IS ROUTINE PREOPERATIVE POLYSOMNOGRAPHY NECESSARY IN PATIENTS HAVING BARIATRIC SURGERY?

1DIVISION OF BARIATRIC/MINIMALLY INVASIVE SURGERY,STATEN ISLAND UNIVERSITY HOSPITAL, STATEN ISLANDNEW YORK.
KAREN E. GIBBS1,ABDUL S. BANGURA1,STELIN JOHNSON1

Background: Obstructive sleep apnea (OSA) is recognized in obese patients.It maybe associated withsignificant perioperative morbidity and mortality.Polysomnography remains the gold standard for thediagnosis and assessment of the severity of OSA. Some Bariatric centers adopt a selective screeningapproach based on clinical suspicion; others, screen every patient. The aim of our study is to determine
the prevalence of OSA , and whether BMI correlates with OSA prevalence. These results will form the basis
for making a case for or against routine preoperative polysomnography in patients having bariatricsurgery. Methods: A five year(2005- 2010) retrospective chart review was performed.Patients demographicand sleep study data was collected and analyzed. The severity of OSA was divided into mild, moderateor severe according to the American Sleep Disorders Association guidelines. Mild OSA is defined as anapnea/hypopnea index of 5-15, moderate as 15-30 and severe as &gt30 . Results were analyzed usingstatistical software.Results: 555 patient charts were reviewed. Of these, 359(65%) had polysomnography.
309(86%) of the 359 patients had OSA , 50(14%) had no OSA. The overall prevalence of sleep apnea was
86%, mild OSA 18%(63/359), moderate OSA 17%(62/359), severe OSA 51%(184/359). The prevalence of OSA byBMI category was as follows: BMI(35-39.9 kg/m2): 92%(34/37). BMI(40-49.9 kg/m2): 82%(178/218).
BMI(50-59.9 kg/m2): 92%(78/85). BMI(&gt60 kg/m2): 100%(19/19).Conclusion: OSA is highly prevalent(86%)
in our patient population, with most of them(51%) having severe OSA.OSA is highly prevalent in all BMI
categories. However,a BMI &gt60 kg/m2 correlates with a 100% prevalence of OSA.Based on theseresults,routine polysomnography is necessary as part of the pre operative work up for all bariatricpatients .

IS ROUTINE PREOPERATIVE VENOUS DUPLEX SCREENING NECESSARY FOR PATIENTS HAVING BARIATRIC SURGERY?

1DIVISION OF BARIATRIC/MINIMALLY INVASIVE SURGERY, STATEN ISLAND UNIVERSITY HOSPITAL, STATEN ISLAND ,NEW YORK.
KAREN E. GIBBS1,ABDUL S. BANGURA1,STELIN JOHNSON1

Background:Morbidly obese patients are perceived to be at high risk for perioperative deep veinthrombosis(DVT). Routine preoperative bilateral lower extremity venous duplex screening for DVT is apart of their preoperative work up in many Bariatric centers. The purpose of our study is to determine
the prevalence ofpreoperative DVT in our patient population,and form a basis to make a case for oragainst routine preoperative venous duplex screening in bariatric patients.Methods: A five year (20052010) retrospective chart review was performed, of our prospectively maintained bariatric database.
Demographic data and the incidence of preoperative DVT was analyzed using statistical software.Results:
555 patients underwent bariatric surgery during this five year period. 402 (72%) were females, and153(28 %) were males. The age range was 18- 67 (median age 43). 454 (82 %) of patients were Caucasians,46(8%) were Hispanics, 45(8%) were black and 10(2%)other race. The mean BMI was 47.1(SD 6.8).177 (32%)
patients underwent the Roux-en-y gastric bypass procedure, while 378(68%) had the lap band procedure.
Only one patient with a history of chronic DVT was found to have a positive preoperative venous duplex.
The incidence of preoperative DVT was 0.2%Conclusion: The incidence of preoperative DVT is very low inthese patients. Routine preoperative venous duplex screening is therefore unnecessary. We would suggest
preoperative duplex screening in those patients with a previous history of DVT or evidence of significant
venous insufficiency

Routine Preoperative Barium Swallow to detect Hiatus Hernia in Bariatric Surgery Patients: Is itWorthwhile?

1

North Queensland Obesity Surgery Centre, Mater Hospital, Townsville, Australia

John Avramovic1,Laura Craig1,Sam Baker1,Christopher Aubrey1

Routine Preoperative Barium Swallow to detect Hiatus Hernia in Bariatric Surgery Patients:
Is it Worthwhile?PurposeTo determine if routine preoperative barium swallow before laparoscopic
bariatric surgery can predict those patients who require crural repair for hiatus hernia.Method100
consecutive patients undergoing bariatric surgery underwent preoperative barium swallow to detect hiatus
hernia. The radiological results were compared to the operative findings.Results98 patients underwent
a complete radiological study. 17 patients were reported to have a hiatus hernia radiologically. 37
patients were found to have a hiatus hernia at operation, and had a sutured anterior crural repair asperourunitprotocol.

Operative

Finding

Hiatus hernia

No Hiatus HerniaRadiological

Hiatus Hernia-710 Finding

No Hiatus Hernia

3051 The true positive rate was 7%. The calculated sensitivity

for barium swallow in detecting a hiatus hernia prior to surgery was 21%.
hada41%probabilityofdetecting

ahiatushernia-A positive barium swallow

subsequently

confirmed

atsurgery.ConclusionPreoperative barium swallow in morbidly obese patients undergoing laparoscopic
bariatric surgery was poor at predicting the presence of hiatus hernia. Routine barium swallow priorto bariatric surgery for the detection of hiatus hernia was unreliable and not warranted.

IS ROUTINE PREOPERATIVE UPPER ENDOSCOPY NECESSARY FOR PATIENTS HAVING BARIATRIC SURGERY?

1DIVISION OF BARITRIC/ MINIMALLY INVASIVE SURGERY, STATEN ISLAND UNIVERSITY HOSPITAL, STATEN ISLAND,NEW YORK.
KAREN E. GIBBS1,ABDUL S. BANGURA1,STELIN JOHNSON1

Background: Upper endoscopy is a routine preoperative investigation in patients undergoing bariatric
operations in most bariatric centers.However,the level of evidence supporting this recommendation israther not strong.The rationale for performing upper endoscopy is to detect and treat lesions that might
potentially affect the type of surgery performed. The aim of our study is to analyze the prevalalenceof the various findings on preoperative upper endoscopy in our patient population, and to evaluate howthese findings impacted the choice of surgery.Methods: A five year(2005-2010)retrospective chart review
was performed,of our prospectively maintained bariatric database. Patient demographics,and endoscopy
findings were collated. The prevalence of endoscopic findings was analyzed using statistical soft
ware.Results: 555 patient charts were reviewed, 389(70%) of these had preoperative upper endoscopy.
381(98%) of the 389 patients that had endoscopy show positive findings, 8(2%)patients had normal findings.
More than 90% of patients had a combination of at least two findings. The prevalence of individual findings
are as follows: GASTRITIS: 92%(359/389), HIATAL HERNIA: 35 %(137/389). ESOPHAGITIS: 24%(94/389),
HELICOBACTER PYLORI: 13%(50/389), DUODENITIS: 5%(20/389), POLYPS: 2%(8/389),ULCERS:0.2% (1/389),
TUMORS(LIPOMA):0.2%(1/389), BARRETTS 0.2%(1/389). Conclusion: Upper endoscopy has a high incidence ofpositive findings (98%) in bariatric patients, the most common being gastritis and hiatal hernia. The
findings did not change the operative management for these patients. Given that patients are evaluatedfor hiatal hernias at the time of surgery, preoperative endoscopy is not necessary to make this diagnosis.
Thus, routine preoperative upper endoscopy is unnecessary in the work-up of bariatric patients.