplications were performed (22 total and 5 partial fundoplications). Of these operations, 11 were done before and 16 after the transplant. In 3 patients a pyloroplasty was also performed. Two other patients had a pyloroplasty without fundoplication.

**Results:** All patients underwent a laparoscopic fundoplication and/or pyloroplasty. There were no conversions to an open operation. All patients were admitted to the ICU for observation and were followed by a multidisciplinary transplant team. Twenty-six patients recovered uneventfully (90%). Median hospitalization was 2 days (range 1-34) for patients who were admitted for elective operations. Hospitalization was not delayed in the 3 patients who had fundoplications immediately following transplantation. Eleven of 13 post-transplant patients (85%) and 2 of 3 pre-transplant patients (67%) had delayed gastric emptying.

**Conclusions:** The results of our study show that: 1) laparoscopic foregut surgery can be performed safely in selected patients with ESLD before or after lung transplantation by an experienced, multidisciplinary team; and 2) gastric emptying should be objectively measured in all patients as it is frequently abnormal and may play an important role in the etiology of reflux.

## Posters of Distinction – P009

**INCIDENTAL GALLBLADDER CANCER AFTER LAPAROSCOPIC CHOLECYSTECTOMY AND THE PROBLEM OF A PRACTICAL CLASSIFICATION,**
Thorsten Goetze PhD,Vittorio Paolucci PhD, Clinic for general-, abdominal- and minimally invasive surgery of the Ketteler- Krankenhaus

**Introduction:** Since the first description of port site metastases and tumor cell seeding it is supposed that the laparo-

scopic technique could deteriorate the prognosis of gallbladder cancer. In the literature there is a variety of different 5 year survival curves for the different T-stages and operation methods, so it seems to be very difficult for the surgeons to compare the different results. These assumptions are going to be verified by DGCH- Register.

**Material and method:** To obtain data we are using the DGCH- Register of incidental gallbladder carcinoma, which is an institution of the German Society of Surgery. We have calculated the data for the T-stages, UICC/AJCC-stages and the modified Nevin- classification, which seems to be a very practical kind of classification.

Results: 441 cases of incidental gallbladder cancer have been recorded so far.

There are 239 patients treated by the laparoscopic procedure, 131 by the open one, 69 with an intraoperative conversion from the laparoscopic to the open technique.

The Kaplan- Meier survival shows a significant advantage for the laparoscopic procedure compared with the open surgery for the entire patients (n=441) (p< 0,05).

According to the T-stages calculated with the Kaplan Meier method the laparoscopy seems not to worsen the prognosis. In the stadium T2 (200 patients) there is a significant better survival for the laparoscopic group (p<0,05). After analyzing with the complex UICC/AJCC-stages there seems also to be no disadvantage for the laparoscopic group.

The mod. Nevin I stadium shows a significant better survival for the laparoscopic treated patients. The advanced tumor stages with metastases (mod. Nevin IV/V) show no difference between the different procedures.

**Discussion:** The access technique open or laparoscopic does not seem to influence the prognosis of incidental gallbladder carcinoma.

The problem in the literature is, that often many authors only classify the tumors according to the T-stages without regarding the "n" and "m" status, so a variety of different 5 year survival curves exists. A possible explanation could be that nodal status is not known, or that the UICC/AJCC-system is very complex and difficult, so according to the authors the mod. Nevin classification is in such cases a very good additional system to divide local, local advanced and metastatic tumors, as a system added to T-system so that every reader can see and compare the different data.

## Posters of Distinction – P010

**RECURRENCE AFTER LAPAROSCOPIC VENTRAL HERNIA REPAIR:**
A PROSPECTIVE COMPARISON OF SUTURES VERSUS TACKS,
Alexander Greenstein MD,Scott Q Nguyen MD,Kerri E Buch FNP RN,Jessica Schnur BS,L. Brian Katz MD,Mark A Reiner MD,Robert A Aldoroty MD,Daniel M Herron MD,Edward Chin MD,Kaare J Weber MD,Celia M Divino MD, Mount Sinai School of Medicine, New York, NY

**Background:** Mesh fixation in laparoscopic ventral hernia repair typically involves the use of tacks and/or transabdominal permanent sutures. Sutures pass through all layers of the fascia and muscle of the anterior abdominal wall while tacks secure the mesh to the innermost millimeters of the peritoneal cavity. Controversy exists regarding the optimal method to fix the prosthetic mesh to the anterior abdominal wall, and it is commonly reported that use of sutures as the primary fixation method is imperative to avoid recurrence. We compare postoperative recurrence rate between the two techniques. Methods: Patients undergoing laparoscopic ventral hernia repair at the Mount Sinai Medical Center were prospectively enrolled in the study. They were sorted into two groups 1) Hernia repairs consisting primarily of transabdominal suture fixation and 2) Hernia repairs consisting primarily of tack fixation. The patients were not randomized. The technique of surgical repair and mesh material was based on surgeon preference. Office documentation, CT reports and a telephone questionnaire were used to determine recurrence events. Results: During 2004-2005, 50 pts were enrolled in the study. 28 had hernia repair primarily with transabdominal sutures and 22 had repair primarily with tacks. The two groups had similar average age, surgical history, operative time, postoperative length of stay, and follow up duration, but the tack group had a larger average
defect size (105cm? vs 87 cm?). At an average follow-up of 18 (range 6-22) months, the overall recurrence rate was 14% with events ranging from one month to 20 months post-op. While operative time (162 min vs. 122 min) and hernia defect areas (161cm? vs. 85cm?) appeared to be greater in those patients who recurred, no significant factors were detected. There were three recurrences in the suture group and four recurrences in the tack group, yielding no significant difference in recurrence between the two groups.

**Conclusion:** Patients undergoing laparoscopic ventral hernia repair with primarily transabdominal sutures or tacks experience similar recurrence rates. Even in the presence of large defects, tacks may be used as the primary method for mesh fixation without concern for increased incidence of recurrence.

## Posters of Distinction – P011

**A NEW TECHNIQUE FOR COLONOSCOPY, Yukihoro**

Hamahata MD, Yasunobu Tsujinaka MD, Hiroshi Azuma MD, Tokatsu Tsujinaka Hospital

**OBJECTIVE:** Recent progress of endoscope has allowed us to perform colonoscopy easier, still it is difficult to acquire the skill. To facilitate colonoscopy, we have employed a disposal distal attachment putting at the tip of endoscope. In this study, we discuss the method and results of the technique.

**METHODS:** A disposal distal attachment, or transparent soft plastic cap is attached at the tip of endoscope. Preoperatively, patients were given one ampoule of Opystan, 0.2 ampoule of Silece, and one ampoule of Buscopan. When inserting endoscope, irrigation is mainly used to obtain better visualization in place of insufflation. Because small amount of water and the attachment secure good intraluminal view and prevent colon from being overextended. Without stretching mucosal folds, endoscope can go through the folds like screwing. This technique can be applied to reduce pain and incidence of intestinal perforation as well.

**RESULTS:** We employed this technique in 1999. Since 2003, almost all colonoscopy cases have been performed with this technique. During June and September 2001, a randomized study between this technique and conventional technique was done by a single surgeon and demonstrated no significant difference both in time for reaching at cecum and in patients' satisfaction rate. However, three cases, which were failed to reach at cecum, were succeeded in total colonoscopy by attaching the cap. Furthermore, overextension of sigmoid colon was observed 83.0% in conventional technique and 20.6% in new technique. Overall, reaching rate to cecum has improved from 96.7% in 2000 to 99.1% in 2006; the patients' satisfaction rate has also been increased from 84.1 points in 2000 to 90.0 points in 2006. Incidentally occurred perforation was observed in 3 cases out of 42,684 cases before the new technique was employed in 2000; no perforation has been observed 42,359 cases after that. Polyp detection rate has also increased from 35.2% in 2000 to 42.1% in 2006.

**DISCUSSION:** This new technique is very simple; just putting a cap at the tip of endoscope. Nevertheless, it alleviates patients' pain, increases the safety of the colonoscopy, and increases reaching rate to cecum and polyp detection rate. So, we believe this technique is efficient and feasible. This attachment also secures a good intraluminal view so that operator can perform colonoscopy comfortably without overextending colon.

## Posters of Distinction – P012

STUDY OF INTRA-GASTRIC AND INTRA-BLADDER PRESSURE CHANGES DURING REST, COUGHING, WEIGHT LIFTING, RETCHING AND VOMITING, Atif Iqbal MD, Mumnoon Haider MD, Vanessa Salinas MD, Sue Corkell RN, Kiran Turaga MD, Charles J Filipi MD, University of Missouri Columbia, Columbia MO. Creighton University School of Medicine, Omaha NE.

**Objective:** We aimed to quantify and compare the intra-gastric and intra-bladder pressures during rest, coughing, bench pressing using specified weights, induced retching and vomiting.

**Methods:** Intra-gastric and bladder pressures were measured in 10 healthy volunteers after insertion of manometry and Foley catheters. Baseline pressures were recorded. Each subject was then asked to cough 10 times and bench press weights (26, 44, 70, 88 and 114 lbs) 5 times each. Vomiting and retching was induced by Ipecac administration. Gastric and bladder pressures were continuously recorded during these activities and analyzed thereafter using SPSS (v.11). The t test and ANOVA were used for analysis. Significance was established at p<0.05.

**Results:** Ten volunteers with a mean age of 26 yrs and a mean BMI of 25 were studied. Maximum pressure generated in the stomach during vomiting was 288 mm Hg (mean 82) and for retching 280 mm Hg (mean 68), coughing 232 mm Hg (mean 35) and weight lifting 55 mmHg (mean 3.8). There was a significant difference between pressures generated during coughing and vomiting (p<0.0001) and coughing and retching (p<0.0001) with vomiting and retching being higher than coughing. All pressure changes were significantly different from baseline (p<0.004). There was no significant difference between gastric and bladder pressures during any activity and a strong correlation was seen between the two (r=0.97).

**Conclusion:** Gastric and bladder pressure does not significantly differ at rest or during activities. There is significantly higher intragastric pressure with vomiting and retching as compared to coughing which causes significantly higher pressures than weight lifting. Intra-abdominal pressures as high as 290 mmHg are seen with vomiting which is equivalent to 1/50th of the suture pull out force (20.3 N/m) in porcine models. Maximal tensile strength of the cadaveric abdomen (1600 N/m) is 4600 times the maximal pressure generated during vomiting. Further studies are required to delineate the effects of weight lifting and to determine the authenticity of postoperative weight lifting restrictions. Vomiting and retching can render significant forces on any tissue apposition device within the stomach or anywhere within the peritoneal cavity. This applies to procedures such as hernia repair, fundoplication, gastroplasty and future gastric port closures after trans-gastric surgery.

## Posters of Distinction – P013

LAPAROSCOPIC SIGMOID COLECTOMY FOR DIVERTICULITIS AFTER PERCUTANEOUS DRAINAGE, Sanjay Jobanputra MD, Amit Khanna MD, Bashar Safar MD, Jill Genua MD, Susan Cera MD, Dana R Sands MD, Eric G Weiss MD, Anthony M Vernava III MD, Juan J Nogueras MD, Steven D Wexner MD, Cleveland Clinic Florida, Weston, Florida

**Background:** Percutaneous drainage followed by colonic resection is an acceptable method to treat diverticular abscess. However the effect on subsequent surgical outcomes is unknown. The aim of this study was to evaluate whether preoperative percutaneous drainage (PPD) influences conversion rate, operative time, complication rate, or length of stay (LOS).

**Methods:** Retrospective review of all patients entered into our prospective database who underwent laparoscopic or laparoscopic attempted diverticular resection between 2001 and 2006. 150 patients underwent laparoscopic or laparoscopic assisted surgery for diverticular disease, 14 of whom had preoperative percutaneous drainage. These patients were compared to 136 patients who had no preoperative percutaneous drainage (NPD). Age, gender, ASA, BMI, prior abdominal surgery, conversion rate, operative time, complication rate, and LOS were evaluated. Mean time between drainage and surgery was 62.9 days.

**Results:** The laparoscopic conversion rate was 28.5% for PPD and 35.3% for NPD (p=0.71) and the mean operative time was 184 minutes for PPD and 201 minutes for NPD

<figure><img src="image_58.png" /></figure>
<figure><img src="image_59.png" /></figure>

SAGES POSTER ABSTRACTS

(p=0.30). The complication rate was 14.3% for PPD and 20.6% for NPD (p=0.62) while the mean LOS was 5.5 days for PPD and 5.84 days for NPD (p=0.66).

**Conclusion:** Percutaneous drainage of diverticular abscess prior to laparoscopic diverticular resection does not influence conversion rate, operative time, complication rate, or LOS. Laparoscopic resection should be offered to patients who have had PPD as the outcome of emergent resection while the abscess is present is unknown.

## Posters of Distinction – P014

**LAPAROSCOPIC DISTAL PANCREATECTOMY FOR PANCREATIC NEOPLASIA**, Michael L Kendrick MD, Geoffrey B Thompson MD, David R Farley MD, Mayo Clinic College of Medicine

**Background:** Laparoscopic distal pancreatectomy (LDP) is increasingly performed. Outcomes of laparoscopic approaches for pancreatic resection of neoplasia are not well defined. Our aim was to define the feasibility and outcome of laparoscopic distal pancreatectomy for benign and malignant pancreatic neoplasms.

**Methods:** Retrospective review of all patients undergoing laparoscopic distal pancreatectomy at a single institution. Data are presented as mean ± standard deviation or as a range.

**Results:** 28 patients with a mean age of 63 (range: 44-83) years underwent attempted LDP; 3 patients required conversion to laparotomy for failure to progress (n=2) or bleeding (n=1). Spleen preserving and extended LDP was performed in 3 and 4 patients respectively. Operative time was 235±40 minutes, and blood loss was 211±156 ml. Diagnosis was non-functioning islet-cell tumor (n=10), serous or mucinous cystadenoma (n=10), pancreatic adenocarcinoma (n=4) insulinoma (n=3) and metastatic cancer (n=1). A concomitant procedure was performed in 7 patients (cholecystectomy, Nissen fundoplication, or herniorrhaphy). One patient underwent en-bloc wedge resection of adherent stomach. Mean tumor size was 2.6 cm (range: 1-5.1). Days to oral intake and length of hospital stay were 3±1 days and 6±3 days, respectively. Among patients undergoing LDP, there was no perioperative mortality. Perioperative morbidity occurred in 30% with pancreatic leak (n=4), DVT/PE (n=3), abdominal infection (n=2), lymphocele (n=1) and anemia requiring transfusion (n=1). At mean follow-up of 14 months (range: 1-54), all patients are alive without disease with exception of one patient with recurrent adenocarcinoma.

**Conclusion:** Laparoscopic distal pancreatectomy appears safe and effective in patients with pancreatic neoplasia. Further controlled trials are necessary to evaluate oncologic outcomes with laparoscopy versus open approaches.

## Posters of Distinction – P015

**IS THERE A DIFFERENCE IN ANASTOMOTIC COMPLICATIONS BETWEEN DIFFERENT GASTROJEJENUAL TECHNIQUES FOR GASTRIC BYPASS?**, J Lau, T LaMasters, J Hagedorn MS, M Curet MD, B Safadi, J Morton MD, Stanford Department of Surgery

**Background:** Many surgical techniques have been successfully applied to the laparoscopic Roux-en-Y gastric bypass (RYGBP). The method of gastrojejunostomy (GJ) particularly the circular stapled approach has been linked to complications of the anastomotic site such as ulcer/stricture (U/S) and leak. Our study aim was to compare the incidence of these complications between the circular stapled (CS) and the hand-sewn (HS) techniques.

**Methods:** Single institution retrospective review was conducted for all patients undergoing laparoscopic RYGBP over a three year period with average follow up of 1.7 years. All surgeries were conducted by three fellowship trained surgeons. Patients were divided into two cohorts: gastrojejunostomy technique via transabdominal 25 mm EEA stapled (Ethicon Endosurgery) or two-layered hand-sewn. The incidence of ulcer, stricture and anastomotic leak were determined by retrospective chart review, upper GI series report, and endoscopic findings.

**Results:** 484 patients underwent laparoscopic RYGBP with-

out conversion (83% female, mean age 43, and mean BMI 49). There were 304 patients in the CS group and 180 patients in the HS group. The two patient groups were similar in age, gender and preoperative BMI. U/S developed in 10 (3.3%) of the 304 patients in the CS group and in 7 (3.9%) of the 180 patients in the HS group (p<0.7343). Anastomotic leak developed in 4 (1.32%) of the patients in the CS group and in 2 (1.11%) of the patients in the HS group (p<0.18).

**Conclusion:** This large volume single institution experience indicates that the incidence of gastrojejunial ulcer, stricture or anastomotic leak is low overall without a difference between a circular stapled or hand-sewn gastrojejunostomy technique for laparoscopic RYGBP.

## Posters of Distinction – P016

**LYMPHATIC SPARING SURGERY FOR VARICOCELE IN ADOLESCENTS IS EFFECTIVE IN CONTROLLING HYDROCOCELE DEVELOPMENT**, Anies Mahomed MD, Simon Blackburn, Royal Alexandra Children's Hospital, Brighton, United Kingdom.

**Background:** The standard laparoscopic Palomo technique for varicocele ligation has been associated with a post operative hydrocele rate of up to 31% in children. However, current laparoscopic technology allows for the exclusive ligation of spermatic veins preserving accompanying lymphatic channels. The impact of this modification on recurrence/peristence of varicocele and the development of post operative hydrocele are as yet not completely defined.

**Aim:** To determine the incidence of persistent/recurrent varicocele and complicating hydrocele, following a lymphatic/ spermatic artery sparing, modified laparoscopic Palomo procedure in children.

**Method:** A prospective series conducted over 3 years on consecutive cases having laparoscopic varicocele surgery by a single surgeon. Patient demographic and outcome data were collected on a Microsoft Excel database and analysed. Technique: A transperitoneal approach using three 5mm ports were utilised -umbilical/camera with suprapubic and right iliac fossa working ports. The camera utilised was an integrated parfocal zoom lens f = 14-28mm (2x). Following peritoneal division the spermatic vein, exclusively, was isolated above the pelvic brim and controlled between Liga clips before division. The accompanying spermatic artery and lymphatics were preserved.

**Results:** A total of 10 cases with mean age of 14.9 years underwent unilateral surgery over a 3 year period. There were no intraoperative complications and 7 were well enough for discharge on the day of surgery with the rest discharged the next morning. At a mean follow up of one year (SD 211 days) no patients experienced complicating hydroceles although a single patient had a persistent albeit reduced varicocele.

**Conclusion:** Preliminary results of this study demonstrate that the incidence of hydroceles following a modified Palomo procedure (spermatic artery and lymphatic sparing) is markedly lower than that reported for other approaches. However the incidence of recurrent/persistent varicocele does not appear to be any different to that already reported for other approaches. The findings of this study would therefore support this subtle modification to the technique of varicocele surgery.

## Posters of Distinction – P017

**LAPAROSCOPIC CANNULATION: USE OF THE SAGES LEARNING CENTER TO VALIDATE A POTENTIALLY NEW FLS TASK**, A L McCluney MD, M C Vassiliou MD, J Cao, P A Kaneva, D D Stanbridge RN, L S Feldman MD, G M Fried MD, Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montreal, QC, Canada

**SAGES Fundamentals of Laparoscopic Surgery (FLS) tasks** are valid measures of technical skill. However post-test questionnaires of FLS subjects and interviews with experts identify laparoscopic cannulation as a clinically relevant skill not currently assessed by FLS. In this study, the validity of an FLS-compatible laparoscopic cannulation task (LCT) was
evaluated.

A 2x90 mm plastic tube, fixed at 45 degrees were used to approximate the common bile duct. The LCT requires subjects to insert a cholangiocatheter into the "duct" and remove it. Subjects viewed a LCT instructional video. A pilot study was conducted at our institution to determine scoring metrics and feasibility. During the 2006 SAGES Conference, additional subjects were tested at the Learning Center. In total, 140 subjects were tested: 44 novice (student/PGY 1-2), 25 intermediate (PGY 3-4) and 71 expert (PGY 5/fellow/attending) laparoscopic surgeons. A subset of 30 subjects also underwent FLS skill testing. ANOVA with posthoc analysis compared mean LCT scores across experience levels. Student t-test compared subjects from our institution (n=65) to those from the Learning Center (n=75). Correlations between LCT and FLS scores were analyzed with Pearson's coefficient. Receiver operator curves were used to determine the optimal pass-fail score for the LCT. Data are reported as mean±SD. Significance was defined as p<0.05.

Mean LCT scores increased with experience (p<0.01). Scores for novices (49±36) were significantly lower than those for intermediates (79±25) and experts (87±25). Intermediates and experts did not differ significantly. Novice and intermediate scores from the Learning Center were significantly higher than at our institution (novice: 73±36 vs. 41±32; intermediate: 93±12 vs. 68±27). Expert scores did not differ significantly at the two testing sites. Individual LCT scores correlate well (0.79) with FLS scores. A LCT pass-fail score of 86 maximizes sensitivity and specificity.
LCT distinguishes novices from other experience levels. Novice and intermediate subjects attending the 2006 SAGES Conference are likely interested in laparoscopy and thus outperform their more broadly selected colleagues from our institution. Individual LCT scores are predictive of FLS scores, and a LCT pass-fail score of 86 optimizes sensitivity and specificity. Overall, the LCT satisfies multiple criteria for validity as a test of laparoscopic skill, and as such, warrants consideration as a new FLS task.

## Posters of Distinction – P018

**FEASIBILY OF TRANSRECTAL NATURAL ORIFICE TRANSLUMENAL ENDOSCOPIC SURGERY (NOTES) IN THE PORCINE MODEL**, Michael F McGee MD, Jeffrey M Marks MD, Amitabh Chak MD, Raymond P Onders MD, Steve J Schomisch BS, Jaime M Andrews BS, Conor P Delaney MD, Case Medical Center, Case Western Reserve University, Department of Surgery, Department of Gastroenterology, Cleveland, Ohio, USA

**BACKGROUND:** NOTES access via a transrectal approach may be a beneficial alternative to transgastric approaches by providing superior visualization and eliminating need for endoscopic retroflexion. Transrectal NOTES may also introduce a second point for tissue retraction and triangulation when used in conjunction with transgastric NOTES. The optimal means of performing transrectal NOTES has not been described.

**METHODS:** Transrectal NOTES was performed in 6 pigs using various techniques to evaluate means of peritoneal access and closure. Using a rigid operating anoscope, 2 animals had a 1.5 cm transmural proctotomy made by conventional hand-held electrocautery which enabled peritoneal passage of a flexible endoscope. Transrectal NOTES access was achieved in 2 other animals by endoscopic balloon dilation over a transmural access wire. Finally, in 2 animals, an endoscopic needle-knife papillotome made a transmural incision enabling passage of the endoscope without dilation. Once feasibility of access was demonstrated, closure of the rectal defect was attempted. 2 animals had direct sutured closure under anoscopic visualization with a continuous absorbable suture. A third animal underwent closure with

the NDO Plicator, an endoscopic tissue plicating device.

**RESULTS:** In all animals, transrectal access was achieved quickly and easily without injury to adjacent organs. In the first 2 animals, a laparoscope was used to provide guidance until the learning curve was completed. In 2 subsequent animals, guidance was obtained with a transgastric NOTES endoscope and combined transgastric and transrectal NOTES cholecystectomy was performed. In the last 2 animals, the transrectal endoscope was passed directly into the peritoneal cavity without additional video guidance. Direct suture closure of the proctotomy was easily performed under anoscopic visualization and demonstrated negative leak tests in vivo. Endolumenal closure with the NDO Plicator was easily performed; however one small leak was present on ex vivo tissue examination.

**CONCLUSIONS:** Transrectal NOTES, either as a stand-alone procedure or combined with transgastric NOTES, is feasible and provides safe access to the peritoneal cavity. Closure of the proximal rectal NOTES access point can be done by hand with suture. Despite one small leak, Plicator closure of rectal defects is intuitive and promising. Additional survival studies are required to determine the long-term effects of transrectal NOTES.

## Posters of Distinction – P019

**INTRAOPERATIVE CHOLANGIOGRAPHY IN PERFORMANCE OF LAPAROSCOPIC CHOLECYSTECTOMY. SELECTIVE OR ROUTINE? OUR EXPERIENCES.**, Shahram Nazari MD, Semira Mousavi Khosroshahi MD, Abolfazl Jamalabasi MD, Milad Hospital

**Background:** 10% to 18% of patients undergoing cholecystectomy for gallstones have common bile duct (CBD) stones. In the performance of laparoscopic cholecystectomy (LC) diagnosis of such stones intra-operatively is a matter of debates. Treatment options for these stones include pre- or post-operative endoscopic retrograde cholangiopancreatography (ERCP) or open or laparoscopic surgery.

**Selection Criteria:** The inclusion criteria was cholecystolithiasis with normal liver function tests, no history of gallstone pancreatitis, common bile duct (CBD) diameter less than 10 mm in pre-operation ultrasonography and no previous history of jaundice.

**Hypothesis and Aims:** The aim of the present study was to show if intraoperative cholangiography (IOC) during LC can be safely omitted for all patients who fit standard criteria, namely normal liver function tests, no history of gallstone pancreatitis, common bile duct (CBD) diameter less than 10 mm or no previous history of jaundice (1-4-5-8). Some investigators believe that routine IOC in the performance of Laparoscopic Cholecystectomy must be done and they state that with this tool they reduced intra and post operative complications (6-11-12). In this prospective study we evaluate the role of IOC for patients undergoing LC to determine whether it could be safely omitted for all patients who fit our standard criteria (4-5-7-24-26).

**Patients, Data Collection and Analysis:** Data were collected prospectively from 277 consecutive patients who had LC for symptomatic gall bladder disease. The patients who were fit with our standard criteria grouped in 2 different groups. In every 2 groups, the patients have normal liver function tests, no history of gallstone pancreatitis, and common bile duct (CBD) diameter less than 10 mm or no previous history of jaundice. Then randomly in one group (Group A) intraoperative cholangiography was done and in the second group (Group B) intraoperative cholangiography was not done.

**Main Results:** This study confirms one CBD retained stone (0.36%) and no CBD injury among patients who fit our criteria.

**Authors' Conclusions:** Our experience demonstrates that LC performed without routine IOC does not result in an increased incidence of retained stones in selected patients.
<figure><img src="image_60.png" /></figure>

# SAGES POSTER ABSTRACTS

## Posters of Distinction – P020

### SAFE COMBINED PLACEMENT OF THE LAPAROSCOPIC DIAPHRAGM PACING STIMULATION SYSTEMS(DPS) AND PERCUTANEOUS ENDOSCOPIC GASTROTOMY(PEG)

### TUBES: RESULTS OF A PHASE ONE STUDY IN AMY-OTROPHIC LATERAL SCLEROSIS(ALS), Raymond P Onders

MD, MaryJo Elmo RN, Bashar Katirji MD, Robert Schiltz DO, Anthony R Ignangi MS, Case Medical Center of University Hospitals of Cleveland

**Background:** ALS (Lou Gehrig's Disease) is a progressive neurodegenerative disease affected 6,000 patients annually and respiratory failure is the usual cause of death. The laparoscopic DPS system has been shown to be 96% effective in replacing mechanical ventilation in spinal cord injured patients. The DPS system is being evaluated in ALS patients to decrease the decline in forced vital capacity (FVC) and delay the need for ventilators. ALS patients become malnourished because of progressive bulbar symptoms leading to a need for enteral access. The goal of this study is to assess the surgical outcomes of patients undergoing combined laparoscopic DPS placement and PEG tubes.

**Methods:** Patients who met FDA and IRB approved criteria for the DPS system and also required a feeding tube were evaluated. Patients underwent laparoscopic mapping of their diaphragm to locate the phrenic nerve motor points with two electrodes implanted in each hemidiaphragm. The electrodes are a teflon coated double helix of fourteen stainless steel strands that allow tissue ingrowth. The electrodes leave the abdominal cavity in the epigastric area and are tunneled to a percutaneous exit site on their right chest. Patients then underwent PEG tube placement.

**Results:** Eleven ALS patients underwent DPS placement with an average FVC of 57% predicted at time of surgery. One patient had a PEG prior to DPS and this was excluded from the field for DPS placement. One patient had a PEG placed after the DPS with no compromise of the abdominal wires. 5 patients underwent combined DPS and PEG placement. There were no operative adverse events with the combined placement and with an average follow-up of 8.5 months no patients developed any wire infections. In post-implant data after conditioning the diaphragm with the DPS, patients show an average rate of decline in FVC of 1% per month from the pre-implantation decline of 3.1% a month, which extrapolates to an additional 20 months of ventilator free survival for these patients.

**Conclusion:** ALS patients are at a surgical risk because of their declining respiratory function with reported morbidity from PEG alone. This study confirms that these patients can undergo combined placement of the DPS system during a clean-contaminated PEG decreasing the possible need for two surgical procedures. The lack of infection also opens the possibility that the DPS system could be implanted with NOTES techniques at the same time as a PEG.

## Posters of Distinction – P021

### PROPHYLACTIC PLACEMENT OF REMOVABLE INFERIOR VENA CAVA FILTERS IN PATIENTS UNDERGOING GASTRIC BYPASS FOR MORBID OBESITY, David W Overby

MD, Timothy M Farrell MD, University of North Carolina, Chapel Hill, Department of Surgery, Chapel Hill, NC, USA

### INTRODUCTION
Postoperative Venous Thromboembolism (VTE), including Deep Vein Thrombosis (DVT) and subsequent Pulmonary Embolism (PE), continues to be a leading cause of death in patients treated surgically for morbid obesity. Still, there remains little evidence regarding the risks, benefits, and cost-effectiveness of VTE prophylaxis strategies to guide bariatric surgeons. Given the recent availability of new technology in the form of removable Inferior Vena Cava Filters (IVCF), we developed protocols that included selective prophylactic placement in 110 of our Gastric Bypass (GB) patients since September 2003.

### METHODS
We performed a retrospective chart review of 288 morbidly obese patients undergoing GB between 1/2001 and 9/2006 to determine patient characteristics, as well as outcomes including mortality, VTE, DVT, and PE rates.

Beginning 9/15/2003, we implemented selective prophylactic IVCF (P-IVCF) placement, along with screening lower extremity CT angiogram prior to filter removal, in patients deemed to have an increased risk of VTE. We determined rates of P-IVCF placement, removal and complications, and compared patients who had P-IVCF to those who had not using the 2-tailed Fisher's exact test.

### RESULTS
288 morbidly obese patients (mean BMI 50.4 kg/m^2, range 35.4-86.4) underwent GB with 87% being laparoscopic, 8% open-redo, and 5% open primary. 7 deaths occurred from all causes within one year of GB (2.4%). 1 death (0.35%) was definitely attributed to PE. Of 288 patients, 110 (38.2%) had P-IVCF, but all of these were implanted in the 183 patients since 9/15/03 giving a rate of 60.1% for our P-IVCF experience to date. 1 complication (0.9%) resulted from P-IVCF placement. 5 of 178 patients (2.8%) without P-IVCF had VTE events, compared with 7 of 110 (6.4%) with P-IVCF (p=0.22). 2 of 178 (1.1%) patients without P-IVCF had DVT vs. 7 of 110 (6.4%) with P-IVCF (p=0.03). 4 of 178 (2.24%) without P-IVCF had PE vs. 0 of 110 with P-IVCF (p=0.30). The overall PE rate was 1.4%.

### CONCLUSIONS
IVC filters are safe and effective means for prophylaxis against PE after GB for morbid obesity. Complications are rare. Most filters can be removed when surgery-associated VTE risks are past. In this series of high-risk patients, placement of prophylactic IVC filters was associated with a trend toward fewer PE?s, despite the higher number of DVT's seen by routine CT scan prior to filter retrieval.

## Posters of Distinction – P022

### FUNDAMENTALS OF LAPAROSCOPIC SURGERY (FLS) SKILLS TRAINING IS APPROPRIATE FOR SENIOR MEDICAL STUDENTS ENTERING SURGICAL RESIDENCY, Richard A

Pierce MD, Debra Tiemann RN, Brent D Matthews MD, L. Michael Brunt MD, WASHINGTON UNIVERSITY SCHOOL OF MEDICINE, ST. LOUIS, MO

**Introduction:** Laparoscopic skills training is often reserved for residents with substantial exposure to open surgical techniques. We examined the ability of senior medical students (MS) matched in a surgical specialty to perform the skills tasks of the Fundamentals of Laparoscopic Surgery (FLS) program developed by SAGES.

**Methods:** Seven 4th year MS matched in a surgical residency were instructed in the FLS drills as a part of a skills preparation course for surgical internship. The FLS skills exam was administered within 7 days (pre-test) of a 2.5 hour instructional session and again 5 weeks later (post-test) after independent practice and one additional 45 min instruction session. Tests were administered by an FLS approved proctor and were scored by standard FLS criteria (passing score 54). Test results were compared using Wilcoxon matched-pairs analyses (p <0.05 significant).

**Results:** Mean pre- and post-test times (seconds) and scores for each FLS task are shown in the table (suture 1 = extracorporeal, suture 2 = intracorporeal). Improvement for each task was seen but the degree of improvement was significant for the PEG transfer times only. Average total time to complete the 5 tasks was 1036 ± 364 sec pre vs 769 ± 269 sec post and mean composite test scores were 50.8 ± 19 pre vs 67.2 ± 18 post (both p<0.05). All but one student showed improvement in composite post-test scores (p=NS). Two students achieved passing scores on all 5 tasks and 2 other students passed 4 of 5 tasks. Practice time ranged from 45-315 minutes (mean 139 min). The two lowest scoring students also logged the least amount of individual practice time (45 and 60 min).

<table><thead><tr><td>Task</td><td>Peg</td><td>Cutting</td><td>Endoloop</td><td>Suture 1</td><td>Suture 2</td></tr></thead><tbody><tr><td>Time Pre</td><td>121 ± 39</td><td>203 ± 68</td><td>125 ± 16</td><td>298 ± 159</td><td>291 ± 133</td></tr><tr><td>Time Post</td><td>100 ± 50*</td><td>160 ± 46</td><td>100 ± 38</td><td>199 ± 63</td><td>211 ± 134</td></tr><tr><td>Score Pre</td><td>74 ± 16</td><td>35 ± 20</td><td>38 ± 12</td><td>48 ± 39</td><td>58 ± 27</td></tr><tr><td>Score Post</td><td>84 ± 24</td><td>49 ± 18</td><td>56 ± 27</td><td>73 ± 23</td><td>75 ± 26</td></tr></tbody></table>

**Conclusion:** Training in FLS skills, including laparoscopic suturing, is feasible for 4th year medical students entering

<footnote>*p <0.05</footnote>
surgical residency. FLS skills training should be integrated into skills training curricula earlier than is practiced in most residency programs, including at the senior medical student level.

## Posters of Distinction – P023

**EFFECT OF CARBON DIOXIDE PNEUMOPERITONEUM ON HEPATIC TISSUE PERFUSION, Gerry N Polyhronopoulos**
MD,Liane S Feldman MD,Sebastian V Demyttenaere
MD,Anthony McCluney MD,Gerald M Fried MD, Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill
University, Montreal, Quebec, Canada.

**INTRODUCTION:** While pneumoperitoneum (PP) consistently decreases renal perfusion, previous studies examining the relationship between PP and hepatic tissue perfusion (HTP) have yielded conflicting results. The aim of this study was to assess the effect of carbon dioxide (CO2) PP on HTP in a porcine model.

**METHODS:** Eight female pigs were anesthetized and ventilated. Catheters were inserted in the external jugular vein and carotid artery to monitor central venous pressure (CVP) and blood pressure; cardiac output (CO) and stroke volume (SV) were measured using esophageal Doppler. HTP was measured with a laser Doppler probe laparoscopically placed on the left medial lobe of the liver. In each pig, 20-minute intervals without PP preceded 30-minute periods of CO2 PP to 8, 12 and 16 mmHg. Paired t-test was used to compare HTP at the end of each control period to that at the end of each corresponding period of PP. The primary measure of interest was HTP. Secondary measures of interest included CO, SV, CVP, and end-tidal CO2 (ETCO2). A p-value of <0.05 was considered statistically significant.

**RESULTS:** There was no significant difference between the baseline HTP and the HTP measured following an increase in PP to 8 (37.8 to 36.3 tissue perfusion units (tpu), p=0.48), 12 (36.7 to 38.2 tpu, p=0.64) or 16 mmHg (34.6 to 35.9 tpu, p=0.82). There was also no significant change in CO or SV when the PP was increased from baseline to 8, 12, or 16 mmHg. There was a significant increase in CVP between each baseline and corresponding level of increased PP to 8 (10 to 13 mmHg, p<0.001), 12 (10 to 14 mmHg, p<0.001), or 16 mmHg (10 to 16 mmHg, p<0.001). There was also a significant increase in ETCO2 between each baseline and corresponding level of increased PP to 8 (30 to 36 mmHg, p=0.017), 12 (31 to 37 mmHg, p=0.001), or 16 mmHg (31 to 41 mmHg, p=0.01).

**CONCLUSIONS:** Our study findings suggest that in a porcine model, CO2 pneumoperitoneum to 16 mmHg does not significantly impair hepatic tissue perfusion.

## Posters of Distinction – P024

**TRANSAXILLARY ENDOSCOPIC THYROIDECTOMY FOR MULTINODULAR GOITER: A NEW APPROACH TO AN OLD DISEASE,** Qamar Rashid MD, Titus Duncan MD, Ijeoma Ejeh
MD, Fredne Speights MD, Department of Surgery,
Morehouse School of Medicine Atlanta, Georgia

**Introduction:** Multinodular goiters are most often managed medically. Indications for surgical intervention are compressive symptoms, malignancy, and cosmesis. The typical incision of an open approach is large and obvious in a highly visible area of the neck. Endoscopic procedures of the neck to approach the thyroid and parathyroid gland have been previously described by others. We describe our experience using a transaxillary endoscopic approach to perform a near total thyroidectomy for multinodular goiter.

**Methods and Procedures:** Between December 2004-February 2006 we performed transaxillary endoscopic thyroidectomies in 6 patients requiring surgical intervention for the treatment of multinodular goiter. Three 5-mm trocars were placed in the right anterior axillary line in a supine patient. Sharp dissection was accomplished above the pectoralis major muscle toward the ipsilateral thyroid gland. The ipsilateral gland was excised, and then the contralateral gland was approached and excised taking care to identify and protect all vital structures. A drain was left in the area of dissection for 48 hours.

**Results:** The mean age of patients was 43 years (range 20-61). The average size of the resected gland was 78 gm (range 37 - 130 gm). Three patients had follicular hyperplasia on final pathologic exam. Two patients had nodular hyperplasia, and one patient had nodular hyperplasia with follicular thyroiditis and microinvasive papillary carcinoma. A near total thyroidectomy was completed in all patients. The recurrent laryngeal nerve (RLN) and parathyroid glands were visualized in all patients. There were no injuries to the RLN, and no patient suffered from postoperative hypocalcemia.

**Conclusion:** The benefits of endoscopic surgery of the neck (ie improved visualization, cosmesis, and recovery) have been well documented. Because the transaxillary approach is typically reserved for patients harboring unilateral thyroid disease, surgical excision for multinodular goiter has not been previously described using this technique. This study shows that adequate visualization of both ipsilateral and contralateral structures can be adequately visualized and preserved using this approach. We conclude that transaxillary near total thyroidectomy for patients with indication to undergo surgery for multinodular goiter is a safe and feasible alternative to the open cervical approach.

## Posters of Distinction – P025

**CONVERSION RATES IN LAPAROSCOPIC COLECTOMY AFTER PREOPERATIVE ENDOSCOPIC TATTOOING,**
Christina Seo MD, Sanjay Jobanputra MD, Jill Genua
MD, Susan Cera MD, Dana R Sands MD, Eric G Weiss
MD, Juan J Nogueras MD, Steven D Wexner MD, Cleveland
Clinic Florida, Weston, Florida

**Background:** Preoperative tattooing is a common practice for nonpalpable endoscopically irretrievable colonic pathology. While useful in intraoperative localization of these lesions, the correlation of preoperative endoscopic inking among laparoscopic findings and surgical conversion rate has not been defined. Methods: 32 consecutive patients were identified retrospectively from the prospective departmental operative database between September 2002 and July 2006 with lesions that had been preoperatively endoscopically tattooed to facilitate laparoscopic colectomy.

**Results:** In 17 cases, the endoscopist and the surgeon were the same (ESS), whereas in the other 15 cases the endoscopist and colorectal surgeon were different (ESD). The tattoo was laparoscopically found in 69% (n=22) of the total. 76% (n=13) of patients in the ESS group had positive laparoscopic ink findings versus 60% (n=9) in the ESD group. Only one of the patients in whom the ink was intraoperatively identified required conversion secondary to failure to progress. 5 of 10 patients in whom the tattoo was not clearly identified required conversion to laparotomy (p= 0.0014).

**Conclusions:** The ability to intraoperatively identify the operatively applied tattoo was a significant predictor of the success of laparoscopy. There was no correlation between the endoscopist who performed the tattoo and the need for conversion.

## Posters of Distinction – P026

**PREVALENCE OF INTERNAL HERNIAS AFTER LAPAROSCOPIC COLORECTAL RESECTION,** Stefano Sereno
MD, Mehran Anvari PhD, Joel Leroy MD, Jacques Marescaux
MD, IRCAD-EITS, University Louis Pasteur, Strasbourg,
France

**INTRODUCTION** Laparoscopic approach for colorectal resections is gaining popularity. Internal small bowel herniation (SBH) through a mesenteric defect has been described and although rare is a severe complication. The aim of this study was to evaluate the incidence and outcome of internal hernias after laparoscopic colorectal resection.

**PATIENTS AND METHODS** During a 5 years period, all patients who underwent laparoscopic left colon resection were included in the study. A retrospective data base query was performed searching for all patients in whom SBH required surgical reintervention.

**RESULTS** A total of 436 laparoscopic left colorectal resections were performed from January 2000 to July 2006. Five

<figure><img src="image_61.png" /></figure>
<figure><img src="image_62.png" /></figure>

# SAGES POSTER ABSTRACTS

male patients presenting a symptomatic internal hernias required re-operation. Four had a resection for cancer (2 rec- tal resections, 1 sigmoidectomy and 1 extended left colecto- my), and one for sigmoiditis. The mesenteric defect was not Initially closed in three cases, closed with staples in one and sealed with Ligasure® device in one. The initial presentation was intestinal obstruction in four cases and shock in one. Time from first surgery to re-operation varied from 2 to 13 days.

In all cases we found small bowel hernias through the mesocolon defect. One patients had also a perforation of the small bowel and the colon. The treatment always consisted in reduction of the hernia. A terminal ileostomy was per- formed in 2 patients. Mean hospital stay was 19 days (range 8-30 days). One patient was re-operated on po day 2 for mesenteric ischemia and died after 24 hours.

**DISCUSSION:** Internal hernia is a rare but fatal complication after laparoscopic colonic resection. Suspicion of this diag- nosis requires emergency re-operation because symptoms are non specific. All mesenteric defects created during col- orectal laparoscopy surgery should be meticulously closed.

## Posters of Distinction - P027

**EVALUATING THE IMPACT OF A MINIMALLY INVASIVE PEDIATRIC SURGEON ON HOSPITAL PRACTICE AND RESI- DENT TRAINING,** Sohail Shah MD,Alexander Feliz MD,Rahul Anand MD,Katherine Barsness MD,Douglas Potoka MD,Barbara Gaines MD,George Gittes MD,Timothy Kane MD, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh

We hypothesized that a pediatric surgeon committed to min- imally invasive surgery (MIS) could effectively change hos- pital practice by creating an emphasis on MIS that would increase hospital volume and enhance resident training. Annual case volume from 1997-2005 at a tertiary pediatric hospital, with a minimally invasive pediatric surgeon as of 2001, was evaluated for trends in MIS for 10 different opera- tions. The hospital MIS volume was then compared to the resident MIS case logs for each procedure from 2000-2005. Statistics were generated using Pearson correlation. The total hospital volume showed a statistically significant negative correlation between MIS and open surgery for all 10 case-types, indicating a strong trend toward increasing MIS (Figure A shows Nissen fundo as an example: r= -0.885, p<0.01). As the number of MIS cases increased within the hospital there was a positive correlation in the resident MIS experience (Figure B shows Nissen fundo as an example: r= 0.990, p<0.01).

The study demonstrates that upon arrival of a dedicated minimally invasive pediatric surgeon there was a significant change in hospital practice, with an overall trend of increas- ing MIS. This trend also translated into greater resident experience in minimally invasive pediatric surgery.

<figure><img src="image_63.png" /></figure>

## Posters of Distinction - P028

**LAPAROSCOPIC VERSUS OPEN EMERGENCY APPENDICEC- TOMY- LENGTH OF HOSPITAL STAY IN ENGLAND 2000- 2004,** S L Singer,A A Al-Sarira,G G David,M Deakin,S N Selvachandran MD,D Cade, Department of General Surgery, Leighton Hospital, Crewe, U.K. ; Department of General Surgery, University Hospital of North Staffordshire, Stoke on Trent, U.K.

**Introduction:** Emergency appendicectomy is a common sur- gical procedure. It can be performed as open or laparoscop- ic procedure. Many studies have been published comparing the advantages of one over the other based on findings

from a single site. These studies have shown post-operative hospital stay is reduced for laparoscopic appendicectomy. However, little data has been published from the UK on this subject. We set out to investigate whether length of postop- erative hospital stay is reduced for laparoscopic as com- pared to open appendicectomy.

**Methods:** Hospital Episode Statistics (HES) data for the financial years 2000-2001,2001-2002, 2002-2003 and 2003- 2004 were obtained from the Department of Health and were analysed using Microsoft Access. Data from all patients undergoing emergency appendicectomy as primary operative procedure, as identified by OPCS-4 code H01 were included. Laparoscopic and laparoscopic converted to open procedures were identified by secondary operative codes Y508 and Y718 respectively.

**Results:** In the 4-year period 135848 emergency appendicec- tomies were identified. The proportion of patients who had attempted laparoscopic appendicectomy was 8588 (6.3%), this proportion increased significantly from 4.2% in 2000/01 to 9.1% in 2003/04 (P < 0.001). Laparoscopic appendicecto- my was more frequent in female as opposed male patients 9.1% to 3.9% respectively (P < 0.001). The median age of the study population was 23 years (Inter quartile range (IQR) 14 - 37 years) and there was a significant difference between the median age of open and laparoscopic groups 23 years (IQR 14 - 37 years) vs 25 years (IQR 18 - 38 years) (P <0.001). The median post-operative hospital stay was reduced by one day when appendicectomy was done laparoscopically - 2 days (IQR 2 - 4 days) compared to open appendicectomy - 3 days (IQR 2 - 4 days) (P <0.001).

**Conclusions:** Over the four-year period studied, use of laparoscopic appendicectomy has increased. It is more likely to be performed in women as compared to men. Length of hospital stay post-operatively is reduced following laparo- scopic appendicectomy.

## Posters of Distinction - P029

**THE USE OF EPIDURAL ANALGESIA IN LAPAROSCOPIC COLORECTAL SURGERY,** Angela J Skull MD,Henry M Dowson MD,Sarah Burton MD,Timothy A Rockall MS, Minimal Access Therapy Training Unit, Royal Surrey County Hospital, Guildford, UK

**Introduction and Objective:** Enhanced recovery programmes are increasingly being utilised in colorectal surgery. Epidural analgesia is one of the key features of these programmes. However the continued use of epidurals in laparoscopic sur- gery is open to question. The aim of this study was to evalu- ate the role of epidural analgesia in laparoscopic surgery.

**Methods:** A prospective database was established for all laparoscopic colorectal resections. Data were collected between January 2004 and July 2006 on anaesthetic and perioperative factors, in-hospital stay, and complications. Use of epidural analgesia in our unit was determined by the preference of individual anaesthetists. Outcomes of patients with epidural analgesia were compared with those who had alternative forms of analgesia.

**Results:** 222 patients underwent laparoscopic colorectal resections, of whom 46 had an epidural. There was no sig- nificant difference between the groups in terms of age, sex, and operation type. There was a significant difference between the epidural and no epidural groups with regards to the length of anaesthetic time (38 v 25 minutes, p=0.001) and length of post-operative stay (7.13 days v 4.8, p=0.007). There was no significant difference in the complication rates between the groups.

**Conclusion:** Our data suggests that epidural usage delayed patient discharge and therefore should not play a key role in enhanced recovery programmes in laparoscopic surgery.
## Posters of Distinction – P030

### EFFECT OF PREVIOUS ABDOMINAL SURGERY ON LAPAROSCOPIC COLORECTAL SURGERY, H Tomioka MD,S

Yamaguchi PhD,H Morita MD,M Ishii MD,S Saitou PhD,Y Kinugasa MD,S Akamoto MD,K Morimoto MD,T Okumoto MD,H Hazama MD, Department of Colorectal Surgery, Shizuoka Cancer Center Hospital, Japan

**INTRODUCTION.** This study aimed to investigate the effect of previous surgery on laparoscopic colorectal surgery.

**METHODS.** In this study, we examined 271 patients who underwent laparoscopic colorectal surgery between September 2002 and December 2005. All 271 patients were classified into 7 groups according to laparoscopic procedure (ileocecal resection, 30 cases; right colectomy, 41 cases; transverse colectomy, 20 cases; left colectomy, 22 cases; sigmoid colectomy, 43 cases; high anterior resection, 71 cases; low anterior resection, 44 cases). In each of 7 groups, patients were classified into 3 subgroups according to previous surgical procedures (appendectomy or other operations), previous surgical locations (upper abdomen or lower abdomen), and previous surgical frequency (0-2 times), and surgical outcomes in each of 3 subgroups were compared regarding to duration of surgery, blood loss, length of the hospital stay, diet start, and complications (ileus, leakage and wound infection). The chi-squared test or Fisher's exact test were used to compare proportions, and the Mann-Whitney U test or the Kruskal-Wallis test were used to compare continuous variables. $P < 0.05$ was considered significant.

**RESULTS.** There was no statistical difference in overall patient with or without previous abdominal surgery. Only in the subgroup of previous surgical locations in the high anterior resection group, there were statistical differences in blood loss (the group without previous surgery, 13 g; the group with previous upper abdominal surgery, 44.5 g; the group with previous lower abdominal surgery, 24 g) and ileus (the group without previous surgery, 0%; the group with previous upper abdominal surgery, 0%; the group with previous lower abdominal surgery, 12.5%).

**CONCLUSION.** Previous abdominal surgery is not a contraindication for laparoscopic colorectal surgery. However it was suggested that high anterior resection was high risk of bleeding and ileus.

## Posters of Distinction – P031

### EFFECT OF VIRTUAL REALITY TRAINING BY NOVICES ON LAPAROSCOPIC CHOLECYSTECTOMY IN A PORCINE

**MODEL,** Nancy J Hogle MS, Akuezunkpa O Ude MD, Dennis L Fowler MD, College of Physicians and Surgeons, Columbia University, New York, NY

**Intro:** The purpose of this study is to determine whether training on a surgical simulator results in improved operative performance during laparoscopic cholecystectomy (LC) in an animal model.

**Methods:** 21 surgery interns completed LC in a pig on the first day of internship. To create a baseline score against which improvement could be measured, an experienced laparoscopic surgeon evaluated and quantified each intern's performance. A validated global assessment tool was used to grade each subject's performance on a scale of one (poor) to five (excellent) in five domains: depth perception, bimanual dexterity, efficiency, tissue handling and autonomy. The interns were then randomized to Group A (train to criteria on a laparoscopic simulator [LapSim® Surgical Science Ltd., Göteborg, Sweden]) and Group B (no training). After completing the trial period of 6 weeks, each intern completed another LC in a pig and was again evaluated. Within each group, the mean pre-training scores for each domain were compared with the mean post-training scores for each domain using a non-paired t-test.

**Results:** Pre-/Post-Training Scores for each Domain for each Group

<table><thead><tr><th></th><th>Depth Perception</th><th>Bimanual Dexterity</th><th>Efficiency</th><th>Tissue Handling</th><th>Autonomy</th></tr></thead><tbody><tr><td>Group A</td><td>2.30/7.30</td><td>1.90/2.45</td><td>2.00/2.70</td><td>2.40/2.80</td><td>2.30/2.90</td></tr><tr><td>p</td><td>0.04</td><td>0.13</td><td>0.09</td><td>0.30</td><td>0.13</td></tr><tr><td>Group B</td><td>2.09/2.45</td><td>1.82/2.27</td><td>2.36/2.36</td><td>2.36/2.55</td><td>2.36/2.55</td></tr><tr><td>p</td><td>0.29</td><td>0.27</td><td>0.91</td><td>0.38</td><td>0.59</td></tr></tbody></table>

**Conclusions:** The interns who trained scored higher and showed greater improvement in all domains than those who did not train, but the only statistically significant improvement was in the domain of Depth Perception. These results suggest that training on the simulator has predictive validity for improving intraoperative performance.

## Posters of Distinction – P032

### HOW MANY ESOPHAGEAL CANCERS NEED TO BE PREVENTED TO MAKE ABLATION OF BARRETT'S ESOPHAGUS COST-EFFECTIVE?, Vic Velanovich MD, Henry Ford Hospital

**Background:** Barrett's esophagus increases the risk of developing esophageal adenocarcinoma. Because of this increased risk, strategies for management have generally centered on close surveillance to identified malignancies at an early stage. An alternative strategy would be to ablate the Barrett's mucosa in order to prevent cancers occurring to begin with. However, there is concern that many patients would be treated in order to prevent a few cancers. The purpose of this study was to determine how many cancers need to be prevented to make ablation cost-effective.

**Methods:** Assumptions: Incidence of the development of esophageal adenocarcinoma in patients with Barrett's esophagus is 0.5%/yr. The cost of ablation using the Barrx system (Barrx Medical Inc., Sunnyvale, CA) is $3,642. The hospital cost of an esophagectomy is $45,600. The median income of the USA is $46,242. The life expectancy of a 40 year old is 38.5 years (working life 25 years), a 50 year old is 29.5 years (working life 15 years), and a 60 year old 21.3 years (working life 5 years).

**Results:** For every 1,000 patients with Barrett's esophagus ablated using the Barrx device, from the standpoint of prevention of esophagectomies, 80 cancers need to be prevented to make Barrett's ablation cost effective. If ablation completely eliminates the risk, this will be obtained within 17 years after ablation. From the standpoint of patient earning power: for every 1,000 40 year olds, 3 cancers need to be prevent (achieved after 1 year); for every 1,000 50 year olds, 5 cancers need to be prevented (achieved after 1 year); for every 1,000 60 year olds, 16 cancers need to be prevented (achieved after 3 years).

**Conclusions:** Using real cost incurred due to esophagectomy, 80 cancers prevented in 1,000 initially treated patients would make ablation cost-effective. This is achieved within 17 years of the ablation, which is within the average life expectancy of the United States population up to the age of 60 years. When assessing lifetime income loss, many fewer cancers need to be prevented in order to make ablation worthwhile.

## Posters of Distinction – P033

### PATIENT PERCEPTIONS OF NATURAL ORIFICE TRANSLUMINAL SURGERY (NOTES), Eric T Volckmann MD, Eric S Hungness MD,Nathaniel J Soper MD,Lee L Swanstrom MD, Northwestern University Feinberg School of Medicine and Legacy Health System Departments of Surgery

**Introduction:** Natural Orifice Transluminal Endoscopic Surgery (NOTES) has captured the imagination of surgeons and interventional gastroenterologists. Its possible advantages are theoretical and there are many developmental and perceptual hurdles to overcome. As public attitude toward NOTES will influence its adoption, our aim was to assess patients' opinions regarding NOTES.

**Methods:** A 58 item survey was administered to 192 sequential patients at 2 busy surgery clinics. The basic concepts of NOTES and laparoscopic surgery (LS) were described along with an example case. Patients were then asked to rate the importance of various aspects of surgical procedures and to decide whether they would prefer cholecystectomy (chole) by NOTES or LS, and why.
<figure><img src="image_64.png" /></figure>

## SAGES POSTER ABSTRACTS

**Results:** Forty-nine percent of patients were male, the mean age range was 50-59 yo, 64% were employed, 79% had some college education, 60% had prior flexible endoscopy (FE), 52% had prior LS and 48% had previous open surgery (OS). Subjects considered the risk of having a complication, recovery time, and amount of postoperative pain to be more important than cosmesis, cost, length of hospital stay (LOS), or anesthesia type (all p<0.001). Patients perceived NOTES to be associated with less pain, cost, risk of complications, and recovery time while also requiring more surgical skill than either OS or LS (all p<0.04). In the hypothetical chole, 56% of respondents preferred NOTES and 44% chose LS. For patients who did not choose NOTES, reasons were that NOTES was too risky (35%), too new (35%), had no advantages over LS (22%) or simply that the concept was not appealing (36%). Patients who attended college were more likely to choose NOTES, and patients >= 70 years old or who had undergone FE were less likely to select NOTES (all p<0.04). Although 80% of patients would still prefer NOTES if it was 1% riskier than LS, only 18% would choose NOTES if it had a 10% complication risk. NOTES preference also decreased as hospital distance and cost increased and as surgeon experience decreased (all p<0.001).

**Conclusion:** When offered a choice, the majority of patients prefer cholecystectomy by NOTES. This is particularly true when patients are younger, have more education, and have not had prior FE. When comparing operations, procedure-related risks, pain, and recovery time are more important than cosmesis, cost, LOS, or anesthesia type. Patients are willing to accept some increased risk for NOTES, but are less willing to accept NOTES as the risks and cost increase and as surgeon experience and procedure availability decrease.

## Posters of Distinction - P034

**DYNAMIC DECISION MAKING RESEARCH IN LAPAROSCOPIC CHOLECYSTECTOMY**, Dawit Worku MD,Bijendra Patel,S Sarker, St. Bartholomew's and The London School of Medicine and Dentistry

Over the last two decades, laparoscopic cholecystectomy (LC) has gained worldwide acceptance and considered as "gold standard" in the surgical management of symptomatic cholelithiasis. Despite the expertise gained in performing the procedure, complications such as bile duct injuries continue to occur at unacceptable rates. Understanding the decision process involved in LC is believed to ameliorate some of the errors associated with the procedure. Using methodologies of Naturalistic Decision Making (NDM) (Hierarchal Task Analysis (HTA), Cognitive Task Analysis, Direct Observation, Interface Survey), 12 laparoscopic cholecystectomy procedures were analyzed while being carried out by 4 consultant surgeons and 4 Registrars (equivalent of senior resident). The aims of the study were to analyse the dynamic decision making process involved in LC, identify mental models utilized by surgeons performing the procedures and suggest decision support techniques and technologies. HTA of LC was carried out. Performances of the Consultant surgeons and Registrars were compared using a valid global scoring system for generic and specific technical skills. Situation Awareness (SA) and Recognition-Primed Decision (RPD) have been identified as plausible mental models used by surgeons performing LC. Five types of skills involved in performing LC have been identified and relevant training strategies suggested. Five principal stages of skill acquisition have been discussed. The need for additional decision support technique and technologies to the already existing one, for use in difficult cases and by inexperienced surgeons, have been highlighted and potential decision aids suggested. In conclusion, Dynamic Decision Making (DDM) research applying the techniques of NDM studies can produce useful information helpful in tailoring surgical training to needs and suggesting decision support techniques and technologies.

## Posters of Distinction - P035

**LAPARO-ENDOSCOPIC BOWEL RESECTION: A HYBRID PROCEDURE FOR FUTURE TRANSGASTRIC SURGERIES**, Yassar K Youssef MD,Alfonso Torquati MD,Erik Hansen MD,William O Richards, Vanderbilt University Medical Center

**Background:** Endoluminal and transgastric interventions are newly evolving techniques, and the transgastric approach to the peritoneal cavity for diagnostic and therapeutic purposes including liver biopsies, manipulation of intra-abdominal organs, gastro-jejunostomy, ligation of fallopian tubes and transgastric cholecystectomy have been previously demonstrated. The aim of this study is to develop the technique of transgastric removal of abdominal organs as a hybrid procedure of laparoscopic and transgastric surgery.

**Methods:** Laparoscopic colectomy or enterectomy was performed in 7 dogs. The animals were fasted for 24 hours before the procedure except for water access. All procedures were performed under general anesthesia. A segment of colon (~15 cm) or small bowel (~25 cm) was resected laparoscopically. The bowel segment was secured in and Endo-catch bag. Transoral gastroscopy was then performed with subsequent laparoscopic gastrotomy and passage of the endoscope into the peritoneal cavity. The Endo-catch bag was tied to an endoscopically placed endo-loop and the specimen was removed with the endoscope via the mouth. No incision larger than 12 mm was required. The gastroomy was closed laparoscopically followed by repeat endoscopy to rule out any immediate complication.

**Results:** Seven dogs were included in the study. Laparoscopic colectomy was performed in 3 and enterectomy in 4 animals. The first animal was done laparoscopically and converted to open for education and quality control. The average time of the procedure was about 2 hours. All specimens were successfully removed thru the mouth with no evidence of any immediate complications noted on upper endoscopy following the procedure. All specimens were examined and there was no gross pathological distortion.

**Conclusions:** Laparo-Endoscopic bowel resection is a hybrid procedure that allows the removing of some abdominal organs and specimens without the need for an open incision for retrieval. This study demonstrated that transgastric removal of bowel is technically feasible.

## Bariatric Surgery - P036

**ROUX LIMB OBSTRUCTION SECONDARY TO CONSTRICTION AT TRANSVERSE MESOCOLON AFTER LAPAROSCOPIC RETROCOLIC ROUX-EN-Y GASTRIC BYPASS (LRYGB).**, Ahmed R Ahmed MD,Gretchen Rickards,Syed Husain MD,Joseph Johnson MD,Thad Boss MD,William O'Malley MD, University of Rochester Medical Center

**INTRODUCTION:** Partial small bowel obstruction can occur as a result of thickened cicatrix formation causing circumferential extrinsic compression of the retrocolic Roux limb as it traverses the transverse mesocolon. This study examines the incidence of this complication with particular attention to the timing of presentation and associated weight loss. Small bowel obstruction is a recognized complication of laparoscopic gastric bypass occurring in up to 4% of patients undergoing surgery. Causes include internal herniation, postoperative adhesive bands, anastomotic strictures and incarcerated incisional hernias. A series of 20 patients who underwent surgery for small bowel obstruction at the transverse mesocolon rent after retrogastric, retrocolic laparoscopic gastric bypass is presented. 18/20 cases underwent Upper GI contrast study which confirmed the diagnosis. In all cases, laparoscopic intervention succeeded in releasing the constricted Roux limb.

**METHODS:** A retrospective chart review was performed of all patients undergoing LRYGB who developed symptomatic small bowel obstruction requiring operative intervention between Jan 1 2000 and September 15 2006.

**RESULTS:** see Table below.

**CONCLUSION:** Narrowing at the transverse mesocolon rent is an uncommon cause of small bowel obstruction after laparoscopic retrocolic Roux-en-Y gastric bypass. Unlike
internal hernias which tend to occur later in the clinical course and are associated with significant weight loss, roux limb obstruction caused by transverse mesocolon stricture occurs earlier after gastric bypass and is not associated with significant weight loss.

### Roux limb constriction

<table><tr><td>Incidence</td><td>20/2215 (0.9%)</td></tr><tr><td>Days post LRYGB</td><td>49+/-6 (35-61)*</td></tr><tr><td>Wt loss (kgs)</td><td>19+/-2 (15-23)*</td></tr><tr><td>%EBWL</td><td>29+/-2 (24-33)*</td></tr></table>

( )* = 95% conf intervals, p<0.01

## Bariatric Surgery - P037

**CHOLECYSTECTOMY DURING LAPAROSCOPIC GASTRIC BYPASS HAS NO EFFECT ON DURATION OF HOSPITAL STAY**, Ahmed R Ahmed MD, Gretchen Rickards, O'Malley William MD, Johnson Joseph MD, Boss Thad MD, University of Rochester Medical Center, Rochester, New York

**INTRODUCTION:** Laparoscopic cholecystectomy can be safely performed at the time of laparoscopic Roux-en-Y gastric bypass. This study was primarily conducted to examine whether there is any difference in the length of hospital stay and duration of operation in patients who undergo concomitant cholecystectomy with their gastric bypass. In addition, the frequency and nature of complications in the two groups was compared.

**METHODS:** Retrospective chart analysis and comparison of 200 patients who underwent laparoscopic gastric bypass alone with 200 patients who underwent laparoscopic gastric bypass with simultaneous cholecystectomy.

**RESULTS:** Concomitant cholecystectomy does not increase length of hospital stay (2.04 ±0.20 days vs 2.06 ±0.29 days in the gastric bypass alone group; p=0.85). Furthermore the addition of cholecystectomy only adds an extra 29 minutes to the operation (p<0.01). In both groups, there was no difference in the rate of postoperative complications (8.5% in both groups, p= 0.21), the nature of which was more or less equally distributed amongst the two groups.

**CONCLUSION:** Laparoscopic cholecystectomy performed at the time of laparoscopic gastric bypass does not alter length of hospital stay or frequency of postoperative complications and only adds an extra half hour to total operation time. Therefore there may be a role for routine prophylactic cholecystectomy in patients who are undergoing uncomplicated gastric bypass surgery.

## Bariatric Surgery - P038

**TRENDS IN INTERNAL HERNIA INCIDENCE AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS (LRYGB)**, Ahmed R Ahmed MD, Gretchen Rickards, Syed Husain MD, Joseph Johnson MD, Thad Boss MD, William O'Malley MD, University of Rochester Medical Center

**INTRODUCTION:** This study investigates the relationship between extent of patient weight loss and time course after gastric bypass and internal hernia incidence. It examines whether switching to running closure of the Peterson's mesenteric defect has an impact on incidence of this particular type of internal hernia. Lastly, it compares the incidence of internal hernia occurrence in patients with retrocolic versus antecolic Roux limb placement.

The incidence of internal hernia after LRYGB is greater in the laparoscopic approach than in the open technique and has been estimated to be 3-4.5% in previous studies. It has been observed that the vast majority of internal hernias present months and not days after surgery. It has been postulated that the weight loss seen in these patients, typically occurring some months after surgery, results in reduced intraperitoneal fat which in turn leads to larger mesenteric defects. Most surgeons close these defects at the index operation using an interrupted technique or continuous suture.

**METHODS:** A retrospective chart review was performed of all patients undergoing LRYGB who developed symptomatic internal hernia requiring operative intervention between Jan 1 2000 and September 15 2006.

**RESULTS:** 54 internal hernias occurred in 2572 patients, an incidence of 2.1%. The site of internal hernias varied: 25 (1%) - transverse mesocolon; 22 (0.8%) - enteroenterostomy; 7 (0.3%) - Peterson's space. The mean time to intervention for an internal hernia repair was 413 ±46 days (95% c.i. 319-596, p<0.01), whereas average % excess body weight loss (%EBWL) in this period was 59 ±3.3 (95% c.i. 52-65, p<0.01) (Student's t test). Subgroup analysis demonstrates internal hernia incidence to be 2/357 (0.6%) in antecolic Roux versus 52/2215 (2.4%) in retrocolic Roux limb (Odds ratio= 4, P<0.05) (Chi Square analysis). Of the 7 patients presenting with a Peterson's type internal hernia, 3 had undergone interrupted closure and 4 had undergone continuous closure of this defect.

**CONCLUSION:** This study demonstrates an association between presentation of internal hernia after LRYGB and time after surgery as well as weight lost. Furthermore the antecolic approach is associated with a reduced incidence of internal hernia. Continuous closure versus interrupted stitching of Peterson's space does not seem to alter the incidence of internal hernia at this location.

## Bariatric Surgery - P039

**THE EFFECT OF STAPLE LINE REINFORCEMENT SLEEVES (SEAMGUARD) ON INTERNAL HERNIA INCIDENCE AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS (LRYGB)**, Ahmed R Ahmed MD, Gretchen Rickards, Syed Husain MD, Joseph Johnson MD, William O'Malley MD, Thad Boss MD, University of Rochester Medical Center

**INTRODUCTION:** This study has been designed to observe the impact of using glycolide copolymer staple-line reinforcement sleeves (Seamguard - W L Gore & Associates, Inc) applied onto linear staplers when dividing small bowel mesentery during LRYGB on the incidence of internal hernia. Typically, mesenteric defects created during LRYGB are closed using interrupted or continuous suture. In our unit we started using Seamguard reinforcement sleeves. The main benefits of this are (i) reduced bleeding and (ii) increased staple line strength. It has also been suggested that these strips can be adhesiogenic. Our own observations concur with this. We have found from reoperating on patients who have had previous staple line reinforcement strips used that there is significant adhesion formation between the strip and neighboring native tissue. Therefore, one surgeon (WB) at our unit switched from suturing all the mesenteric defects closed to using Seamguard.

**METHODS:** A retrospective chart review was performed of all patients undergoing LRYGB with and without the use SeamguardTM and who developed symptomatic internal hernia requiring operative intervention between Jan 1 2000 and September 15 2006. Seamguard was used in the process of small bowel and mesenteric division during creation of an antecolic Roux limb.

**RESULTS:** see Table

**CONCLUSION:** This comparative investigation suggests that the use of glycolide copolymer staple-line reinforcement (Seamguard) decreases the incidence of internal hernia formation, though this effect was not statistically significant. Additionally it obviates the need for suture closure of all mesenteric defects thereby reducing operative time.

<table><thead><tr><th></th><th>No Seamguard</th><th>Seamguard</th></tr></thead><tbody><tr><td>LRYGB N</td><td>2215</td><td>330</td></tr><tr><td>Int hernia N(%)</td><td>28 (1.3%)*</td><td>1 (0.3%)*</td></tr><tr><td>Hernia locus:</td><td>21 - enteroent<br>7 - Peterson's</td><td>1 - enteroent</td></tr></tbody></table>

* odds ratio 4.2 (p=0.06)
<figure><img src="image_65.png" /></figure>

SAGES POSTER ABSTRACTS

**Bariatric Surgery – P040**

REDUCTION OF CIRCULAR STAPLER RELATED WOUND INFECTION IN PATIENTS UNDERGOING LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS, Fahad S Alasfar

MD,Adheesh A Sabnis MD,Rockson C Liu MD,Bipan Chand MD, Cleveland Clinic Foundation

**Background:** Circular-stapled anastomosis with trans-oral anvil insertion for the creation of the gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass (LRYGB) is associated with frequent infections at the abdominal wall site where the circular stapler is inserted.

**Methods:** Patients who underwent routine LRYGB over a 1.5 year period at The Cleveland Clinic Foundation without any concomitant procedures were included. After our initial experience with circular-stapled anastomosis related wound infections, we implemented measures to reduce the infection rate. Prevention measures included chlorhexidine "swish and swallow," a plastic barrier device over the stapler, wound irrigation, loose skin approximation, and placement of loose packing. We compared wound infection rates in patients before (?no prevention?) and after (?prevention?) implementing these measures.

**Results:** Ninety-one patients with a mean age of 42 years and average body mass index of 48 kg/m2 underwent laparoscopic Roux-en-Y gastric bypass. The infection rate was 30% among the "no prevention" (n=10) group and 1% in the "prevention" (n=81) group (p< 0.05).

**Conclusion:** Trocar site infection related to the circular-stapled anastomosis technique can be significantly reduced with simple prevention measures.

**Bariatric Surgery – P041**

IMPACT OF SOCIOECONOMIC FACTORS ON PATIENT PREPARATION FOR BARIATRIC SURGERY, Lisa M Balduf

MD,Joseph A Galanko PhD,Timothy M Farrell MD, University of North Carolina

The prevalence of severe obesity and the incidence of bariatric surgery (BS) have increased. Socioeconomic factors (SEF) are linked to the prevalence of obesity, affect access to and outcome of BS and may affect patient preoperative preparation. The purpose of this study was to examine the effects of income, formal education, race, health insurance and employment status on patient self-educational and behavioral activities prior to BS. Over an 11-month period, a 20-minute cross-sectional telephone survey was administered to 127 individuals who contacted our office regarding BS. Study participants were asked to report their income, formal education, health insurance and employment status, height, weight and standard demographic data. The type and number of self-educational resources (SR) utilized were elicited. Current eating and exercise behaviors were recorded and a 19-item objective assessment (OA) of knowledge of the risks of both obesity and BP was completed. Univariate analysis of the effect of each SEF on type and number of educational resources, engagement in healthy behaviors and OA scores were performed using Student's t-test, Chi square or ANOVA. A backwards stepwise multivariate analysis was then performed for those SEFs found to be significant on univariate analysis (p<=0.05). Participants had a mean age of 41.2±10.8 years, 85% were women and mean BMI was 51.8±10.6 kg/m2. The most valuable SR cited by respondents was the internet (41.2%), which was unaffected by SEF. On univariate analysis, those with employment (2.89±1.0 vs 2.53±1.0, p=0.05), private insurance (2.84±1.0 vs 2.47±1.0, p=0.05), white race (2.86±1.0 vs 2.49±1.0, p=0.05) and income>$20,000/yr (2.93±1.0 vs 2.34±0.1.0, p< 0.001) used a greater mean number of SR than their peers. Subjects with private insurance (15.3±2.5 vs 14.0±3.3, p=0.02), higher formal educational levels (15.9±2.4 vs 13.9±3.1) and income >$20,000/yr (15.9±2.20 vs 13.2±3.14, p<0.0001) demonstrated greater proficiency on the OA instrument. Engagement in healthy eating and exercise behaviors was unaffected by any SEF. On multivariate analysis, higher income was the sole factor directly related to the number of SR utilized and score on the OA. We conclude that obese patients from lower income households

may benefit from additional preoperative education, while all obese individuals, regardless of SEF, must be encouraged to implement healthy eating and exercise behaviors preoperatively.

**Bariatric Surgery – P042**

MRI ASSESSMENT OF GASTRIC FUNCTION AFTER

LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING - A PILOT STUDY., John M Bennett BA,Paul Malcolm,Alex P Boddy BA,Martin Wickham BS,Stuart Williams,Andoni Toms,Ian T Johnson PhD,Michael Rhodes MD, Norfolk and Norwich University Hospital NHS Trust and Institute of Food Research

**Background:** LAGB is a restrictive bariatric surgical procedure. Patients post LAGB state they remain sated for several hours after a small meal despite on going weight loss. We utilised MRI to investigate post LAGB gastric function.

**Method:** MRI scanning post an eight-hour fast with two test meals (water and 3% Locust Bean Gum) of post-LAGB patients and age/sex matched controls. MRIs are repeated every 15 minutes out to 80 minutes post test meal. Axial MRI slices are examined to calculate gastric volumes. Visual analogue scores for hunger are recorded prior to each scan.

**Results:** 5 post-LAGB patients (47yrs, 32-53) with good weight loss (%EWL mean 84.8±12.0) and good subjective assessment of post meal satiety and 4 non-obese controls (38 yrs 29-50) have been recruited. MRIs with LBG have been completed on 4 patients and 3 controls and with water on 3 patients. Gastric pouch filling varies greatly between patients (see figure), as does initial pouch volume (6,0,50,0ml). Three of the four (MP01, 02, 05) demonstrated significant oesophageal dilatation (delayed transit or reflux) which impacts on gastric and pouch volumes. Comparison with control volunteers will be presented.

<figure><img src="image_66.png" /></figure>

**Discussion:** The study demonstrates that gastric filling varies post LAGB. The occurrence of significant oesophageal dilatation post meal in 3 out of 4 patients imaged with LBG is undergoing further investigation.

**Bariatric Surgery – P043**

THE EFFECT OF FOLLOW UP ON THE OUTCOME OF LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING IN THE TREATMENT OF MORBID OBESITY., John M Bennett

BS,Michael Rhodes MD, Norfolk and Norwich University Hospital NHS Trust and BUPA Hospital, Norwich

**Introduction:** The National Institute of Clinical Excellence (NICE) estimate that there are 1.2 million people in the UK clinically eligible for morbid obesity surgery. The commonest type of surgery worldwide is laparoscopic gastric banding and increased intensity of follow up may improve the outcome.

**Methods:** Patients? weight loss results were recorded on a prospective database also documenting their attendance at a monthly follow up "club" run by specialist nurses. Percentage excess weight loss (EWL) was recorded in patients attending 2 or less follow-up sessions as compared to 3 or more sessions

<figure><img src="image_67.png" /></figure>
SAGES POSTER ABSTRACTS

**Results:** 63 patients have had surgery to date (M-6, F-57; Median age 43 yrs (range 24-62); Mean preop BMI 44.6 Kgm-2 (35-60)). Median operating time was 35 minutes (range 25-75), median hospital stay 1 day (1-5) and return to normal activities at a mean of 12.7 days (sd 2.97). There were no deaths. 30 day morbidity was 1.8%. Total complications to date are 11.3% with delayed complications of 9.4% (3 port rotations, one band infection and one band slip-page). **Conclusion:** The more intensive the follow up the better the result after LAGB. This follow up can be completed routinely by nurse led patient &x93;clubs&x94; with surgical input only when necessary.

Bariatric Surgery - P044

PAIN MANAGEMENT IN LAPAROSCOPIC GASTRIC BYPASS SURGERY, VENKATA BODAVULA MD, SAGAR MEHTA BS, SURYA NALAMATI MD, LEONARD MAFFUCCI MD, MADHU RANGRAJ MD, SOUND MEDICAL CENTER OF WESTCHESTER, NEW ROCHELLE, NY

SAGES - POSTER PRESENTATION

**Introduction:** Post-operative pain management can be handled with multiple modalities in patients who undergo Laparoscopic Roux-en-Y Gastric Bypass Surgery (LRYGBP). Due to the less invasive nature of laparoscopic technique, a reduced amount of pain medication is usually required when compared to open procedures. Pain control can be attained with the use of intermittent non-opioid drugs in conjunction with opioids resulting in decreased amount of total pain medication use as well as a decrease in associated nausea and respiratory depression. The pain control is comparable to PCA and Epidural Analgesia.

**Methods:** We reviewed the charts of patients who underwent LRYGBP, focusing on length of hospital stay, pain medications administered during the length of hospital stay, nausea, vomiting and respiratory complications. Goal of pain management to keep the VAS score <2-3.

**Results:** 200 patients from June 2005 to September 2006 were reviewed. Average operative time was 165 minutes. Average length of hospital stay was 2.5 days. Morphine 24 mg(n=100), Demerol 150mg(n=60), Ketorolac 90 mg (n=40) was used POD#1. The requirement for pain medication decreased by one third, on the second postoperative day. All patients were discharged home on oral pain medications. Complications - nausea in 40% of the patients, respiratory depression was in 7(14%) patients. Hemorraghe was in 7(3.5%) patients.

**Conclusion:** Postoperative pain management has been simplified with combinations of intermittent Morphine and Ketorolac. A Morphine sparing effect can be seen with increasing use of Ketorolac and an associated decrease in nausea and respiratory complications associated with opioids. Ketorolac is not associated with increased bleeding as feared.

Bariatric Surgery - P045

INTRAGASTRIC MIGRATION OF A GASTRIC BANDING:
ABOUT 13 CASES, Bernard BOKOBZA MD, Evelyne BISSON,
Hospital Group of Le Havre

**Background:** Gastric erosion is a potentially severe complication of adjustable gastric banding.

**Methods:** From June 1998 to December 2005, 13 patients have been operated for intra-gastric migration of an adjustable band. In the same period of time 338 patients had an adjustable band, i.e. a 3,85 % erosion rate. 11 F (mean BMI 45,6), and 2 M (mean BMI 49,6) were operated on. The mean interval between the placement of the band and its removal has been 44 months (8 - 68). Symptoms were epigastric pain (5), abscess of the access-port (4), and band slippage with GERD (4). Weight-loss had stopped in all cases.

**Results:** The laparoscopic approach has been used in all cases but one (open procedure for a 6 months pregnant woman who had the band partially inserted into the spleen). Post-op gastric baryum swallow has been routinely performed. No complication occurred.
5 Bypass have been performed, including 2 intra-operative-

ly. Mean BMI at this time was 44,3, and dropped to 30,7 after an 8 months follow-up.

**Conclusions:** Intragastric erosion of a band is a rare and serious complication after lap-banding that entails a careful monitoring of the patients including upper GI endoscopy in case of suspicion. A secondary bypass may obtain good results in these cases, which question the results of lap-banding.

Bariatric Surgery - P046

LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS: AN INSTITUTION'S REVIEW OF WEIGHT LOSS IN BOTH EXTENDED AND SHORT ROUX LIMBS, James A Bonheur MD, Lisa Rynn BS, Ibrahim Azer MD, Laura Choi MD, Keith Zuccala MD, Danbury Hospital

**Objective:** The purpose of this study was to examine weight loss in patients with a BMI => 50 who underwent laparoscopic Roux-en-Y gastric bypass surgery with an extended roux limb length of 150 cm (eRYGP) and weight loss in patients with a BMI <= 49 who underwent laparoscopic gastric bypass with a shorter roux limb (sRYGP) of 100 cm at six months and one year intervals post surgery.

**Methods:** This study was a retrospective chart review. A total of 458 patients who underwent Laparoscopic Roux-en-Y gastric bypass surgery over a four-year period were reviewed. All procedures were performed at Danbury Hospital in Danbury CT by two laparoscopic/bariatric surgeons. The standard procedure was a Roux-en-Y gastric bypass with a 100 cm Roux limb for the morbidly obese patient (BMI <=49) and, an extended 150 cm Roux limb for the super obese patient (BMI =>50).

**Results:** Both groups demonstrated weight loss as early as 3 months post procedure. Patients who underwent the eRYGP (BMI => 50) demonstrated an average weight loss of 104lbs at six months with an additional 23.8 lb weight loss at one year. Patients who underwent sRYGP (BMI <= 49) demonstrated an average weight loss of 83lbs at six months with an additional 13lb weight loss at one year. In addition, patients classified as super-super obese (BMI => 60) demonstrated an even greater weight loss, with an average of 106.7lbs and an additional 46.8lbs at six months and one year respectively.

**Conclusion:** Surgical therapy has proven to be the sole treatment in achieving significant long-term weight loss, improving obesity-related co-morbidities, reducing the risk of premature death, and improving the quality of life in morbidly obese patients. The Roux-en-Y gastric bypass is the most widely performed surgical procedure for morbid obesity in the United States. Although there are considerable risks associated with this procedure, published data suggest that the risks are offset by the extensive health benefits. Our review coincides with previously published data and confirms weight loss surgery, more specifically laparoscopic Roux-en-Y gastric bypass, as a safe and effective treatment for morbid obesity.

Bariatric Surgery - P047

LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS VERSUS LAPAROSCOPIC GASTRIC BANDING: AN INSTITUTION'S COMPARISON OF WEIGHT LOSS, James A Bonheur MD, Lisa Rynn BS, Ibrahim Azer MD, Laura Choi MD, Keith Zuccala MD, Danbury Hospital

**Objective:** The aim of this study was to compare weight loss in morbidly obese patients (BMI =>40) who underwent laparoscopic gastric banding (LB) versus Roux-en-Y Gastric Bypass surgery (RYGB). This study focuses on the total weight loss within the first six months and one year following surgery.

**Methods:** This study was a retrospective chart review. A total of 112 patients were reviewed during a 1-year period. Seventy-three patients underwent RYGB versus thirty-nine patients who underwent LB. All procedures were performed at Danbury Hospital in Danbury CT by two laparoscopic/bariatric surgeons. The standard procedures were the laparoscopic RYGB with a 100 - 150 cm roux limb and the LB using either Van Guard bands or Inamed Lap Bands in

<figure><img src="image_68.png" /></figure>
<figure><img src="image_69.png" /></figure>

# SAGES POSTER ABSTRACTS

patients with BMI => 40.

**Results:** There was no significant difference demonstrated in preoperative weight, BMI, operative time, estimated blood loss, or length of stay within both procedure groups. Average body weight was found to decrease over the one year period in both groups. Patients who underwent RYGB surgery experienced an average weight loss of 104lbs and 127.8lbs at six months and one year respectively. Patients who underwent LB experienced an average weight loss of 40.9lbs and 64.2 lbs at six months and one year respectively. A significant difference in weight loss is demonstrated between the two groups; with a greater weight loss seen in the patients who underwent laparoscopic RYGB one year post surgery. In addition, a small subset of patients noted to have a BMI => 60 who underwent LB, demonstrated an even greater average weight loss of 65.8 lbs and 89.4lbs at six months and one year respectively. This finding was also noted in the subset of patients with a BMI => 60 who underwent laparoscopic RYGB surgery with an average weight loss of 106.7lbs and 153.5lbs at six months and one year respectively.

**Conclusion:** Previous studies have demonstrated that both gastric bypass and gastric banding procedures result in significant weight loss in obese patients. This effect is seen as early as 6 months postoperatively and often times sooner. Both procedures have been demonstrated to be safe and effective in the management of morbid obesity. This study demonstrates that RYGB results in greater weight loss as compared to LB within the first 6-12 months following surgery. In particular, our study found RYGB to be more effective in the treatment of a cohort of patients with a BMI => 60.

## Bariatric Surgery - P048

**LAPAROSCOPIC TRUNCAL VAGOTOMY FOR WEIGHT-LOSS: INITIAL EXPERIENCE IN 15 PATIENTS FROM A PROSPECTIVE, MULTI-CENTER STUDY, Thad Boss MD, Jeffrey Peters**
MD, Marco Patti MD, R Lustig MD, J Kral, Department of Surgery, Highland Hospital; Department of Surgery, University of Rochester; Division of General Surgery, UCSF; Division of Endocrinology, UCSF; Department of Surgery, SUNY Downstate

**INTRODUCTION:** The objective of this study was to test the hypothesis that laparoscopic truncal vagotomy among severely obese men and women would promote weight loss and improvements in medical comorbidities.

**METHODS:** Laparoscopic truncal vagotomy via 5mm access ports was performed under general anesthesia on 15 severely obese patients. Thirteen of the 15 were women. Mean age was 37±9.5 years, ranging from 25-54 years. The posterior and anterior vagus nerves were identified, clipped and a segment removed for pathologic review. Esophageal dissection was carried out to assure division of additional vagal fibers. The adequacy of vagotomy was assessed by inspection and intraoperative/endoscopic congo red test under IV baclofen stimulation. Outcome measures included total weight loss and BMI changes, percent excess body weight lost, operative morbidity, and adverse events. Follow-up was at least 3 months in all patients.

**RESULTS:** Seventy three percent of the 15 patients lost weight. Mean preoperative weight was 112±20.4 kg (range: 85-159) and BMI 41±3.0 kg/m2 (range: 35-48). There were no operative complications. One patient required re-admission for transient severe diarrhea of bacterial origin. On symptom assessment at 3 months, 2 patients complained of postoperative abdominal pain. BMI change and % excess weight loss (%EWL) for all 15 patients and for the 11/15 (73%) responders is shown in the table.

**CONCLUSION:** Although early, these data using an objective and otherwise difficult to achieve end point such as weight loss, suggest that truncal vagotomy may be a viable treatment for obesity.

<table><thead><tr><td>Time</td><td>No</td><td>Change BMI</td><td>%EWL</td></tr></thead><tbody><tr><td>3 mo/Total</td><td>15</td><td>2.1</td><td>12.2</td></tr><tr><td>3 mo/Responders</td><td>11</td><td>3.0</td><td>18.1</td></tr></tbody></table>

## Bariatric Surgery - P049

**SPECTRUM AND PREDICTORS OF COMPLICATIONS AFTER GASTRIC BYPASS, Guilherme M Campos MD, Ruxandra Ciovica MD, Stanley Rogers MD, Mark Takata MD, Andrew Posselt MD, Eric Vittinghoff PhD, John Cello MD, Bariatric Surgery Program, University of California San Francisco.**

**Background:** Complications after gastric bypass (GBP) occurs in 10 to 25% of patients. Objectives: To determine the spectrum and predictors of complications after open and laparoscopic GBP. Setting: University tertiary referral center. Patients: Three-hundred and seventy-nine morbidly obese patients that underwent open (n=65) or laparoscopic (n=314) GBP. Outcomes: Complications, stratified by Grade as: Grade I-requiring only bedside procedure, Grade II-requiring therapeutic intervention but without lasting disability, Grade III-resulting in organ resection or irreversible deficits, and Grade IV-death.

**Methods:** Occurrence of complications compared using Fisher's exact test. Patients with more than one complication, the highest grade was used for analysis. Logistic regression was used to identify independent predictors of complications. Predictors considered were age, gender, insurance and marital status, BMI, comorbidities, surgical technique, and surgeon experience (<51 cases).

**Results:** One-hundred and fourteen complications occurred in 72 patients (19%). Mortality was 0.3%. Grade I complications were more frequent after open GBP (Table), 87% were wound related. Grades II to IV complications occurred in 41 patients (10.8%), and frequency was similar (Table). Two factors were predictive of complications after open GBP: BMI>70 (odds ratio=8.7; 95% CI=1.3-58, p=0.02) and surgeon experience (odds ratio=4.1; 95% CI=1.1-15, p=0.03). Only surgeon experience (odds ratio=2.2; 95% CI =1.1-4, p=0.02) was predictive of complications after laparoscopic GBP.

<table><thead><tr><th></th><th>Open GBP n=65</th><th>Lap. GBP n=314</th><th>p value</th></tr></thead><tbody><tr><td>Complications</td><td>28 (43%)</td><td>44 (14%)</td><td>&lt;0.01</td></tr><tr><td>Grade I</td><td>16 (25%)</td><td>15 (5%)</td><td>&lt;0.01</td></tr><tr><td>Grade II</td><td>10 (15%)</td><td>26 (8%)</td><td>ns</td></tr><tr><td>Grade III</td><td>1 (1.5%)</td><td>3 (1%)</td><td>ns</td></tr><tr><td>Grade IV</td><td>1 (1.5%)</td><td>0 (0%)</td><td>ns</td></tr></tbody></table>

**Conclusion:** Grades II to IV complications occurred at low and similar rates in both groups. Surgeon early experience strongly predict complications after open and laparoscopic GBP. BMI>70 is an additional predictor after open GBP.

## Bariatric Surgery - P050

**BARIATRIC SURGERY - ASIAN PERSPECTIVE, Pradeep Chowrey MS, CHAIRMAN, MINIMAL ACCESS AND BARIATRIC SURGERY CENTRE, SIR GANGA RAM HOSPITAL, NEW DELHI, INDIA**

The incidence of obesity in India is reported at 7-9%. Although comprising only a small percentage, the actual number of obese persons is significant due to the sheer size of the Indian population. The most important factor behind this escalating problem of obesity in India is a changing lifestyle. It is the affluent urban middle class with the highest prevalence of obesity. Lifestyle changes observed in this strata of society include a change in eating habits and an increasingly sedentary life. Refined food with low dietary fiber, an increasing ratio of sugars and fats in the diet contributes to obesity. This unbalanced diet results in vitamin and mineral deficiencies.

Surgery for obesity is relatively unknown in India. It is not surprising since understanding of obesity as a disease is also a recent phenomenon. Bariatric surgery assumes a significant status when it comes to management of patients suffering from clinically severe obesity. Bariatric surgery in fact is the only treatment option which has reported effective, consistent and sustained prophylaxis and improvement of obesity related complications.

The data on obesity from the Asia pacific region brings to light certain differences in behavior patterns of obese individuals here as compared to that observed in the west. This difference in behaviour may warrant a modification of guidelines for bariatric surgery in the asian-population.
Bariatric surgeons in India are in evolution and to day sur-
gery is performed by only a few surgeons. Procedure of
choice at most laparoscopic centre is LAGB, with increasing
experience and expertise the Roux-en-Y gastric bypass is
also becoming popular.

Bariatric Surgery – P051

LAPAROSCOPIC SPLEEN PRESERVING DISTAL PANCREATE-
CTOMY AFTER GASTRIC BYPASS FOR NESIDIOBLASTOSIS,
Benjamin L Clapp MD,Sherman Yu MD,Terry Scarborough
MD,Erik B Wilson MD, The University of Texas Health
Science Center at Houston and the Minimally Invasive
Surgeons of Texas

**Introduction:** As the laparoscopic Roux-en-Y gastric bypass (RNYGB) operation becomes more common, rare post operative complications are being seen more often. One of these rare complications is postprandial hyperinsulinemic hypoglycemia and nesidioblastosis. Once the diagnosis is made, a distal pancreatectomy can be curative.

**Case Report:** We report a case of a 40 year old female who underwent an open RNYGB 15 years ago who presented with postprandial hypoglycemia. The patient had weight loss in excess of expected and was experiencing fatigue, dizziness and weakness after eating. An extensive workup revealed a postprandial hyperinsulinemic hypoglycemia. A pancreatic protocol CT of the abdomen ruled out an islet cell tumor and further investigation, including a selective arterial calcium stimulation test, revealed findings consistent with nesidioblastosis. A laparoscopic spleen preserving distal pancreatectomy was performed with complete resolution of her symptoms.

**Discussion:** Postprandial hyperinsulinemic hypoglycemia after RNYGB is being reported now in the literature. To our knowledge, this is the fourth such report. Although there is no evidence to suggest that the RNYGB can cause nesidioblastosis, there may be an association, and additional work up of postprandial hypoglycemia is necessary in the post gastric bypass patient.

**Conclusion:** Postprandial hyperinsulinemic hypoglycemia after a RNYGB can be a sign of nesidioblastosis. Distal pancreatectomy can be curative. Laparoscopic spleen preserving distal pancreatectomy is effective and feasible.

Bariatric Surgery – P052

IS IT TIME TO ABANDON THE 21MM STAPLER FOR GAS-
TROJEJUNOSTOMY IN LAPAROSCOPIC RNY GASTRIC
BYPASS?, Daniel R Cottam MD,Barry Fisher MD,Jim
Atkinson MD, Sugical Weight Control Center

The construction of the gastrojejunal anastamosis (GJ) is
perhaps the most important step in the laparoscopic Roux
en Y gastric bypass (LRYGBP). We have previously reported
the higher rates of stenosis associated with the 21mm sta-
pler. However, we were willing to accept higher stenosis
rates if it resulted in improved weight loss. This study seeks
to address this question by looking at the short term wt loss
results when comparing a 21 v 25 circular stapled anasta-
mosis.

**Methods** 200 patients were randomized to 21mm or 25mm stapler use upon induction of anesthesia. Patients, surgeons and staff taking measurements were blinded to stapler size for the duration of the study. Patients were then followed for one year.

**Results** Preoperatively there were no differences in age (41.4 v 41.5) or wt (310 v 297)or BMI. At three, six and 12 months postoperatively there was no statistically significant difference in BMI or EWL.

**Conclusion** The 25mm stapler for Ethicon has similar weight loss profile to the 21mm stapler from Ethicon. Published weight loss curves show that weight loss achieved during the first year is a good predictor of long term wt loss. Due to high stenosis rates and similar weight loss the 21mm EEA stapler should be replaced by the 25 mm stapler.

Bariatric Surgery – P053

PATIENTS CAN BE SAFELY DISCHARGED AFTER 24 HOURS
FOR A LAPAROSCOPIC GASTRIC BYPASS, Nestor de la
Cruz-Munoz MD, Luz Velez MD, Cristina Torres MD, Surgical
Weight Loss Institute

**Introduction:** Roux-en-Y gastric bypass (RYGB) is an effective treatment of severe obesity and one of the fastest growing surgical procedures in the United States. A decreased length of stay (LOS) is one of the many advantages of laparoscopic over open Roux-en-Y gastric bypass for the treatment of morbid obesity. There has been no consensus as to what constitutes an optimal length of stay in this procedure.

**Materials and Methods:** We retrospectively reviewed all patients undergoing laparoscopic Roux-en-Y gastric bypass from August 2005 to August 2006 for one surgeon in private practice. Data obtained was length of stay and readmissions. All patients were offered the chance of discharge on post operative day 1, and those that wished to go, were allowed to go home.

**Results:** A total 317 patients underwent LGB. Of these 230 patients (72.5 %) were discharged on postoperative day 1 (Group A). 87 patients stayed 2 or more days (Group B). There were 5 readmissions (2.2%) in the Group A and 2 readmissions (2.3%) in Group B. There were no mortalities in either group.

**Discussion:** Our findings suggest that gastric bypass patients can safely be discharged after one day, without increased risk of readmission or complication.

Bariatric Surgery – P054

GASTRIC BYPASS IN PATIENTS >60 YEARS OLD, Nestor F
de la Cruz-Munoz MD, Luz Velez MD, Juan C Cabrera
MD, Cristina Torres MD, Surgical Weight Loss Institute

**Background:** Surgical weight loss has been utilized as a means for weight reduction and treatment of obesity related comorbidities in morbidly obese patients. NIH criteria for bariatric surgery had a maximum age limit of 60yo. Recent studies have shown a higher than expected morbidity and mortality rate for older patients. This has raised the question as to the safety of gastric bypass in the elderly.

**Study Design:** The charts from 40 patients who underwent GBP by one surgeon from 2002 to 2006 ranging between the ages of 60 to 73 where studied retrospectively. During this time, the surgeon performed over 1200 GBP. Weight and BMI during the first postoperative year, preoperative comorbidities, and postoperative complications were evaluated and compared to national norms for all age patients.

**Results:** The average weights decreased from an initial of 273 pounds to 187 pounds at one year. The average BMI was 49 initially. The average BMI at one year was 33 for an excess weight loss percentage of 57%. The mean hospital stay was less than 2 days. Common preoperative comorbidities were obstructive sleep apnea, diabetes, hypertension, GERD, hypercholesterolemia, arthritis and peripheral edema. The patients experienced significant improvement and or resolution of most of their comorbidities. There were 9 postoperative complications in 8 patients. Of these only one was major, requiring reoperation. The complications included (1) clostridium difficile infection, (1) pulmonary edema, (2) anastamotic strictures, (2) wound infections, (1) hemorrhage, (1) pneumonia, and (1) case of anastomotic stenosis. 7 occurred during the first postoperative month while 2 occurred during the first postoperative year. There was no mortality within the group.

**Conclusion:** Patients over 60yo can undergo gastric bypass surgery with acceptable complication rates that can approach those of younger patients. Weight loss surgery in patients over the age of 60 is beneficial and should be considered.

<figure><img src="image_70.png" /></figure>