Body composition was measured by bioelectrical impedance. Car-diac episodes were those requiring cardiologist consultation. Re-spiratory complications included atelectasis, �2 L oxygen, and theneed for respiratory medications.Results: The data showed that surgical candidates who per-formed mild-to-moderate exercise before surgery experiencedsignificantly (p �0.01) fewer surgical respiratory and cardio-vascular complications and spent less time in the hospital(3.42 � 0.17 days vs. 3.96 � 0.15 days, p �0.03) comparedwith their age-matched non-exercise controls. Mild-to-moder-ate exercise performed postoperatively helped to reduce the lossof lean body tissue that commonly occurs in the most rapidweight loss period (i.e., 3 months). Loss of fat-free mass 3months postoperatively for the exercise group averaged 5.7%compared with 11% for the nonexercise cohort (p �0.05).Furthermore, the exercise patients lost significantly more bodyfat than did the nonexercise controls (31.1% vs. 25.5%, respec-tively, p �0.05).Conclusions: The data have shown that mild-to-moderate exerciseperformed preoperatively is beneficial in the prevention of surgicalrespiratory and cardiovascular complications and that mild-to-moderate exercise performed postoperatively enhances fat loss andhelps to preserve lean body tissue.

PII: S1550-7289(05)00176-0

47.

BAROSCREEN: USING MACHINE LEARNING TOIMPROVE PATIENT SELECTION FOR IMPLANTABLEGASTRIC STIMULATIONScott A Shikora, M.D., Roand Maude-Griffin, Ph.D., Tufts-NewEngland Medical Center, Transneuronix, Inc., Boston, MA.

Purpose: Implantable gastric stimulation (IGS) has been found toreduce appetite and increase satiety in severely obese patients.Some patients are unresponsive to this change in hunger cues,experiencing unsatisfactory weight loss. Baroscreen was devel-oped to target IGS treatment more precisely, avoiding implants inhighly unmotivated patients, who would likely do poorly under arange of obesity treatments, including IGS.Methods: Machine learning methods were used to predict IGSweight loss from preimplant age, sex, body mass index, andSF-36 questionnaire responses. The predictor was based on theCART regression tree algorithm, applied to 252 participants inU.S. and European IGS trials (80% women with average age,body mass index, and follow-up of 40 years, 44 kg/m2, and 16months). CART was used in conjunction with “boosting,”which improves out-of-sample prediction by combining predic-tions from hundreds of CART trees, constructed in perturbedversions of the observed sample. Baroscreen uses the resultingmodel to predict a candidate patient’s weight loss from readilyobservable characteristics, recommending IGS if this predictionexceeds a preset threshold.Results: Baroscreen has been tested by Monte Carlo Cross-Vali-dation and by applying it to predict outcomes in 42 new IGSpatients for whom data were acquired after the screen’s creation. Inboth cases, patient selection using Baroscreen dramatically im-proves expected weight loss under IGS.Conclusions: The methods used in Baroscreen led to far moreaccurate outcome predictions than those obtainable with standard

statistical methods. This approach to patient selection might alsoprove useful in other bariatric treatments, as well as in IGS.

PII: S1550-7289(05)00177-2

48.

THE ITALIAN MULTICENTER EXPERIENCE ON 2375PATIENTS TREATED BY BIOENTERICSINTRAGASTRIC BALLOONA. Genco, T. Bruni, S. B. Doldi, P. Forestieri, M. Marino,C. Giardiello, L. Angrisani, L. Pecchioli, P. Stornelli, M. Zappa,M. Alkilani, A. Nigri, N. Di Lorenzo, F. Furbetta, M. Cipriano,N. Basso, M. Lorenzo, Italian collaborative Study Group forLap-Band and Bib (GILB), c/o Citta della Scienza, Naples, Italy.

Purpose: Use of temporary Bioenterics Intragastric Balloon (BIB)positioning in the morbidly obese is expanding worldwide.Methods: Data were recruited from the database of the ItalianCollaborative Study Group for Lap-Band and BIB (GILB). TheBIB was positioned after EGDS, and filled with saline (500–700mL) and methylene blue (10 mL). Patients were discharged withdiet counseling (�1000 Kcal) and medical therapy (H2-blockers orproton pump inhibitors). The BIB was removed after 6 months.Placement and removal were performed under conscious or un-conscious sedation. Mortality, complications, body mass index,percentage of excess weight loss, and comorbidities were evalu-ated. Data are expressed as the mean � standard deviation.Results: From May 2000 to May 2004, 2375 patients underwentBIB (682 men and 1693 women, mean age 38.7 � 14.3 years,range 12–71; mean body mass index 44.2 � 7.7 kg/m2, range28–79.1; mean excess weight 59.4 � 29.6 kg, range 16–210). BIBpositioning was not complicated in all but 2 cases (0.08%), withgastric acute dilation treated conservatively. The overall compli-cation rate was 0.9% (22 of 2375 patients). Gastric perforationpresented in 4 patients (0.1%) with previous gastric surgery: 2 diedand 2 were treated by laparoscopic repair after balloon removal.Gastric obstruction (n � 5; 0.2%) and balloon rupture (n � 9;0.3%) were treated by BIB removal, and esophagitis (n � 3; 0.1%)and gastric ulcer (n � 1) were treated conservatively with drugs.Preoperative comorbidities were diagnosed in 1284 (54%) of 2375patients and were resolved in 572 (44.5%), improved (less phar-macologic dosage) in 567 (44.1%), and unchanged in 145 (11.4%)of 1284 patients. After 6 months, the mean body mass index was33.7 � 12.5 kg/m2 (range 24–73), and the percentage of excessweight loss was 34.5 � 17.8 kg (range 0–87).Conclusions: BIB is an effective procedure with satisfactoryweight loss and improvement in comorbidities after 6 months.Previous gastric surgery is a contraindication for BIB placement.

PII: S1550-7289(05)00178-4

49.

TWO-YEAR COMPARATIVE RESULTS IN 300CONSECUTIVE CASES OF THREE TYPES OFADJUSTABLE GASTRIC BANDS IMPLANTED AFTERLEARNING CURVE IN SINGLE CENTERAlmino C. Ramos, M.D., Manoela Galvao, M.D.,Andrey Carlo, M.D., Edwin G. Canseco, M.D.,Abel M. Hiroshi, M.D., Manoel Galvao Neto, M.D., GastroObeso Center, Sao Paulo, Brazil.

242 Abstracts: Plenary Session/Surgery for Obesity and Related Diseases / 1 (2005) 222–283

Purpose: The adjustable gastric band (AGB) is one of options forbariatric surgery. At least five models of AGB are available on themarket, each with its own characteristics. The most known are theLap-Band (Fodd and Drug Administration and CE approval),Swedish Adjustable Gastric Band (SAGB; CE approval, on Foodand Drug Administration trial), Midband, Heliogast, and Softband(CE approval). Since December 1999, our group have implantedmore then 1000 SAGB, Heliogast, and Midband bands (most ofthem SAGB). Our aim was to compare those three AGB typesretrospectively in 100 consecutive cases after 50 initial cases witheach of the bands.Methods: Between November 2001 and September 2002, the 100consecutive patients undergoing SAGB, Heliogast, and Midbandplacement (after discharging the first 50 cases) had their filesreviewed to raise data about casuistic, operative time, intraopera-tive complications, hospital discharge, complications, mortality,and revisional procedures.Results: No significant differences were found between sex, age,weight, initial weight and body mass index, operative time, intra-operative complications, and hospital discharge. The mortality ratewas 0%. Differences occurred among the late complications, suchas the rate of slippage for SAGB (0%), Heliogast (3%), andMidband (24%) and the rate of band intragastric migration forSAGB (1%), Heliogast (1%), and Midband (0%). No port com-plications were noted. The revisional procedure rate was 3% forSAGB, 6% for Heliogast, and 26% for Midband. Without signif-icant differences among the bands, the body mass index decreasedfrom 45.2 to 30.1 kg/m2.Conclusions: Among the AGBs analyzed, the Midband presentedwith a significantly greater rate of slippage, which led to a high rateof revisional surgery.

PII: S1550-7289(05)00179-6

50.

LAPAROSCOPIC REVISION OF VERTICAL BANDEDGASTROPLASTY TO ROUX-EN-Y GASTRIC BYPASS:AN OUTCOMES ANALYSISDaniel J. Gagne, M.D., David Goitein, M.D.,Pavlos K. Papasavas, M.D., Nicole Hayden, P.A.-C.,Julie Maurer, P.A.-C., Philip F. Caushaj, M.D., Western Penn-sylvania Hospital, Clinical Campus Temple University School ofMedicine, Pittsburgh, PA.

Purpose: Although vertical banded gastroplasty (VBG) was en-dorsed by the 1991 National Institutes of Health Consensus Con-ference for the treatment of morbid obesity, it has largely beenabandoned owing to the poor long-term results. We present ourexperience with laparoscopic revision of failed VBG to Roux-en-Ygastric bypass (RYGBP).Methods: Retrospective review of a prospectively collected data-base. Follow-up data were available in 100% of patients.Results: In a 3.5-year period, 25 laparoscopic revisions of previ-ous open VBG to RYGBP were performed. Indications for revi-sion were inadequate weight loss or weight gain in 23 patients andintractable vomiting in 2. Of the 25 patients, 23 (92%) werewomen. The mean age was 45 years (range 30–66), and the meanbody mass index was 44.8 kg/m2 (range 30.5–83). The meanfollow-up was 17.6 months (range 1–41). All procedures werecompleted laparoscopically. The mean operative time was 4.5

hours (range 3–7.5), mean estimated blood loss was 90 mL, andmean length of hospital stay was 3 days (range 2–38). No mortal-ities occurred. Six patients (24%) experienced eight complications,including gastric remnant leak in 1, abscess in 2, gastrojejunos-tomy stricture in 3, internal hernia in 1, and prolonged ventilatorysupport in 1. The mean excess body weight loss was 42%, 49%,47%, and 51% at 6, 12, 24, and 36 months, respectively. Diabetesresolved in 5 (100%) of 5 patients. Hypertension resolved in 5(63%) of 8 patients.Conclusions: Laparoscopic revision of failed open VBG toRYGBP is a challenging but feasible procedure. It provides ac-ceptable weight loss and reversal of weight-related comorbidities.

PII: S1550-7289(05)00180-2

SESSION IX (10:30 A.M. – 12:30 P.M.)CONCURRENT WITH SESSION XIII

OBESITY SURGERY AND COMORBID CONDITIONS

51.

PREVALENCE OF VITAMIN D DEPLETION AMONGMORBIDLY OBESE PATIENTS SEEKING GASTRICBYPASS SURGERYArthur M. Carlin, M.D., Ali M. Meslemani, M.D.,Jeffrey A. Genaw, M.D., Shiri Levy, M.D., Arti Bhan, M.D.,D. Sudhaker Rao, M.B., B.S., F.A.C.P., F.A.C.E., Henry FordHospital, Detroit, MI.

Purpose: Abnormalities in calcium and vitamin D metabolismhave been reported after bariatric surgery. The purpose of thisstudy was to evaluate vitamin D nutritional status among morbidlyobese patients before gastric bypass surgery.Methods: The information collected on 124 morbidly obese pa-tients seeking gastric bypass surgery included age, sex, race, andbody mass index. Serum samples were analyzed for calcium,alkaline phosphatase, intact parathormone, 25-hydroxyvitamin D,and 1,25-dihydroxyvitamin D.Results: The mean patient age was 43 years; 83% were women,and 74% were white. Serum calcium and alkaline phosphatase wasnormal in 96% and 91% of patients, respectively. Vitamin Ddepletion (25-hydroxyvitamin D �20 ng/mL) was identified in 53patients (51%). Black patients had a significantly greater 25-hy-droxyvitamin D deficit (13.6 � 5 ng/mL) compared with whites(23.3 � 8 ng/mL; p �0.001). The serum 25-hydroxyvitamin Dlevel was not dependent on age, sex, weight, or body mass index.A significant inverse correlation was found between intactparathormone and 25-hydroxyvitamin D (r � 0.71; p �0.001).Elevated intact parathormone was observed in 40% of patients.Significant elevations in intact parathormone were noted withincreasing weight (p � 0.003) and body mass index (p � 0.001).Conclusions: Before gastric bypass surgery, one half of the mor-bidly obese patients have vitamin D depletion despite normalcalcium and alkaline phosphate levels. This vitamin D depletion isassociated with secondary hyperparathyroidism. Morbidly obeseblack patients are at a significantly increased risk of vitamin Ddepletion. Studies evaluating the effects of gastric bypass on vita-min D metabolism must consider the patients’ preoperative status.

PII: S1550-7289(05)00181-4

243Abstracts: Plenary Session/Surgery for Obesity and Related Diseases / 1 (2005) 222–283