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249Abstracts / Surgery for Obesity and Related Diseases 7 (2011) 246-255

istry for MIF and immunoassay of serum pro-inflammatory mark-ers. Immunohistochemistry for Mif and bromodeoxyuridine label-ling were performed on AhCre mouse and ApcMin/� mouse (withand without functional Mif alleles) intestine respectively.Results: Rectal epithelial cell mitosis and crypt size in obese patients(mean BMI [SEM] 54.5 (2.3) kg/m2) remained elevated 3 years after

YGB compared with pre-operative values (1.7- and 1.5-fold respec-ively; p � 0.05) despite a mean excess weight loss of 46.2%. Thereere significant reductions in median levels of serum C-reactiverotein (CRP) (6.5 to 0.3 mg/ml), interleukin (IL)-6 (4.2 to 1.1 pg/ml)nd MIF (8.7 to 5.6 ng/ml) following RYGB. However, there was a0-fold (95% CI 13-125) increase in mucosal MIF transcript levels atyears associated with increased epithelial cell MIF protein levels.onditional Apc loss in AhCre mice led to increased epithelial cellif content. Mif deficiency in ApcMin/� mice was associated with a

combined defect in intestinal epithelial cell proliferation and migra-tion, which was reflected by the longitudinal clinical data.Conclusions: Mucosal biomarkers of CRC risk remain abnormallyelevated 3 years after RYGB and include an increase in thepro-tumorigenic cytokine MIF, which is up-regulated followingApc loss and which contributes to intestinal epithelial cell homeo-stasis. These observations suggest an increased risk of CRC fol-lowing RYGB and should prompt further longitudinal clinicalstudies of colorectal neoplastic risk after bariatric surgery.

B02. DEVELOPMENT AND VALIDATION OF A NEWBARIATRIC SPECIFIC HEALTH RELATED QUALITYOF LIFE INSTRUMENT: BARIATRIC AND OBESITYSPECIFIC SURVEY (BOSS)Raed Tayyema, Abdulmajid Alia, John Atkinsonb,Colin Martinb, aThe Ayr Hospital, Ayr, United Kingdom, aTheUniversity Of The West Of Scotland, Paisley, United Kingdom

A systematic literature review showed the lack of psychometricallysatisfactory bariatric specific health related quality of life (HRQOL)instrument. A mono-centric prospective study was conducted to de-velop and validate a new bariatric specific 81-item self report HRQOLinstrument called Bariatric and Obesity Surgery Survey (BOSS).

Data were collected from 236 participants: 83 patients who wereunder consideration for bariatric surgery, 68 patients who alreadyhave had a bariatric procedure and 85 volunteers.

In addition to BOSS, participants were asked to completeShort Form Health survey (SF-36), Hospital Anxiety and De-pression (HAD) scale, Moorehead-Ardelt Quality of life Ques-tionnaire (M-A QoLQ II), and a demographic data sheet. 2weeks following the completion of these 5 questionnaires, par-ticipants were asked to complete BOSS once more alone with afeedback sheet.

Exploratory factor analysis revealed a multidimensional instrumentconsisting of 42 items distributed over 6 domains that address variousHRQOL aspects and dimensions pertinent to bariatric surgery, andrelevant to morbidly obese patients. Further psychometric analysisshowed that BOSS has adequate internal consistency reliability(Cronbach � � 0.970), test re-test reliability (ICC � 0.926), constructvalidity, criterion validity, face validity and acceptability.

To conclude, BOSS is a multidimensional instrument that hassatisfied the psychometric properties of validity and reliability; and

therefore, may offer clinically useful and relevant measure in

bariatric surgery. Study limitations and direction of future researchare further discussed.

B03. TRAINING IN BARIATRIC SURGERY IN UK: THEIMPLEMENTATION OF AN AMERICAN STYLEFELLOWSHIP IN THE NHSFrancesca Lirosi, James Hewes, Andrew Jenkinson,Majid Hashemi, Marco Adamo, UCLH Centre for Weight Loss,Metabolic and Endocrine Surgery, London, United Kingdom

Introduction: Bariatric surgery (BS) is the fastest growing surgi-cal specialty worldwide. In 2008 the number of laparoscopic bari-atric procedures performed in the USA was greater than cholecys-tectomies. Surgery is complex, requires specific training and has asteep learning curve. Evidence suggests that high patient through-put is essential to achieve good outcomes and low complicationrates. No formal training model in BS has been established in theUK for surgical trainees.Methods: An industry funded (Ethicon-Endosurgery) Bariatricsurgical fellowship has been developed at University CollegeLondon Hospital (UCLH) to improve training. UCLH has adedicated high-volume purpose-built bariatric unit. The pro-gramme is for one year and has been developed according to theAmerican (ASMBS) guidelines. Core curriculum included cog-nitive, clinical and technical experience. This included educa-tion sessions on multidisciplinary topics regarding obesity inadults and adolescents as well as regular MDT and morbiditymeetings. Participation in ongoing research was encouraged.Clinical activities included patient assessment and pre-opera-tive workup, MDT preparation, perioperative care and follow-up. The Fellow was expected to be involved in over 100bariatric procedures (laparoscopic gastric bypass, sleeve gas-trectomy, gastric banding and revisional surgery) and to be theprimary surgeon in at least 50% (defined as performing eitherkey steps or the whole operation).Results: The planned number of procedures undertaken by thefellow was achieved within 9 months and the other training targetsmet. There was no increase in complication rates or operating timeduring this period.Conclusions: The fellowship based on the ASMBS model hasproved effective in an NHS teaching unit. It should be an essentialpart of training programs for senior trainees with an interest inBariatric surgery.

B04. POSTOPERATIVE UPPER GASTROINTESTINALENDOSCOPIES IN GASTRIC BYPASS PATIENTS:FREQUENCY AND FINDINGSMichael S.J. Wilson, Ali Alhamdani, Kamal Mahawar,Maureen Boyle, Norbert Schroeder, Shlokarth Balupuri,Peter Small, Sunderland Royal Hospital, Sunderland, UnitedKingdom

Background: A number of patients require postoperative endos-copies after laparoscopic Roux en y gastric bypass (LRYGB). Thisstudy reports the frequency of such examinations, nature of find-ings and subsequent interventions.Methods: Patients who have undergone LRYGB were identifiedfrom our prospectively maintained database and cross referenced

with our endoscopy unit’s database of patients.

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250 Abstracts / Surgery for Obesity and Related Diseases 7 (2011) 246-255

Results: We have performed 309 LRYGB in our unit betweenJanuary 2005 and August 2010. The mean age of patients was 43.4years (range 18-66). 246 (79.6%) patients were females with amean follow-up of 17.9 months.

53 (17.2%) patients have required 85 upper gastrointestinalendoscopies postoperatively to date. Of these;

• 25 (47.2%) patients no abnormality was detected• 16 (30.2%) patients had anastomotic strictures requiring dila-

tation• 9 (17.0%) required removal of anastomotic suture material or

staples• 6 (11.3%) had pre-anastomotic ulcers• 6 (11.3%) had post-anastomotic erosions• 3 (5.7%) had incompetent oeseophogastric junctions• 2 (3.8%) hiatus hernias• 2 (3.8%) oesophagitis• 1 (1.9%) food bolus• 1 (1.9%) anastomotic bleed.

Conclusions: A significant portion (1:6) of patients undergoingLRYGB require upper gastrointestinal endoscopy in the postoper-ative period for various indications. Surgeons should be madeaware of the above endoscopic findings in the early and late postoperative period after LRYGB, and of the need to perform earlyendoscopy in patients reporting dyspeptic symptoms in the post-operative period.

B05. LAPAROSCOPIC ROUXENY GASTRIC BYPASS ISSAFE AND EFFECTIVE IN PATIENTS WITH A BMI > 60KG/M2

Michael S.J. Wilson, Ali Alhamdani, Maureen Boyle,Norbert Schroeder, Shlokarth Balupuri,Peter K. Small, Sunderland Royal Hospital, Sunderland, UnitedKingdom

Background: Many studies advocate a staged surgical approachfor patients with BMI � 60 kg/m2. In our unit we perform bothrimary and secondary laparoscopic Roux-en-y gastric bypassLRYGB). We present our experiences with this cohort of patients.

ethods: We have performed 309 LRYGB in our unit between005 and 2010. 43 (13.9%) patients had a BMI � 60 kg/m2 (Group

A), and 266 (86.1%) with BMI � 60 kg/m2 (Group B). Wecompared Group A and Group B with regards to demographics,morbidity, mortality and weight loss with the application of MannWhitney and Fisher’s exact test. Data was retrospectively analysedfrom a prospectively maintained database.Results: The table below details cohort demographics and out-comes to date. There was no mortality. In group A mean preop-erative BMI was 66.2 (range 60.0 to 80.3) kg/m2, whereas in group

mean BMI was 49.3 (range 37.0 to 59.7) kg/m2.

Group A(n � 43)

Group B(n � 266)

P value

Female:male 38:5 210:56 0.21Mean age 40.8 43.6 0.06Mean preoperative BMI 66.2 49.3 <0.0001Mean % excess weight loss 51.2 54.9 0.28Mean operating time 2h 55 3h 0 0.23Post op hospital stay 3.4 3.7 0.11Early readmission rate 4.7% 6.8% 1.000

Late readmission rate 18.6% 14.7% 0.4957

Group A(n � 43)

Group B(n � 266)

P value

Mean follow-up (mo) 15.9 18.2 0.6841Conversion to open (%) 1 (2.3%) 4 (1.5%) 0.5298Postop cholecsytectomy 2 (4.7%) 5 (1.9%) 0.2525Primary balloon insertion (%) 7 (16.3%) 17 (6.4%) 0.0575

Conclusions: We demonstrate safe and effective performance ofLRYGB with acceptable morbidity, mortality, and weight loss inpatients with BMI � 60kg/m2 that is comparable with our patientswith BMI �60 kg/m2.

06. LAPAROSCOPIC BARIATRIC SURGERY IN THEUPER-OBESE: A COMPARISON OF THREEROCEDURESonor Magee, Shopon Saha, Jayne Brocklehurst,ob Macadam, Shafiq Javed, David Kerrigan, Gravitas,iverpool, United Kingdom

ntroduction: The ideal bariatric procedure in the super-obeseBMI � 50 kg/m2 is controversial. We compared the outcomes ofrimary laparoscopic duodenal switch (LDS), Roux-en-Y gastricypass (RYGB) and adjustable gastric band (LAGB) in the super-bese.ethods: Analysis of prospective database.esults: 288 patients were identified with 2-year follow-up (me-ian BMI 57 kg/m2, age 43, OSMRS 2). Endpoints were excess

weight loss and response of comorbidities (type 2 diabetes-T2DM,hypertension-BP and sleep apnoea-OSA).

N BMI kg/m2 Age OSMRS 1 yr%EWL

2 yr%EWL

LAGB 32 52 (50-63) 42 1 28 (13-80) 46 (6-89)RYGB 147 55 (50-69) 43 2 66 (6-140) 70 (20-107)LDS 58 50 (50-78) 42 2 66 (26-107) 88 (49-114)

Resolution/Improvement rates at 2 years follow-up (figuresgiven as number of cases (%resolution/improvement))

LAGB RYGB LDS

T2DM 4 25% 33 33% 27 85%BP 8 25% 38 42% 33 37%OSA 3 0% 16 44% 13 54%

Conclusions: Acceptable weight loss in the super-obese can beachieved with bariatric surgery. However the best results are seenwith the gastric bypass and duodenal switch procedures. Co-mor-bidity improvements are best seen with the duodenal switch. Therole of the gastric band in the super-obese requires further inves-tigation and definition. Furthermore long-term outcomes need tobe reported and compared.

B07. PRE-OPERATIVE PREDICTORS OF VITAMIN DDEFICIENCYJayne Brocklehurst, Conor Magee, Shopon Saha,Robert Macadam, Shafiq Javed, David Kerrigan, Gravitas,Liverpool, United Kingdom

Background: Post-operative vitamin D deficiency is well docu-

mented and several reports have suggested that morbidly obese