Naveen Ballem

Standardized outcomes reporting in metabolic and bariatric surgery

ASMBS, SOARD, outcome reporting standards Standardized outcomes reporting in metabolic and bariatric surgery Stacy A. Brethauer, MD*, Julie Kim, MD, Maher el Chaar, MD, Pavlos Papasavas, MD, Dan Eisenberg, MD, Ann Rogers, MD, Naveen Ballem, MD, Mark Kligman, MD, Shanu Kothari, MD for the ASMBS Clinical Issues Committee Bariatric and Metabolic Center, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio Department of Surgery, Tufts University, Boston, Massachusetts Department of Surgery, St. Luke’s Hospital, Allentown, Pennsylvania Department of Surgery, Hartford Hospital, Hartford, Connecticut Department of Surgery, Stanford University and Palo Alto VA Health Care Center, Palo Alto, California Department of Surgery, Penn State University, Hershey, Pennsylvania Center for Advanced Surgical Weight Loss, Montclair, New Jersey Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland Department of Surgery, Gundersen Health System, La Crosse, Wisconsin Received February 2, 2015; accepted February 2, 2015

Standardized outcomes reporting in metabolic and bariatric surgery.

When appropriate for the study design, the percentage of patients comprising the original study group who complete each follow-up period reported for the study should be reported (i.e., report the numerator and denominator available for follow-up at each time point reported). For prospective studies, percent follow-up should represent the percentage of patients from the original study group(s) who remained in the study until the study endpoint(s) are reached or for the final reported follow-up interval. The reasons for patient attrition from the study should be reported when possible. For

Pharmacologic prophylaxis against venous thromboembolic complications is not mandatory for all laparoscopic Roux-en-Y gastric bypass procedures.

BACKGROUND Venous thromboembolism (VTE) is a leading cause of postoperative mortality in bariatric surgical patients. The aim of this study is to report the rate of VTE and bleeding complications using no prophylactic pharmacologic anticoagulation among patients undergoing laparoscopic Roux-en-Y gastric bypass. STUDY DESIGN Nine hundred fifty-seven consecutive patients who were older than 18 years, had no history of VTE, and had laparoscopic Roux-en-Y gastric bypass by a single surgeon (RHC) between January 2000 and October 2008 were included. Outcomes, including deep vein thrombosis and pulmonary embolism, were prospectively collected and retrospectively analyzed using SAS (version 9.1, SAS Institute Inc). VTE prophylactic regimen consisted of calf-length pneumatic compression devices placed before anesthesia induction and mandatory ambulation beginning on the day of operation. No prophylactic pharmacologic anticoagulation was used. All data presented as mean +/- SEM. RESULTS Of the 957 patients, 792 were women and 165 were men. Mean age was 41.0 +/- 0.3 years, body mass index (calculated as kg/m(2)) was 49.1 +/- 0.2, and American Society of Anesthesiology scores 2 (29.8%), 3 (69.8%), and 4 (0.4%). Mean operative time was 106.0 +/- 0.8 minutes. Clinically evident deep vein thrombosis developed in three patients (0.31%) and one patient had a pulmonary embolism (0.10%). The one mortality in the cohort was unrelated to VTE. There were seven (0.73%) bleeding complications, of which one resolved without treatment, two required reoperation, and four required blood transfusions. CONCLUSIONS Adequate VTE prophylaxis is achieved using calf-length pneumatic compression devices, early ambulation, and relatively short operative times. Pharmacologic anticoagulation is not mandatory when these conditions are met in patients who have no earlier history of VTE. There are few bleeding complications requiring reoperation or blood transfusions without the use of anticoagulants.

ASMBS updated position statement on insurance mandated preoperative weight loss requirements

ASMBS Guidelines/Statements ASMBS updated position statement on insurance mandated preoperative weight loss requirements Julie J. Kim, M.D., F.A.C.S., F.A.S.M.B.S.*, Ann M. Rogers, M.D., Naveen Ballem, M.D., Bruce Schirmer, M.D., on behalf of the American Society for Metabolic and Bariatric Surgery Clinical Issues Committee Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts Department of Surgery, Penn State University, Hershey, Pennsylvania Clara Mass Medical Center, Glen Ridge, New Jersey Department of Surgery, University of Virginia Health System, Charlottesville, Virginia Received April 18, 2016; accepted April 18, 2016

Gastrointestinal symptom improvement after Roux-en-Y gastric bypass: long-term analysis

BACKGROUND Obese patients have a multitude of gastrointestinal symptoms that differ from their nonobese counterparts. The published data remain scant on changes in gastrointestinal symptoms among this cohort before and after Roux-en-Y gastric bypass (RYGB). The aim of this study was to quantify these symptoms and understand the changes that occur after bariatric surgery. METHODS A total of 1724 gastrointestinal symptom surveys were prospectively administered to 763 consecutive patients who underwent laparoscopic RYGB. The patients rated each symptom on a 0-100-mm Liekert scale: 0, absence of symptoms; 33, occasional occurrence; 67, frequent occurrence; 100, continuous. The surveys were administered preoperatively and yearly thereafter. The data are presented as the mean + or - standard error of the mean. RESULTS Of the 763 patients, 137 were black, 610 were white, and 16 were Hispanic; 83% were women and 17% were men. Their age was 40.8 + or - 0.34 years. The body mass index was 48.4 + or - 0.27 kg/m(2). The American Society of Anesthesiologists class was 2 for 31%, 3 for 68%, and 4 for 1%. Of the 763 patients, 63% underwent short-limb RYGB and 37% underwent long-limb RYGB. The preoperative symptom rating was as follows: abdominal pain, 24.3 + or - 0.7; heartburn, 41.0 + or - 0.8; acid regurgitation, 30.9 + or - 0.9; gnawing epigastric sensation, 26.5 + or - 0.9; nausea/vomiting, 18.8 + or - 0.7; borborygmus, 26.2 + or - 0.8; abdominal distension, 30.3 + or - 0.9; eructation, 28.0 + or - 0.8; increased flatus, 38.9 + or - 0.8; decreased passage of stool, 14.8 + or - 0.8; increased passage of stool, 16.4 + or - 0.7; loose stools, 22.1 + or - 0.8; hard stools, 20.5 + or - 0.9; urgent need for defecation, 23.2 + or - 0.8; incomplete evacuation, 22.2 + or - 0.8; difficulty falling asleep, 42.0 + or - 1.1; insomnia, 38.4 + or - 1; feeling rested, 60.1 + or - 1; and difficulty swallowing, 13.5 + or - 0.67. At 1, 2, 3, 4, and 5 years after RYGB, 99.5% 84.2%, 68.4%, 57.9% and 47.4% of these symptoms had improved significantly (P < .05). CONCLUSION Laparoscopic RYGB significantly improves the gastrointestinal symptoms experienced by morbidly obese patients without adversely affecting any of the measured parameters. This improvement in symptoms proved durable in the long term.

ASMBS position statement on alcohol use before and after bariatric surgery

ASMBS Guidelines/Statements ASMBS position statement on alcohol use before and after bariatric surgery Manish Parikh, M.D.*, Jason M. Johnson, D.O., Naveen Ballem, M.D., on behalf of the American Society for Metabolic and Bariatric Surgery Clinical Issues Committee Department of Surgery, New York University Medical Center/Bellevue Hospital Center, New York, New York Department of General Surgery, Spartanburg Regional Healthcare System, Spartanburg, South Carolina Center for Advanced Surgical Weight Loss, Montclair, New Jersey Received October 29, 2015; accepted October 29, 2015

Gastric Bypass in a Factor V Deficient Patient

Factor V deficiency is a rare bleeding disorder requiring special attention during the peri-operative period. Surgical intervention in these patients can be technically challenging. Because of the rarity of this condition, the optimal management is unknown. Available literature supports peri-operative infusion of fresh frozen plasma. We report successful management of a factor V deficient patient undergoing Roux-en-Y gastric bypass. Literature review indicates that this is the first reported case of bariatric surgery in a patient with factor V deficiency.