due to surgeon experience, change in band type or better patient
selection.
C02. REVERSAL OF GASTRIC BYPASS TO NORMAL
ANATOMY. OUR INITIAL EXPERIENCE OF 3 CASES
Samrat Mukherjee, Yashwant Koak, Sanjay Agrawal,
Kesava Reddy Mannur, Homerton University Hospital NHS
Foundation Trust, London, United Kingdom
Background: Laparoscopic Roux-en-Y gastric bypass (RYGB) is
the most common procedure performed and is considered to be a
non-reversible procedure. However, there have been recent reports
of reversal of the RYGB to normal anatomy in patients with
intractable dumping syndrome, intolerance to RYGB induced re-
striction, issues with weight loss and also retrograde intussuscep-
tion and roux-stasis. We present our initial results with 3 patients
who underwent reversal of the RYGB to normal anatomy.
Methods: We undertook a case note review of the 3 patients who
underwent a reversal of RYGB to normal anatomy to analyze the
indications, techniques and outcomes.
Results: Between 2008 and 2010, 3 female patients underwent
laparoscopic reversal of RYGB to normal anatomy. The indica-
tions were intractable dumping syndrome in two and intolerance to
RYGB induced restriction in one patient. The decision for reversal
was made following multidisciplinary consultation involving di-
eticians, psychologist and physicians. Gastroscopy and contrast
swallows ruled out any technical failures of the RYGB construc-
tion and blood tests ruled out any hyperinsulinemic hypoglycae-
mia. The mean interval between the procedures was 7 Ϯ 2 months.
Mean age and BMI at reversal were 39 Ϯ 4 years and 34 Ϯ 2
kg/m
2
respectively. The procedure entailed dismantling the gastro-
jejunostomy and jejunostomy, followed by reanastomosing the
gastric pouch to the gastric remnant and proximal alimentary limb
to distal biliary limb. Mean operating time was 142 Ϯ 16 mins and
all procedures were completed laparoscopically. Median hospital
stay was 7 days (Interquartile range 6.5–16.5). One patient needed
a re-laparoscopy because of increasing pain and also developed
refeeding syndrome in the post-operative period. There were no
other complications. After a mean follow-up of 9 Ϯ 3 months two
patients have started gaining weight and one patient had a relapse
of her diabetes.
Conclusion: Laparoscopic reconversion of RYGB to normal anat-
omy is feasible and safe with surgeon experience. However, the
indications for reversal should be determined on an individual
basis as there are a lot of psychological and nutritional factors that
need to be taken into account by the multidisciplinary bariatric
team.
C03. INTRA-GASTRIC BALLOON VERSUS DIETARY
WEIGHT MANAGEMENT FOR PREOPERATIVE
WEIGHT LOSS
Christine Ward, Mhairri Duxbury, Andrew de Beaux,
Bruce Tulloh, Royal Infirmary of Edinburgh, Edinburgh, Scot-
land, United Kingdom
At our institution the Bioenterics Intragastric balloon (BIB) is
offered to patients presenting with BMI Ͼ 55 to induce weight loss
prior to definitive bariatric surgery. This study compares the
weight loss outcomes of patients using the BIB with those under-
going dietetic weight management alone.
Eligible patients with BMI Ͼ 55 kg/m
2
presenting in 2009 were
studied. Each was given a target of 10% total body weight loss to
be achieved before proceeding to definitive surgery. Patients were
offered the BIB device to assist weight loss along with monthly
appointments with our bariatric nurse and dietician for support and
advice. The same monthly weight management support and advice
was given to patients who declined balloon insertion.
Twenty-five patients were studied. Those receiving the BIB
(“BIB group”) ranged in initial weight from 142 to 244 kg (BMI
54 to 7 kg/m
2
) while those undergoing Weight Management alone
(“WM group”) ranged from 151 to 237 kg (BMI 54 to 68 kg/m
2
).
Three patients in the BIB group and two in the WM group failed
to achieve the 10% weight loss target, including one patient in each
group who actually gained weight over the study period. One BIB
patient had their balloon removed prematurely owing to incessant
vomiting, but continued thereafter in weight management and
achieved their target. Two dropped out of the WM group through
non-attendance. Overall, weight change ranged from ϩ4toϪ31
kg (BIB group) and ϩ4toϪ18 kg (WM group). Median %EWL
was 16.1% (BIB group) and 15.8% (WM group), Mann-Witney U
test p ϭ 0.2.
The outcomes of both groups were similar, with adequate
weight loss being achieved in the majority of cases but with
treatment failures in each group. We conclude that with no overall
benefit in terms of weight loss, the use of the BIB for pre-operative
weight loss cannot be sustained.
C04. WITHDRAWN
C05. SERUM VITAMIN D LEVELS IN A BARIATRIC
POPULATION AT 55°NORTH
Kunjan Patel, Altaf Awan, Chris Strey, Sean Woodcock,
Keith Seymour, Zakir Mohammad, Northumbria Healthcare
NHS Foundation Trust, Northumbria, England, United Kingdom
Background: Many obese patients have low Serum vitamin D
(25-OHD) levels and this malnutrition can be made worse by
bariatric surgery. As well as importance to bone health, Vitamin D
levels are also correlated with hypertension, insulin resistance and
progression to diabetes mellitus. In the ‘normal’ population at high
latitudes a seasonal variance in vitamin D level is noted, this has
been observed to be absent in some bariatric populations.
Methods: A prospective database was used to identify 126 pa-
tients (98 females 26 males; mean BMI 50.54 ϩ/Ϫ 9.64 kg/m
2
;
age range 30-67 years) who had attended Northumbria’s Bariatric
Service. Data extracted included age, sex, BMI, vitamin D levels
at initial presentation and repeat Vitamin D levels after Vitamin D
supplementation.
Results: Abnormalities of vitamin D are common place; of 126
patients, 63.4% of patients had suboptimal vitamin D levels (25-
OHD titres of Ͻ50 nmol/Litre). 21.4% patients were vitamin D
deficient and 2.3% patients had levels of vitamin D likely to cause
osteomalacia (Ͻ15 nmol/Litre). There is a weak negative correla-
tion between BMI and vitamin D level (r ϭ 0.2177, P ϭ 0.02). The
incidence of Vitamin D deficiency (Ͻ25 nmol/L) varies signifi-
cantly with season and is 5.75 fold higher in winter (46%) versus
summer (8%).
253Abstracts / Surgery for Obesity and Related Diseases 7 (2011) 246-255