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253Abstracts / Surgery for Obesity and Related Diseases 7 (2011) 246-255

due to surgeon experience, change in band type or better patientselection.

C02. REVERSAL OF GASTRIC BYPASS TO NORMALANATOMY. OUR INITIAL EXPERIENCE OF 3 CASESSamrat Mukherjee, Yashwant Koak, Sanjay Agrawal,Kesava Reddy Mannur, Homerton University Hospital NHSFoundation Trust, London, United Kingdom

Background: Laparoscopic Roux-en-Y gastric bypass (RYGB) isthe most common procedure performed and is considered to be anon-reversible procedure. However, there have been recent reportsof reversal of the RYGB to normal anatomy in patients withintractable 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 patientswho underwent reversal of the RYGB to normal anatomy.Methods: We undertook a case note review of the 3 patients whounderwent a reversal of RYGB to normal anatomy to analyze theindications, techniques and outcomes.Results: Between 2008 and 2010, 3 female patients underwentaparoscopic reversal of RYGB to normal anatomy. The indica-ions were intractable dumping syndrome in two and intolerance toYGB induced restriction in one patient. The decision for reversalas made following multidisciplinary consultation involving di-

ticians, psychologist and physicians. Gastroscopy and contrastwallows ruled out any technical failures of the RYGB construc-ion and blood tests ruled out any hyperinsulinemic hypoglycae-ia. The mean interval between the procedures was 7 � 2 months.

Mean age and BMI at reversal were 39 � 4 years and 34 � 2kg/m2 respectively. The procedure entailed dismantling the gastro-ejunostomy and jejunostomy, followed by reanastomosing theastric pouch to the gastric remnant and proximal alimentary limbo distal biliary limb. Mean operating time was 142 � 16 mins andll procedures were completed laparoscopically. Median hospitaltay was 7 days (Interquartile range 6.5–16.5). One patient neededre-laparoscopy because of increasing pain and also developed

efeeding syndrome in the post-operative period. There were nother complications. After a mean follow-up of 9 � 3 months twoatients have started gaining weight and one patient had a relapsef her diabetes.onclusion: Laparoscopic reconversion of RYGB to normal anat-my is feasible and safe with surgeon experience. However, thendications for reversal should be determined on an individualasis as there are a lot of psychological and nutritional factors thateed to be taken into account by the multidisciplinary bariatriceam.

03. INTRA-GASTRIC BALLOON VERSUS DIETARYEIGHT MANAGEMENT FOR PREOPERATIVEEIGHT LOSS

hristine Ward, Mhairri Duxbury, Andrew de Beaux,ruce Tulloh, Royal Infirmary of Edinburgh, Edinburgh, Scot-

and, United Kingdom

t our institution the Bioenterics Intragastric balloon (BIB) isffered to patients presenting with BMI � 55 to induce weight lossrior to definitive bariatric surgery. This study compares theeight loss outcomes of patients using the BIB with those under-

oing dietetic weight management alone. s

Eligible patients with BMI � 55 kg/m2 presenting in 2009 werestudied. Each was given a target of 10% total body weight loss tobe achieved before proceeding to definitive surgery. Patients wereoffered the BIB device to assist weight loss along with monthlyappointments with our bariatric nurse and dietician for support andadvice. The same monthly weight management support and advicewas 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 (BMI54 to 7 kg/m2) while those undergoing Weight Management alone(“WM group”) ranged from 151 to 237 kg (BMI 54 to 68 kg/m2).Three patients in the BIB group and two in the WM group failedto achieve the 10% weight loss target, including one patient in eachgroup who actually gained weight over the study period. One BIBpatient had their balloon removed prematurely owing to incessantvomiting, but continued thereafter in weight management andachieved their target. Two dropped out of the WM group throughnon-attendance. Overall, weight change ranged from �4 to �31kg (BIB group) and �4 to �18 kg (WM group). Median %EWLwas 16.1% (BIB group) and 15.8% (WM group), Mann-Witney Utest p � 0.2.

The outcomes of both groups were similar, with adequateweight loss being achieved in the majority of cases but withtreatment failures in each group. We conclude that with no overallbenefit in terms of weight loss, the use of the BIB for pre-operativeweight loss cannot be sustained.

C04. WITHDRAWN

C05. SERUM VITAMIN D LEVELS IN A BARIATRICPOPULATION AT 55°NORTHKunjan Patel, Altaf Awan, Chris Strey, Sean Woodcock,Keith Seymour, Zakir Mohammad, Northumbria HealthcareNHS 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 bybariatric surgery. As well as importance to bone health, Vitamin Dlevels are also correlated with hypertension, insulin resistance andprogression to diabetes mellitus. In the ‘normal’ population at highlatitudes a seasonal variance in vitamin D level is noted, this hasbeen 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 �/� 9.64 kg/m2;ge range 30-67 years) who had attended Northumbria’s Bariatricervice. Data extracted included age, sex, BMI, vitamin D levelst initial presentation and repeat Vitamin D levels after Vitamin Dupplementation.esults: Abnormalities of vitamin D are common place; of 126atients, 63.4% of patients had suboptimal vitamin D levels (25-HD titres of �50 nmol/Litre). 21.4% patients were vitamin Deficient and 2.3% patients had levels of vitamin D likely to causesteomalacia (�15 nmol/Litre). There is a weak negative correla-ion between BMI and vitamin D level (r � 0.2177, P � 0.02). Thencidence of Vitamin D deficiency (�25 nmol/L) varies signifi-antly with season and is 5.75 fold higher in winter (46%) versus

ummer (8%).